scholarly journals How I do it: endoscopic endonasal resection of tuberculum sellae meningioma

2021 ◽  
Author(s):  
Markus Wiedmann ◽  
Aslan Lashkarivand ◽  
Jon Berg-Johnsen ◽  
Daniel Dahlberg
Keyword(s):  
Team Approach ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Ongoing Debate ◽  
Endoscopic Endonasal ◽  
Microsurgical Technique ◽  
Tuberculum Sellae Meningioma ◽  
Tuberculum Sellae ◽  
Dedicated Team ◽  
Neurovascular Structures

Abstract Background Tuberculum sellae meningiomas (TSMs) adherent to neurovascular structures are particularly challenging lesions requiring delicate and precise microneurosurgery. There is an ongoing debate about the optimal surgical approach. Method We describe technical nuances and challenges in TSM resection using the endoscopic endonasal approach (EEA) in two cases of fibrous tumors with adherence to neurovascular structures. The cases are illustrated with a video (case 1) and figures (cases 1 and 2). Conclusion A dedicated team approach and precise microsurgical technique facilitate safe resection of complex TSMs through the EEA.

scholarly journals The expanded endoscopic endonasal approach for treatment of tuberculum sellae meningiomas in a series of 40 consecutive cases

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Peng Yu ◽  
Tutu Xu ◽  
Xinyu Wu ◽  
Zhitong Liu ◽  
Yong Wang ◽  
...  
Keyword(s):  
Anterior Cerebral Artery ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Tuberculum Sellae Meningioma ◽  
Csf Leakage ◽  
Invasive Method ◽  
Tuberculum Sellae

AbstractCompared with traditional craniotomy, the expanded endoscopic endonasal approach (EEEA) may have some advantages for tuberculum sellae meningioma (TSM) treatment. We described our experience of the therapeutic effect of endoscopic TSM treatment. From August 2015 to December 2019, 40 patients with a TSM were treated by the EEEA in our institution. EEEA outcome in TSM treatment was analyzed. Among 39 patients with visual impairment, 38 (97.4%) improved their visual function to some extent after the EEEA, and one case had no significant change in visual acuity. Among all patients, 38 (95.0%) achieved gross total resection (GTR) and 2 (5.0%) achieved near-total resection (NTR). Cerebrospinal fluid (CSF) leakage occurred in three patients (7.5%) and meningitis (post-CSF leakage) in two patients (5.0%). Eight patients (20.0%) suffered postoperative hyposmia, three of whom developed long-term hyposmia. One patient (2.5%) suffered from bleeding of the branch of the anterior cerebral artery intraoperatively leading to postoperative acute cerebral infarction. The EEEA is a safe and reliable minimally invasive method for TSM removal. Compared with traditional craniotomy, the EEEA may have better visual outcomes and a higher prevalence of GTR, but carries the risk of CSF leakage.

Endoscopic Endonasal Approach for Resection of Tuberculum Sellae Meningioma

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Cheng Zhang ◽  
Jianling Ding ◽  
Ye Liu ◽  
Maimaitiyiming Tuoheti ◽  
Xiaopeng Yang ◽  
...  
Keyword(s):  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Tuberculum Sellae Meningioma ◽  
Tuberculum Sellae

Endoscopic Endonasal Approach for Tuberculum Sellae Meningiomas

Neurosurgery ◽  
2011 ◽  
Vol 69 (1) ◽  
pp. E260-E261 ◽  
Author(s):  
Juan C Fernandez-Miranda ◽  
Paul A Gardner ◽  
Carl H Snyderman
Keyword(s):  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Tuberculum Sellae

scholarly journals Combined strategy of maximal endoscopic endonasal resection and early radiation therapy for complex cystic and solid craniopharyngioma: operative video

2020 ◽  
Vol 2 (2) ◽  
pp. V7
Author(s):  
James K. Liu ◽  
Kevin Zhao ◽  
Jean Anderson Eloy
Keyword(s):  
Radiation Therapy ◽  
Optic Chiasm ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Suprasellar Region ◽  
Early Radiation ◽  
The Right ◽  
Combined Strategy ◽  
Neurovascular Structures

Craniopharyngioma is a rare and benign intracranial tumor of the sellar and suprasellar region. Historically, these tumors were mostly accessed through transcranial corridors and resected with microsurgical techniques. Endoscopic endonasal surgery has recently gained popularity in the treatment of these tumors and has shown at least comparable results to transcranial approaches. The endoscopic endonasal approach provides direct midline access through a transplanum transtuberculum corridor and gives excellent visualization of the undersurface of the optic chiasm to allow safe bimanual sharp dissection of the tumor from the hypothalamus. In this operative video, we demonstrate the case of a 56-year-old female who had a complex craniopharyngioma with solid and cystic components extending superolaterally into the right frontal lobe. This lesion was invasive and partially encased the right optic nerve, optic chiasm, and anterior communicating artery complex. Although a traditional transcranial approach could have been utilized, we elected for an endoscopic endonasal approach for a maximal safe near-total resection, preserving the neurovascular structures. The patient underwent radiation therapy with favorable regression of the residual tumor on subsequent imaging studies. This case illustrates the feasibility of a combined strategy of maximal safe endoscopic endonasal resection followed by early radiation therapy for a complex, invasive cystic and solid craniopharyngioma. The technical nuances of safe bimanual microsurgical dissection of tumor adhesions off of critical neurovascular structures are demonstrated.The video can be found here: https://youtu.be/z0AINLpRZGs.

Bone Removal With a New Ultrasonic Bone Curette During Endoscopic Endonasal Approach to the Sellar-Suprasellar Area: Technical Note

2010 ◽  
Vol 66 (suppl_1) ◽  
pp. ons-E118-ons-E118 ◽  
Author(s):  
Paolo Cappabianca ◽  
Luigi M. Cavallo ◽  
Isabella Esposito ◽  
Mohamed Barakat ◽  
Felice Esposito
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Technical Note ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Bone Removal ◽  
Hand Piece ◽  
Skull Base Lesions ◽  
Neurovascular Structures

Abstract Background: Accessing intradural lesions via an extended endoscopic endonasal approach requires a relatively large bony removal over the skull base. Objective: We describe the Sonopet ultrasonic bone curette with a new dedicated endonasal hand-piece. Materials and Methods: We used this ancillary device in 27 nonconsecutive endonasal procedures for different skull base lesions (18 standard pituitary operations and 9 extended approaches for either meningiomas or craniopharyngiomas). Results: The ultrasonic bone curette with endonasal hand-piece was easy to use and effective during the removal of the bone covering or when close to the carotid and optic prominences, as well as in preserving the integrity of the superior intercavernous sinus. In only 1 case was small tearing of the dura mater observed during the bony removal. No cases of injury to the major neurovascular structures occurred. Conclusion: The Sonopet ultrasonic bone curette is a useful tool during endoscopic endonasal skull base surgery.

Endoscopic Endonasal Removal of Primary/Recurrent Meningiomas in the Medial Optic Canal: Surgical Technique and Long-Term Visual Outcome

2019 ◽  
Vol 17 (5) ◽  
pp. 470-480 ◽  
Author(s):  
Kiyohiko Sakata ◽  
Nobuyuki Takeshige ◽  
Yui Nagata ◽  
Hidenobu Yoshitake ◽  
Satoru Komaki ◽  
...  
Keyword(s):  
Visual Loss ◽  
Visual Disturbance ◽  
Optic Canal ◽  
Maximum Diameter ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Tumor Removal ◽  
Endoscopic Endonasal ◽  
Average Maximum ◽  
Tuberculum Sellae

Abstract BACKGROUND Tuberculum sellae meningiomas frequently extend into the optic canals, which leads to a progressive longitudinal visual loss. Therefore, in addition to tumor removal, unroofing and exploration inside the optic canal are important procedures. OBJECTIVE To perform endoscopic endonasal tumor removal with optic canal decompression for small primary or recurrent meningiomas associated with a progressive visual loss at the inferior-medial optic canal, which corresponded to a blind corner in the ipsilateral pterional/subfrontal approach. METHODS We retrospectively reviewed 2 cases of primary meningiomas that arose in the inferior-medial optic canal and 4 recurrent cases from the remnant inside the medial optic canal that had previously undergone craniotomy for tuberculum sellae meningiomas, and were treated by the endoscopic endonasal approach. RESULTS All tumors were detectable and could be removed without manipulation of the affected optic nerve. The average maximum diameter of the tumor was 8.4 mm (range: 5-12 mm). Two patients who had a long history of progressive visual disturbance and papillary atrophy did not recover from severe visual disturbances postoperatively. However, others showed considerable improvement, maintaining postoperative visual function during follow-up. There were no postoperative complications. CONCLUSION Endoscopic endonasal approach has several advantages for meningiomas in the medial optic canal and associated with progressive visual disturbance. In surgery of tuberculum sellae meningiomas, optic canal decompression and exploration inside the optic canal are important procedures to avoid symptomatic recurrence, which may be facilitated by the endoscopic endonasal approach. Papillary atrophy and duration of visual deterioration are predictive factors for postoperative visual outcomes.

scholarly journals Endoscopic Endonasal Approach for Resection of a Pediatric Craniopharyngioma: Operative Video and Technical Nuances

2018 ◽  
Vol 79 (S 03) ◽  
pp. S245-S246 ◽  
Author(s):  
James Liu ◽  
Jean Eloy
Keyword(s):  
Skull Base ◽  
Visual Fields ◽  
Optic Chiasm ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Suprasellar Region ◽  
Skull Base Defect ◽  
Neurologically Intact ◽  
Neurovascular Structures

AbstractWe present a pediatric case of a retrochiasmatic craniopharyngioma in the suprasellar region with third ventricular extension that was resected through a purely endoscopic endonasal approach (EEA) via the transplanum transtuberculum corridor. The patient is a 12-year-old boy who presented with progressive visual loss and panhypopituitarism. The EEA allows direct visualization of the undersurface of the optic chiasm and hypothalamus so that safe and meticulous tumor dissection can be performed to preserve these critical neurovascular structures. This video atlas demonstrates the operative technique and surgical nuances of the endoscopic skull base approach, microdissection of the tumor from the critical neurovascular structures, and multilayered reconstruction of the skull base defect with a nasoseptal flap. A gross total resection was achieved, and the patient was neurologically intact with improved visual acuity and visual fields. In summary, the EEA via the transplanum transtuberculum corridor is an important strategy in the armamentarium for surgical management of pediatric craniopharyngiomas.The link to the video can be found at: https://youtu.be/bmgO_PMRHPk.

Expanded Endoscopic Endonasal Approach for Resection of Intradural Chordoma: Surgical and Anatomic Nuances: 2-Dimensional Operative Video

2018 ◽  
Vol 17 (2) ◽  
pp. E66-E66
Author(s):  
Miguel Marigil ◽  
Joao Paulo Almeida ◽  
Claire Karekezi ◽  
John R de Almeida ◽  
Fred Gentili
Keyword(s):  
Bone Erosion ◽  
Surgical Anatomy ◽  
Gross Total Resection ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Endoscopic Techniques ◽  
Low Testosterone ◽  
Neurovascular Structures

Abstract The expanded endoscopic endonasal approach (EEA) has been growing as a surgical alternative for the treatment of clival chordomas because of their frequent midline location and bone erosion. The endoscopic transclival approach provides with a safer and more direct anatomic route for tumors located predominantly in the midline contributing to minimize postoperative comorbidities. In this video, we demonstrate the step-by-step technique for resection of such challenging clival pathology.  This is an operative video of an extended endoscopic resection of a clival chordoma with stepwise description of the surgical technique.  We present the case of a 49-yr-old man in whom, incidentally in the context of low testosterone level, a clival lesion with purely midline location with intradural extension into the ventral brainstem and occupation of the left cerebellopontine angle was discovered. The patient was submitted to an expanded endoscopic transclival approach and a macroscopic gross total resection was successfully achieved. The final pathology was compatible with a conventional chordoma. This video details the surgical anatomy of the clival region to facilitate the identification of surgical landmarks and anatomic boundaries with the goal of avoiding injury to the neurovascular structures involved in this approach.  Extended endoscopic transclival surgery is a useful and safer option for the management of midline chordomas because it provides with a dissection corridor free of major neurovascular structures. Endoscopic techniques are associated with good outcomes in terms of macroscopic gross total resection and low surgical risks in these selected tumors.

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