Combined Endoscopic Endonasal and Transcranial Approach to Complex Intracranial Lesions

2021 ◽  
pp. 35-50
Author(s):  
Mohammed Nuru ◽  
Ankush Chandra ◽  
Manish K. Aghi
Keyword(s):  
Endoscopic Endonasal ◽  
Intracranial Lesions ◽  
Transcranial Approach

scholarly journals Endoscopic endonasal transoculomotor triangle approach for adenomas invading the parapeduncular space: surgical anatomy, technical nuances, and case series

2019 ◽  
Vol 130 (4) ◽  
pp. 1304-1314 ◽  
Author(s):  
Cristian Ferrareze Nunes ◽  
Stefan Lieber ◽  
Huy Q. Truong ◽  
Georgios Zenonos ◽  
Eric W. Wang ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Case Series ◽  
Surgical Anatomy ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
Tumor Extension ◽  
Endoscopic Endonasal ◽  
Transcranial Approach ◽  
Surgical Corridor ◽  
Dural Opening

OBJECTIVEPituitary adenomas may extend into the parapeduncular space by invading through the roof of the cavernous sinus. Currently, a transcranial approach is the preferred choice, with or without the combination of an endonasal approach. In this paper the authors present a novel surgical approach that takes advantage of the natural corridor provided by the tumor to further open the oculomotor triangle and resect tumor extension into the parapeduncular space.METHODSSix injected specimens were used to demonstrate in detail the surgical anatomy related to the approach. Four cases in which the proposed approach was used were retrospectively reviewed.RESULTSFrom a technical perspective, the first step involves accessing the superior compartment of the cavernous sinus. The interclinoid ligament should be identified and the dura forming the oculomotor triangle exposed. The oculomotor dural opening may be then extended posteriorly toward the posterior petroclinoidal ligament and inferolaterally toward the anterior petroclinoidal ligament. The oculomotor nerve should then be identified; in this series it was displaced superomedially in all 4 cases. The posterior communicating artery should also be identified to avoid its injury. In all 4 cases, the tumor invading the parapeduncular space was completely removed. There were no vascular injuries and only 1 patient had a partial oculomotor nerve palsy that completely resolved in 2 weeks.CONCLUSIONSThe endoscopic endonasal transoculomotor approach is an original alternative for removal of tumor extension into the parapeduncular space in a single procedure. The surgical corridor is increased by opening the dura of the oculomotor triangle and by working below and lateral to the cisternal segment of the oculomotor nerve.

Endoscopic Transcranial Duraplasty for Rhinoliquorrhea: A Cadaveric Study

2017 ◽  
Vol 14 (2) ◽  
pp. 188-193
Author(s):  
Andrea Bartoli ◽  
Jean H Fasel ◽  
Karl Schaller ◽  
Max Jägersberg
Keyword(s):  
Cerebrospinal Fluid Leak ◽  
Cadaver Study ◽  
Anterior Skull Base ◽  
Endoscopic Endonasal ◽  
Bovine Pericardial Patch ◽  
Transcranial Approach ◽  
Anterior Fossa ◽  
Endoscopic Placement ◽  
Fluid Leak ◽  
Patch Placement

Abstract BACKGROUND Repair of the anterior skull base for cerebrospinal fluid leak requires either endoscopic endonasal approach or open transcranial approach. OBJECTIVE To present a less invasive surgical procedure for sealing of the entire anterior fossa floor for traumatic rhinoliquorrhea. METHODS Cadaver study in 3 head specimens. Endoscopic placement of a furled bovine pericardial patch bilaterally along the sphenoid ridge and planum in guidewire technique. Unfurling and spreading of the patch under endoscope assistance. RESULTS Patch placement was feasible in all 3 specimens without visible injuries to the frontal lobes. Dissection and preservation of the olfactory tracts was only possible for 50% of olfactory tracts. CONCLUSION Endoscopic transcranial keyhole duraplasty is a promising concept for traumatic rhinoliquorrhea.

Site-Specific Considerations in the Surgical Management of Skull Base Chondrosarcomas

2017 ◽  
Vol 14 (6) ◽  
pp. 611-619 ◽  
Author(s):  
Shaan M Raza ◽  
Paul W Gidley ◽  
Michael E Kupferman ◽  
Ehab Y Hanna ◽  
Shirley Y Su ◽  
...  
Keyword(s):  
Skull Base ◽  
Primary Outcome ◽  
Extent Of Resection ◽  
Subtotal Resection ◽  
Related Factors ◽  
Endoscopic Endonasal ◽  
Factors Affecting ◽  
Cavernous Sinus Invasion ◽  
Soft Tissue Involvement ◽  
Transcranial Approach

Abstract BACKGROUND Numerous approaches have been reported in the management of skull base chondrosarcomas. Data are lacking for surgical outcomes by the tumor site of origin. OBJECTIVE To provide insight into outcomes by site of origin and factors affecting resection in order to aid in surgical approach selection. METHODS A retrospective review was conducted of 49 patients with chondrosarcoma treated at our institution. Charts were reviewed for tumor- and treatment-related factors. Extent of resection was the primary outcome, while neurological function and surgical complications were secondary outcomes. Statistical analyses were performed assessing variables for their impact on the primary outcome. RESULTS The gross total resection rate for the overall cohort was 67.3%, and 97.8% of patients were either neurologically stable or improved postoperatively. A petroclival site of origin had lower rates of resection vs all other sites (P < .05). Histology and previous surgery did not predict outcome (P > .05), while previous radiotherapy and cavernous sinus invasion correlated with a subtotal resection (P < .05). In the petroclival cohort, clival, jugular tubercle, and soft tissue involvement correlated with a subtotal resection (P < .05). An endoscopic endonasal transpterygoid approach alone or combined with a transcranial approach yielded the highest resection rates for petroclival tumors (P < .05). CONCLUSION Chondrosarcomas pose unique challenges based on the site of origin and pattern of extension. While current surgical strategies appear to yield adequate results at a majority of skull base sites, petroclival tumors represent a particular cohort in which improvement is needed. Based on our analysis, strategies incorporating both endoscopic and transcranial skull base approaches are likely necessary to achieve optimal outcomes.

Extended endoscopic endonasal transclival clipping of posterior circulation aneurysms—an alternative to the transcranial approach

2015 ◽  
Vol 157 (12) ◽  
pp. 2077-2085 ◽  
Author(s):  
Sampath Somanna ◽  
R. Arun Babu ◽  
Dwarakanath Srinivas ◽  
Kannepalli V. L. Narasinga Rao ◽  
Vikas Vazhayil
Keyword(s):  
Posterior Circulation ◽  
Endoscopic Endonasal ◽  
Posterior Circulation Aneurysms ◽  
Transcranial Approach

Endoscopic Endonasal versus Transcranial Approach to Resection of Olfactory Groove Meningiomas: A Systematic Review

2020 ◽  
Author(s):  
Aarti Purohit ◽  
Roshani Jha ◽  
Adham M. Khalafallah ◽  
Carrie Price ◽  
Nicholas R. Rowan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Endoscopic Endonasal ◽  
Olfactory Groove ◽  
Transcranial Approach

scholarly journals Endoscopic endonasal versus open transcranial resection of craniopharyngiomas: a case-matched single-institution analysis

2016 ◽  
Vol 41 (6) ◽  
pp. E7 ◽  
Author(s):  
Nelson Moussazadeh ◽  
Vishaal Prabhu ◽  
Evan D. Bander ◽  
Ryan C. Cusic ◽  
Apostolos John Tsiouris ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Outcome Data ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Single Institution ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Visual Improvement ◽  
Select Group ◽  
Transcranial Approach

OBJECTIVE The authors compared clinical and radiological outcomes after resection of midline craniopharyngiomas via an endoscopic endonasal approach (EEA) versus an open transcranial approach (TCA) at a single institution in a series in which the tumors were selected to be equally amenable to gross-total resection (GTR) with either approach. METHODS A single-institution retrospective review of previously untreated adult midline craniopharyngiomas was performed. Lesions were evaluated by 4 neurosurgeons blinded to the actual approach used to identify cases that were equally amenable to GTR using either an EEA or TCA. Radiological and clinical outcome data were assessed. RESULTS Twenty-six cases amenable to either approach were identified, 21 EEA and 5 TCA. Cases involving tumors that were resected via a TCA had a trend toward larger diameter (p = 0.10) but were otherwise equivalent in preoperative clinical and radiological characteristics. GTR was achieved in a greater proportion of cases removed with an EEA than a TCA (90% vs 40%, respectively; p = 0.009). Endoscopic resection was associated with superior visual restoration (63% vs 0%; p < 0.05), a decreased incidence of recurrence (p < 0.001), lower increase in FLAIR signal postoperatively (−0.16 ± 4.6 cm3 vs 14.4 ± 14.0 cm3; p < 0.001), and fewer complications (20% vs 80% of patients; p < 0.001). Significantly more TCA patients suffered postoperative cognitive loss (80% vs 0; p < 0.0001). CONCLUSIONS An EEA is a safe and effective approach to suprasellar craniopharyngiomas amenable to GTR. For this select group of cases, the EEA may provide higher rates of GTR and visual improvement with fewer complications compared with a TCA.

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