Endoscopic Endonasal Anterior Skull Base Surgery: A Systematic Review of Complications During the Past 65 Years

The advent and widespread development of endonasal endoscopic techniques have recently expanded the frontiers of skull base surgery. The reduced invasiveness, wider and adjustable visualization of the operative field, and lack of postoperative cosmetic defects are well-known advantages of the endonasal endoscopic approaches compared with traditional surgical exposures both in adults and in children. The need to avoid disruption of facial growth centers and permanent tooth roots represents a further special consideration in favor of these endoscopic techniques in children. The authors report on a case of solitary myofibroma involving the ethmoid, mesial orbits, and anterior skull base with intracranial intradural expansion in a 17-month-old girl. The occurrence of such proliferative disease along the skull base is exceedingly rare. The tumor was successfully excised via an endoscopy-assisted cranionasal approach in which a transcranial microsurgical exposure was combined with endonasal endoscopic access to ensure a radical resection and optimize skull base reconstruction. To the authors' knowledge, the patient in this case is the youngest reported patient in the literature who has undergone treatment with this surgical strategy. The outcome in this patient underscores the feasibility and safety of endoscopic endonasal surgery even in toddlers and early childhood.

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Use of Mixed Reality Visualization in Endoscopic Endonasal Skull Base Surgery

Operative Neurosurgery ◽

10.1093/ons/opz355 ◽

2019 ◽

Vol 19 (1) ◽

pp. 43-52 ◽

Cited By ~ 2

Author(s):

Joshua Zeiger ◽

Anthony Costa ◽

Joshua Bederson ◽

Raj K Shrivastava ◽

Alfred M C Iloreta

Keyword(s):

Skull Base ◽

Endoscopic Surgery ◽

Mixed Reality ◽

Skull Base Surgery ◽

Anterior Skull Base ◽

Endoscopic Endonasal ◽

3 Dimensional ◽

Camera View ◽

Clinical Series ◽

Cerebrospinal Fluid Leaks

Abstract BACKGROUND Neuronavigation systems assist with spatial orientation during endoscopic transnasal skull base surgery, but they require a correlation of 3-dimensional (3D) views with 2-dimensional (2D) radiology studies. OBJECTIVE To outline an initial experience with a novel technology platform that provides intraoperative navigation using 3D reconstructions of patient anatomy for endoscopic surgery. METHODS A retrospective study of endoscopic anterior skull base and complex paranasal procedures was performed. Data from preoperative computed tomography and magnetic resonance imaging scans were fused to create 3D digital models of patient anatomy. Using the technology developed by Surgical Theater (Mayfield Village, Ohio), these reconstructions were designed to highlight particular anatomic regions of interest. The models were studied to guide the surgical approach and anticipate critical structures. The reconstructions were linked with the navigational technology created by Brainlab (Munich, Germany) during endoscopic surgery. A dynamic image of the reconstruction was displayed alongside a matching endoscopic camera view. These 2 views could be overlaid to provide an immersive, mixed reality image of the patient's anatomy. RESULTS A total of 134 cases were performed. The pathologies included tumors of the anterior skull base or sinonasal cavity, inflammatory sinus disease, and cerebrospinal fluid leaks. Specific anatomic structures, such as the internal carotid arteries and optic nerves, were chosen for enhancement. Surgeons felt that the technology helped to guide the extent of bony dissection and to identify critical structures. CONCLUSION We describe the first clinical series of complex skull base pathologies treated using a novel mixed reality platform.

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Application of hybrid cranioendoscopic approaches in anterior skull base surgery

Neurosurgical Focus: Video ◽

10.3171/2020.4.focusvid.19913 ◽

2020 ◽

Vol 2 (2) ◽

pp. V5

Author(s):

Evan Joyce ◽

Michael Karsy ◽

Serge Makarenko ◽

Gretchen M. Oakley ◽

William T. Couldwell

Keyword(s):

Skull Base ◽

Skull Base Surgery ◽

Surgical Techniques ◽

Anterior Skull Base ◽

Endoscopic Endonasal ◽

Link Type ◽

Skull Base Defect ◽

Base Lesion

Anterior skull base approaches have included endoscopic or open microsurgical approaches for intracranial pathologies. However, discussion of a combined hybrid, cranioendoscopic approach, leveraging the benefits of both techniques, has been limited. Here we describe a case of a combined endoscopic, endonasal, and open microsurgical frontotemporal approach for resection of a complex anterior skull base lesion. A 62-year-old man with a large meningioma extending intradurally through the cribiform plate and sphenoethmoidal sinuses underwent a cranioendoscopic resection. Surgical techniques, including repair of the anterior skull base defect as well as complication avoidance and the coordination of multiple surgeons, are discussed.The video can be found here: https://youtu.be/Ti9tUUdWgJc.

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Is a Single-Dose, Single-Agent Perioperative Antibiotic Protocol Adequate for Endoscopic Endonasal Skull Base Surgery? A 10-Year Review of 422 Cases

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1713771 ◽

2020 ◽

Author(s):

Mark A. Hughes ◽

Nick Phillips ◽

Atul Tyagi ◽

Asim Sheikh ◽

Kavita Sethi ◽

...

Keyword(s):

Single Dose ◽

Skull Base ◽

Skull Base Surgery ◽

Single Agent ◽

Prophylactic Antibiotic ◽

Antibiotic Use ◽

Anterior Skull Base ◽

Csf Leak ◽

Endoscopic Endonasal ◽

Postoperative Meningitis

Abstract Objectives Postoperative meningitis is a rare but potentially fatal complication of endoscopic endonasal skull base surgery. Prophylactic antibiotic use varies considerably worldwide. We sought to analyze the safety of a single-agent, single-dose protocol. Design, Setting, and Participants A retrospective review of 422 procedures performed during 404 admission episodes from 2009 to 2019, encompassing sella, parasella, and other anterior skull base pathologies. Main Outcome Measures Primary outcome measure was development of meningitis within 30 days of surgery. Additional information collected: underlying pathological diagnosis, intraoperative cerebrospinal fluid (CSF) leak, postoperative CSF leak, and primary or revision surgery. Results Of 404 admission episodes for endoscopic anterior skull base surgery, 12 cases developed meningitis. Seven had positive CSF cultures and all 12 recovered. For pathology centered on the sella (including pituitary adenoma), the rate of meningitis was 1.1% (3/283). For pathologies demanding an extended approach (including meningioma and craniopharyngioma), the rate of meningitis was 14.5% (9/62). Postoperative CSF leak requiring surgical repair increased the relative risk by 37-fold. There were no cases of meningitis following repair of long-standing CSF fistula or encephalocoele (0/26) and no cases following surgery for sinonasal tumors with skull base involvement (0/33). Conclusion For sella-centered pathologies, a single dose of intravenous co-amoxiclav (or teicoplanin) is associated with rates of meningitis comparable to those reported in the literature. Postoperative meningitis was significantly higher for extended, intradural transphenoidal approaches, especially when postoperative CSF leak occurred. Fastidious efforts to prevent postoperative CSF leak are crucial to minimizing risk of meningitis.

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Impact of Routine Endoscopic Skull Base Surgery on Subjective Olfaction and Gustation Outcomes

Operative Neurosurgery ◽

10.1093/ons/opab137 ◽

2021 ◽

Author(s):

Nanki Hura ◽

Cinthia P Orlov ◽

Adham M Khalafallah ◽

Debraj Mukherjee ◽

Nicholas R Rowan

Keyword(s):

Skull Base ◽

Skull Base Surgery ◽

Olfactory Dysfunction ◽

Anterior Skull Base ◽

Endoscopic Endonasal ◽

Patient Reported ◽

Psychosocial Implications ◽

Chemosensory Function ◽

Direct Investigation

Abstract BACKGROUND As endoscopic endonasal skull base surgery (EESBS) for sellar pathology has become routine, there is increasing awareness of quality-of-life (QOL) outcomes related to this approach. Similarly, there is a growing interest in postoperative chemosensory function, with notable emphasis on olfaction and the corresponding psychosocial implications of olfactory dysfunction. Meanwhile, there has been minimal direct investigation into gustatory outcomes, and the association between these 2 chemosensory functions remains poorly understood. OBJECTIVE To investigate patient-reported chemosensory function and rhinologic-specific QOL following EESBS for routine sellar pathologies. METHODS Comprehensive clinical characteristics and sinonasal QOL assessments, measured using Anterior Skull Base Nasal Inventory-12 (ASK Nasal-12), were collected from 46 patients undergoing EESBS for sellar pathology. RESULTS Forty-six patients were included: 65.2% female, average age 52.8 yr (range: 27-89). The most common pathology was nonfunctioning pituitary adenoma (n = 28). Preoperative ASK Nasal-12 scores (mean = 0.81) demonstrated postoperative worsening at 2 wk (mean = 2.52, P < .0001) and 1 mo (mean = 1.33, P = .0031), with no difference at 3 mo postoperatively (mean = 0.89, P = .92). Meanwhile, there was significant worsening of preoperative subjective smell (mean = 0.62) and taste function (mean = 0.42) at 2 wk (mean = 3.48, P < .0001; mean = 2.69, P < .0001) and 1 mo (mean = 2.40, P < .0001; mean = 2.03, P < .0001) postoperatively, which persisted at approximately 3 mo postoperatively (mean = 1.26, P = .04; mean = 1.15, P = .0059). CONCLUSION Patients undergoing EESBS for sellar pathologies experience anticipated, temporary disruptions in sinonasal QOL but may have longer lasting perturbations in subjective olfaction and gustation. Given the increasing use of the endoscopic endonasal corridor, further investigation in postoperative chemosensory function is essential.

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Endoscopic-assisted Craniofacial Resection

Otorhinolaryngology Clinics - An International Journal ◽

10.5005/jp-journals-10003-1075 ◽

2011 ◽

Vol 3 (3) ◽

pp. 156-160

Author(s):

Aliasgar Moiyadi ◽

Deepa Nair ◽

Prathamesh S Pai

Keyword(s):

Skull Base ◽

Tumor Resection ◽

Additional Treatment ◽

Anterior Skull Base ◽

Skull Base Tumors ◽

Craniofacial Resection ◽

Endoscopic Endonasal ◽

The Past ◽

Select Group ◽

Sinonasal Tumor

ABSTRACT Management of anterior skull base tumors has progressed steadily since AS Ketcham popularized the craniofacial surgical technique in the seventies with good results. In the past two decades, endoscopic sinonasal tumor resection has been established as an additional treatment option. For tumors that cross the anterior skull base, a cranial access is vital to encompass the tumor all around. For a select group of these transcranial lesions, the sinonasal component is suitable for an endoscopic endonasal oncologically safe resection along with a traditional transcranial access to complete the resection. This article endeavors to describe the endoscopicassisted craniofacial combining the advantages of a transnasal minimal access to reduce facial morbidity and the transcranial access for superior control of tumors with adequate margins.

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