Expanding Cranial Base Surgery

1995 ◽  
Vol 112 (5) ◽  
pp. P136-P136
Author(s):  
Ivo P. Janecka ◽  
Daniel Nuss ◽  
David Vernick ◽  
Gerhard Oberascher
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Cranial Base ◽  
Imaging Modalities ◽  
Educational Objectives ◽  
Congenital Lesions ◽  
New Approaches ◽  
Cranial Base Surgery ◽  
Technical Principles

Educational objectives: To determine the applicability and become familiar with technical principles of new approaches to skull base for oncologic as well as congenital lesions and to understand the current advances in imaging modalities as well as current achievable outcome with skull base surgery.

Surgery of the Skull Base for Head and Neck Neoplasms

1995 ◽  
Vol 112 (5) ◽  
pp. P88-P88
Author(s):  
Paul J. Donald ◽  
Bernard M. Lyons ◽  
Joao J. Maniglia
Keyword(s):  
Head And Neck ◽  
Skull Base ◽  
Head And Neck Neoplasms ◽  
Skull Base Surgery ◽  
Cranial Base ◽  
Posterior Cranial Fossa ◽  
Educational Objectives ◽  
Cranial Fossa ◽  
Relationship Of ◽  
The Relationship

Educational objectives: To understand the relationship of deep facial structures to the cranial base and the pertinent intracranial anatomy; to perform the comprehensive workup required by skull base surgery patients; and to acquire a working knowledge of the basic skull base procedures in the anterior, middle, and posterior cranial fossa.

Surgery of the Posterior and Lateral Cranial Base

1995 ◽  
Vol 112 (5) ◽  
pp. P173-P173
Author(s):  
Robert K. Jackler
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Cranial Base ◽  
Essential Elements ◽  
Educational Objectives

Educational objectives: To appreciate the capabilites and limitations of contemporary skull base surgery and to understand the essential elements needed to organize and equip a multidisciplinary skull base team.

Surgical nuances for nasoseptal flap reconstruction of cranial base defects with high-flow cerebrospinal fluid leaks after endoscopic skull base surgery

2012 ◽  
Vol 32 (6) ◽  
pp. E7 ◽  
Author(s):  
James K. Liu ◽  
Richard F. Schmidt ◽  
Osamah J. Choudhry ◽  
Pratik A. Shukla ◽  
Jean Anderson Eloy
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Cranial Base ◽  
High Flow ◽  
Csf Leak ◽  
Reconstruction Technique ◽  
Dural Defect ◽  
Nasoseptal Flap ◽  
Endoscopic Skull Base Surgery ◽  
Csf Leakage

Extended endoscopic endonasal approaches have allowed for a minimally invasive solution for removal of a variety of ventral skull base lesions, including intradural tumors. Depending on the location of the pathological entity, various types of surgical corridors are used, such as transcribriform, transplanum transtuberculum, transsellar, transclival, and transodontoid approaches. Often, a large skull base dural defect with a high-flow CSF leak is created after endoscopic skull base surgery. Successful reconstruction of the cranial base defect is paramount to separate the intracranial contents from the paranasal sinus contents and to prevent postoperative CSF leakage. The vascularized pedicled nasoseptal flap (PNSF) has become the workhorse for cranial base reconstruction after endoscopic skull base surgery, dramatically reducing the rate of postoperative CSF leakage since its implementation. In this report, the authors review the surgical technique and describe the operative nuances and lessons learned for successful multilayered PNSF reconstruction of cranial base defects with high-flow CSF leaks created after endoscopic skull base surgery. The authors specifically highlight important surgical pearls that are critical for successful PNSF reconstruction, including target-specific flap design and harvesting, pedicle preservation, preparation of bony defect and graft site to optimize flap adherence, multilayered closure technique, maximization of the reach of the flap, final flap positioning, and proper bolstering and buttressing of the PNSF to prevent flap dehiscence. Using this technique in 93 patients, the authors' overall postoperative CSF leak rate was 3.2%. An illustrative intraoperative video demonstrating the reconstruction technique is also presented.

The Carotid Artery

1995 ◽  
Vol 112 (5) ◽  
pp. P84-P84
Author(s):  
Bruce W. Pearson ◽  
Robert H. Wharen
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Skull Base Surgery ◽  
Educational Objectives

Educational objectives: To better understand the preoperative and intraoperative risk to the internal carotid artery in neck and skull base surgery and to work more closely and knowledgeably with their neurovascular surgical colleagues in combined cases.

Transtemporal Skull Base Surgery

1995 ◽  
Vol 112 (5) ◽  
pp. P119-P119
Author(s):  
C. Gary Jackson ◽  
James L. Netterville
Keyword(s):  
Functional Outcome ◽  
Skull Base ◽  
Cranial Nerve ◽  
Skull Base Surgery ◽  
Tumor Resection ◽  
Operative Management ◽  
Educational Objectives ◽  
Defect Reconstruction ◽  
Lateral Skull Base

Educational objectives: To become familiar with diagnostic and operative management principles for lateral skull-base disease and its ICE, emphasizing not only multi-disciplinary tumor resection but functional outcome and to be familiar with concepts of defect reconstruction and cranial nerve rehabilitation that maximize postresection functional outcome.

Improved Planning of Skull Base Surgery by Coregistration of Three-Dimensional Data Sets of Different Angiographic Imaging Modalities Including rDSA, MRA, CTA, and T1-MRI Volume Data

Skull Base ◽  
2007 ◽  
Vol 17 (S 1) ◽  
Author(s):  
Matthias Kirsch ◽  
Thomas Meyer ◽  
Dino Podlesek ◽  
Ute Morgenstern ◽  
Rüdiger von Kummer ◽  
...  
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Three Dimensional ◽  
Imaging Modalities ◽  
Data Sets ◽  
Volume Data

Cranial Base Surgery: Results in 183 Patients

1994 ◽  
Vol 110 (6) ◽  
pp. 539-546 ◽  
Author(s):  
Iva P. Janecka ◽  
Chandranath Sen ◽  
Laligam N. Sekhar ◽  
Sai Ramasastry ◽  
Hugh D. Curtin ◽  
...  
Keyword(s):  
Skull Base ◽  
Congenital Malformations ◽  
Malignant Tumors ◽  
Benign Neoplasm ◽  
Cranial Base ◽  
Benign Tumors ◽  
Inflammatory Lesions ◽  
Duration Of Surgery ◽  
Cranial Base Surgery

OBJECTIVE: To learn about the effects of cranial base surgery. DESIGN: Cohort study with a mean follow-up of 30 months. SETTING: Population-based. PATIENTS: A consecutive sample of 183 patients who underwent cranial base surgery; 118 patients had malignant skull base tumors, the majority of which were previously treated; 50 had benign tumors; 9 had congenital malformations of the skull base; 3 had inflammatory lesions, and 3 had traumatic defects of the skull base. MAIN OUTCOME MEASURES: Disease-free Interval, overall survival, and rate of complications and functional status. INTERVENTION: Cranial base surgery was followed by radiotherapy (In previously untreated patients). RESULTS: After completion of follow-up (mean, 30 months), 30 (25.4%) patients had died of their malignant tumors and 8 (6.8%) had died of other causes. One patient (0.84%) was lost to follow-up. The overall cancer survival rate without regard to histologic type was 67% (63% with no evidence of disease). Among the patients who were treated for benign neoplasm, 72% had no evidence of disease at a mean follow-up of 39 months. The group of patients with congenital malformations and inflammatory and traumatic lesions demonstrated successful correction of their presurgical problem with skull base surgery. One patient (who had invasive aspergillosis) died of disease. The overall surgical-medical mortality rate was 2%; the complication rate was 33%, and the Kamofsky performance score was improved or unchanged after surgery in 83% of patients. The average duration of surgery, number of blood transfusions used, and length of the hospital stay were 10 hours, 3 units, and 15 days, respectively. CONCLUSIONS: Cranial base surgery is a valid surgical technique for treatment of cranial base afflictions. In this study It was found to be beneficial In controlling benign and malignant disease and to be the treatment of choice for selected congenital malformations, trauma, and inflammatory lesions.

scholarly journals Expanded Endoscopic Endonasal Approach to Anterior and Ventral Skull Base: An Evolving Paradigm

2013 ◽  
Vol 2013 ◽  
pp. 1-11 ◽  
Author(s):  
Balwant Singh Gendeh
Keyword(s):  
Skull Base ◽  
Cranial Base ◽  
Anatomical Landmarks ◽  
Endoscopic Endonasal ◽  
Skull Base Reconstruction ◽  
Perioperative Morbidity ◽  
Number Of Patients ◽  
Cranial Base Surgery ◽  
Long Term Impact ◽  
Ventral Skull Base

The transition from external approaches to an endonasal corridor has seen a significant decline in patient morbidity and inpatient care. Our Rhinology and Cranial Base Surgery Group has been able to focus on the management of certain pathologies, endoscopic access to various areas in the skull base, reconstruction of the defect, ensuring that clear anatomical landmarks can be identified during the surgery, and improving the quality of life/function after treatment. The focus on surgical treatment is always to control disease and cure patients by not only reducing recovery time and perioperative morbidity, but also decreasing the long-term impact of having a tumour removed. With a dedicated combined operating theater setting with updated instrumentation, the Neuro-ENT team is able to continue to expand and develop endoscopic care for a greater number of patients and wider range of pathologies. The collaborative Neuro-ENT to work closely via the nose using the two-hole and four-hand technique when performing the operation simultaneously is of added advantage in the diverse and expanding field of cranial base surgery. Our skull base team is joined by expert radiation and medical oncologists who provide essential adjunctive care in the multidisciplinary management of these patients.

Long-term impact of pediatric endoscopic endonasal skull base surgery on midface growth

2019 ◽  
Vol 23 (4) ◽  
pp. 523-530 ◽  
Author(s):  
Wendy Chen ◽  
Paul A. Gardner ◽  
Barton F. Branstetter ◽  
Shih-Dun Liu ◽  
Yue Fang Chang ◽  
...  
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Cranial Base ◽  
Early Surgery ◽  
Endoscopic Endonasal ◽  
Anterior Maxilla ◽  
Surgery Group ◽  
Significant Difference

OBJECTIVECranial base development plays a large role in anterior and vertical maxillary growth through 7 years of age, and the effect of early endonasal cranial base surgery on midface growth is unknown. The authors present their experience with pediatric endoscopic endonasal surgery (EES) and long-term midface growth.METHODSThis is a retrospective review of cases where EES was performed from 2000 to 2016. Patients who underwent their first EES of the skull base before age 7 (prior to cranial suture fusion) and had a complete set of pre- and postoperative imaging studies (CT or MRI) with at least 1 year of follow-up were included. A radiologist performed measurements (sella-nasion [S-N] distance and angles between the sella, nasion, and the most concave points of the anterior maxilla [A point] or anterior mandibular synthesis [B point], the SNA, SNB, and ANB angles), which were compared to age- and sex-matched Bolton standards. A Z-score test was used; significance was set at p < 0.05.RESULTSThe early surgery group had 11 patients, with an average follow-up of 5 years; the late surgery group had 33 patients. Most tumors were benign; 1 patient with a panclival arteriovenous malformation was a significant outlier for all measurements. Comparing the measurements obtained in the early surgery group to Bolton standard norms, the authors found no significant difference in postoperative SNA (p = 0.10), SNB (p = 0.14), or ANB (0.67) angles. The S-N distance was reduced both pre- and postoperatively (SD 1.5, p = 0.01 and p = 0.009). Sex had no significant effect. Compared to patients who had surgery after the age of 7 years, the early surgery group demonstrated no significant difference in pre- to postoperative changes with regard to S-N distance (p = 0.87), SNA angle (p = 0.89), or ANB angle (p = 0.14). Lesion type (craniopharyngioma, angiofibroma, and other types) had no significant effect in either age group.CONCLUSIONSThough our cohort of patients with skull base lesions demonstrated some abnormal measurements in the maxillary-mandibular relationship before their operation, their postoperative cephalometrics fell within the normal range and showed no significant difference from those of patients who underwent operations at an older age. Therefore, there appears to be no evidence of impact of endoscopic endonasal skull base surgery on craniofacial development within the growth period studied.

Protection of the Cranial Base after Endoscopic Transsphenoidal Skull Base Surgery

2016 ◽  
Vol 77 (S 01) ◽  
Author(s):  
Gurston Nyquist ◽  
David Hsu ◽  
Kurren Gill ◽  
James Evans ◽  
Christopher Farrell ◽  
...  
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Cranial Base
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