Modified subtotal-Lothrop procedure for extended frontal sinus and anterior skull-base access: a case series

Object Transsphenoidal approaches have been used for a century for the resection of pituitary and other sellar tumors. More recently, the standard endonasal approach has been expanded to provide access to other, parasellar lesions. With the addition of the endoscope, this expansion carries significant potential for the resection of skull base lesions. Methods The anatomical landmarks and surgical techniques used in expanded (extended) endoscopic approaches to the rostral, anterior skull base are reviewed and presented, accompanied by case illustrations of each segment (or module) of approach. The rostral half of the anterior skull base is divided into modules of approach: sellar/parasellar, transplanum/transtuberculum, and transcribriform. Case illustrations of successful resections of lesions with each module are presented and discussed. Conclusions Endoscopic, expanded endonasal approaches to rostral anterior skull base lesions are feasible and hold great potential for decreased morbidity. The effectiveness and appropriate use of these techniques must be evaluated by close examination of outcomes as case series expand.

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Endoscopic Endonasal Management of Metastatic Lesions of the Anterior Skull Base: Case Series and Literature Review

World Neurosurgery ◽

10.1016/j.wneu.2015.05.061 ◽

2015 ◽

Vol 84 (5) ◽

pp. 1267-1277 ◽

Cited By ~ 7

Author(s):

Brad E. Zacharia ◽

Flavio R. Romero ◽

Sarah K. Rapoport ◽

Shaan M. Raza ◽

Vijay K. Anand ◽

...

Keyword(s):

Literature Review ◽

Skull Base ◽

Case Series ◽

Anterior Skull Base ◽

Base Case ◽

Endoscopic Endonasal ◽

Metastatic Lesions

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Tailored Extended Bifrontal Craniotomy for Anterior Skull Base Tumors: Anatomic Description of a Modified Surgical Technique and Case Series

Operative Neurosurgery ◽

10.1093/ons/opx134 ◽

2017 ◽

Vol 14 (4) ◽

pp. 386-394 ◽

Cited By ~ 5

Author(s):

Michael M Safaee ◽

Michael W McDermott ◽

Arnau Benet ◽

Philip V Theodosopoulos

Keyword(s):

Skull Base ◽

Frontal Lobe ◽

Tomographic Reconstruction ◽

Case Series ◽

Early Postoperative Period ◽

Anterior Skull Base ◽

Skull Base Tumors ◽

Case Examples ◽

Computed Tomographic ◽

Surgical Exposure

Abstract BACKGROUND Open transcranial approaches to the anterior skull base remain an integral component of current skull base practice. Evolution of these and other techniques has resulted in revisions of standard, tried-and-true methods in attempts to improve patient outcomes and cosmesis, while still providing the best combination of surgical exposure and ergonomics. OBJECTIVE To describe a modified approach for midline tumors of the anterior skull base. METHODS We describe the anatomy and techniques of a modified extended bifrontal craniotomy for anterior skull base tumors. Case examples and a postoperative 3-dimensional computed tomographic reconstruction of the craniotomy are provided. RESULTS The technique has been employed with success in 3 tuberculum sellae meningiomas where the anterior limit of the tumor is several centimeters back from the inner table of the frontal bone. The mean distance from the tumor to inner table was 2.8 cm (range 1.3-3.8 cm). Mean tumor dimensions were 3.0 cm (transverse), 3.5 cm (anterior-posterior), and 2.2 cm (craniocaudal). Average operative time was 557 min. No cases had new T2/fluid-attenuated inversion recovery magnetic resonance imaging signal of the inferior frontal lobe to indicate retraction injury. CONCLUSION The tailored extended bifrontal craniotomy for anterior skull base tumors provides adequate access to the anterior cranial fossa and has replaced our standard extended bifrontal approach. Keeping the osteotomy cut lines outside of the orbit reduces orbital swelling and mechanical disruption of conjugate eye movements in the early postoperative period, while allowing for minimal frontal lobe retraction and providing sufficient surgical exposure along the anterior skull base.

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