P.053 Expanded endoscopic endonasal approach for petrous apex lesions: our clinical experience and surgical techniques

Background: Traditionally petrous apex lesions surgical approach is associated with multiple complications including brain injury secondary to brain retraction. Expanded endoscopic endonasal trans-clival (EEET) can be used in selected patients with minimal complications. Methods: We are presenting our experience over the last three years in patients who underwent EEET resection of petrous apex lesions: 8 patients underwent such procedure. All patients underwent extensive workup including MRI and CTA to identify the relation of the carotid to the lesion. All surgeries were done with neuro-physiological monitoring. Intraoperative neuronavigation and endoscopic Doppler were used to identify the petrous segment of the internal carotid artery. Our follow up ranged from 6 months to 2.5 years. Results: All patients presented with severe neurologic symptoms related to either fifth cranial nerve, sixth cranial nerve or brain stem compression. Pathologies included chondrosarcoma, cholesterol granulomas and lymphangioma. All patients demonstrated improvement in their symptoms. None of our patients had intra-operative vascular injury. There was no post-operative CSF leak or infection. Postoperative imaging demonstrated excellent resection with no clear residual. Three patient required adjuvant stereotactic radiosurgery because of their underlying pathology. Conclusions: The expanded endoscopic endonasal approach for petrous apex lesion should be considered as a minimally invasive approach in selected cases.

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P.009 Cervicomedullary decompression through expanded endoscopic endonasal approach: our clinical experience

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2017.94 ◽

2017 ◽

Vol 44 (S2) ◽

pp. S16-S16

Author(s):

F Alkherayf ◽

C Agbi ◽

S kilty ◽

A Lamothe

Keyword(s):

Cranial Nerves ◽

Oral Intake ◽

Velopharyngeal Insufficiency ◽

Csf Leak ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Anterior Decompression ◽

Endoscopic Endonasal ◽

Invasive Approach ◽

Cervicomedullary Junction

Background: patients with ventral cervical-medullary compression require anterior decompression of the cervicomedullary junction. Odontoid resection can be accomplished through expanded endoscopic approach especially in cases of irreducible basilar invagination in which the pathology is situated well above the palatine line. Methods: We are presenting our experience at the Ottawa Hospital (TOH) over the last seven years in patients who underwent expanded endoscopic endonasal decompression of their cervicomedullary junction. 16 patients underwent such procedure, those patients with preoperative cervical instability underwent posterior fusion for stabilization at the same surgical setting. Follow up ranged from 9 months to 5 years. Results: All patients had severe symptoms of myelopathy and some lower cranial nerves dysfunction. All patients were extubated after recovery from anesthesia and allowed oral intake next day. patients demonstrated improvement in their symptoms and none of them required tracheostomy. 12.5% experienced transient velopharyngeal insufficiency. one patient had CSF leak which was successfully treated with lumbar drain and one patient developed infection from the posterior cervical fusion and required debridement. All patients were eventually discharged home. Postoperative imaging demonstrated excellent decompression of the anterior cervicomedullary junction pathology. Conclusions: The expanded endoscopic endonasal approach for odontoidectomy should be considered as a minimally invasive approach for anterior decompression in selected cases

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Pseudocapsule-Based Resection for Pituitary Adenomas via the Endoscopic Endonasal Approach

Frontiers in Oncology ◽

10.3389/fonc.2021.812468 ◽

2022 ◽

Vol 11 ◽

Author(s):

Yuefei Zhou ◽

Jialiang Wei ◽

Feng Feng ◽

Jianguo Wang ◽

Pengfei Jia ◽

...

Keyword(s):

Pituitary Adenomas ◽

Tumor Resection ◽

Csf Leak ◽

Safe Procedure ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Csf Leakage ◽

Extracapsular Resection

IntroductionThe endoscopic endonasal approach (EEA) is a safe and effective treatment for pituitary adenomas (PAs). Since extracapsular resection (ER) of PAs improves tumor resection and endocrine remission rates, the interface between the pseudocapsule and gland draws increasing attention. However, it is difficult to precisely dissect the tumor along the exact boundary, and complete removal of the tumor increases the risks of normal tissue damage and cerebrospinal fluid (CSF) leakage. In this study, we investigated the extracapsular resection as well as the pseudocapsule histology to evaluate the effectiveness and safety of pseudocapsule-related surgical interventions.MethodsFrom December 2017 to December 2019, 189 patients of PAs via EEA in our single center were analyzed retrospectively. The images, operative details, and clinical follow-up of patients were collected. Sixty-four patients underwent pseudocapsule-based ER, and 125 patients also underwent traditional intracapsular resection (IR) with or without intensive excision for FPAs. The clinical characteristics, tumor resection, endocrinological outcomes, and postoperative morbidities of the two groups were compared. Informed consent for publication of our article was obtained from each patient. Histological examination of pseudocapsule was performed using hematoxylin and eosin and reticulin staining.ResultsThe gross total recession was 62 (96.9%) in the ER group and 107 (85.6%) cases in the IR group, whereas the endocrine remission rate was 29/31 (93.5%) and 40/53 (75.5%) cases, respectively. Anterior pituitary functions were not aggravated postoperatively in any patient, but transient diabetes insipidus (DI) occurred more in the IR group (64.0%) than in ER (48.4%). Pseudocapsule specimens were obtained in 93 patients, and clusters of small cell aggregation were detected in 11 pseudocapsule specimens (11.8%) whereas other patients showed no remarkable developed pseudocapsule. Intraoperative CSF leak occurred more in the ER group (28.1%) than in the IR group (13.6%), but no difference was seen between two groups postoperatively. No case of intracranial hematoma or pituitary crisis occurred in both groups. After a mean follow-up of 22.8 months, tumor recurrence was observed in 4 (2.1%) cases.ConclusionPseudocapsule-based extracapsular resection of PAs via EEA is an effective and safe procedure to achieve complete resection with high and sustained endocrine remission and without deteriorating pituitary function.

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Long Term Follow-up after Endoscopic Endonasal Approach for the Treatment of Cushing's Disease

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1669956 ◽

2018 ◽

Vol 80 (03) ◽

pp. 306-309

Author(s):

Alexandre Bossi Todeschini ◽

Américo Rubens Leite dos Santos ◽

Ricardo Landini Lutaif Dolci ◽

José Viana Lima Junior ◽

Nilza Maria Scalissi ◽

...

Keyword(s):

Cushing’S Disease ◽

Early Years ◽

Neurological Deficits ◽

Cushing's Disease ◽

Csf Leak ◽

Sustained Remission ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal

Introduction Surgery has been the standard treatment for Cushing's disease. Currently, the endoscopic endonasal approach (EEA) is the most widely used technique. However, among some endocrinologists and neurosurgeons used to the microscope assisted technique, there are still questions about the effectiveness and safety of transitioning to the EEA. We aim to show our initial experience with such transition. Method Retrospective review of medical records of patients, who underwent EEA in our center as a first treatment for Cushing's disease, and with a minimum 18 months of follow-up, from March 2004 to March 2014 Results Our cohort had 16 patients (14 females and 2 males), with a mean age of 33.7 years. The mean follow-up was 52.0 months. Magnetic resonance imaging (MRI) identified an adenoma in 93.8% of the patients (56.2% microadenomas and 37.5% macroadenomas). Postoperative cerebrospinal fluid (CSF) leak was observed in two patients (12.5%). No new neurological deficits were present after surgery. The early remission and sustained remission rates after a single procedure were 87.5 and 68.75%, respectively. Weight reduction, improved control of blood pressure, and lower serum glucose levels were documented in 68.75, 60, and 55.5% of patients, respectively, after remission. Conclusion Despite the need for specialized training, equipment and team building by ENT (Ear, Nose and Throat) and neurosurgery, the transition from microscope assisted pituitary surgery to endoscopic endonasal approach is possible and safe. The clinical outcomes, even in the early years, are similar to the previous microscope assisted treatment, and over time, with greater experience and knowledge, there is a tendency for improvement.

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Endoscopic endonasal approach to cholesterol granulomas of the petrous apex: a series of 17 patients

Journal of Neurosurgery ◽

10.3171/2011.11.jns111077 ◽

2012 ◽

Vol 116 (4) ◽

pp. 792-798 ◽

Cited By ~ 25

Author(s):

Alessandro Paluzzi ◽

Paul Gardner ◽

Juan C. Fernandez-Miranda ◽

Carlos D. Pinheiro-Neto ◽

Tiago Fernando Scopel ◽

...

Keyword(s):

Strong Correlation ◽

Petrous Apex ◽

Consecutive Series ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Carotid Artery Injuries ◽

Skull Base Lesions ◽

Serous Otitis Media

Object The aim of this study was to report the results in a consecutive series of patients who had undergone an endoscopic endonasal approach (EEA) for drainage of a petrous apex cholesterol granuloma (CG). Methods Seventeen cases with a confirmed diagnosis of petrous apex CG were identified from a database of more than 1600 patients who had undergone an EEA to skull base lesions at the authors' institution in the period from 1998 to 2011. Clinical outcomes were reviewed and compared with those in previous studies of open approaches. Results Nine patients underwent a transclival approach and 8 patients underwent a combined transclival and infrapetrous approach. A Silastic stent was used in 11 patients (65%), a miniflap in 4 (24%), and a simple marsupialization of the cyst in 3 (18%). All symptomatic patients had partial or complete improvement of their symptoms postoperatively and at the follow-up (mean follow-up 20 months, range 3–67 months). Complications developed in 3 patients (18%) including epistaxis, chronic serous otitis media, eye dryness, and a transient sixth cranial nerve palsy. Two patients (12%) had a symptomatic recurrence of the cyst requiring repeat endoscopic endonasal drainage. There were no instances of internal carotid artery injuries, CSF leaks, or new hearing loss. The mean postoperative hospital stay was 2 days (range 0.7–4.6 days). These results were comparable with those in previous studies of open approaches to petrous apex CGs. There was a strong correlation between the size of the cyst and the type of approach chosen (Rpb [point biserial correlation coefficient] = +0.67, p = 0.003359) and a very strong correlation between the degree of medial extension (defined by the V-angle) and the choice of approach (Rpb = +0.81, p < 0.0001). Based on these observations, the authors developed an algorithm for guiding the choice of the most appropriate route of drainage. Conclusions The EEA is a safe and effective alternative to traditional open approaches to petrous apex CGs.

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ENDOSCOPIC ENDONASAL APPROACH FOR CLIVAL CHORDOMAS

Neurosurgery ◽

10.1227/01.neu.0000338071.01241.e2 ◽

2009 ◽

Vol 64 (2) ◽

pp. 268-278 ◽

Cited By ~ 177

Author(s):

Martina Stippler ◽

Paul A. Gardner ◽

Carl H. Snyderman ◽

Ricardo L. Carrau ◽

Daniel M. Prevedello ◽

...

Keyword(s):

Systematic Review ◽

Medical Center ◽

Neurological Complication ◽

Cranial Base ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Review Of The Literature ◽

Endoscopic Endonasal ◽

Invasive Approach

Abstract OBJECTIVE Cranial base chordomas are difficult lesions to treat. The endoscopic endonasal approach (EEA) takes advantage of the natural sinus corridor and may provide a less invasive approach for these midline tumors. METHODS Patients undergoing EEA for chordomas were selected from a database of more than 800 consecutive patients undergoing EEA at the University of Pittsburgh Medical Center and were retrospectively evaluated. Additionally, a systematic review of the literature of endoscopic endonasally resected chordomas was performed and compared with our personal experience. RESULTS Twenty patients (8 females and 12 males) underwent 26 endoscopic EEAs for cranial base chordomas. Eight chordomas (40%) were recurrent. Treatment of the 12 newly diagnosed chordomas included 8 total resections (66.7%), 2 near total resections (16.7%), and 2 subtotal resections (16.7%). Treatment of the 8 recurrent chordomas included 1 gross total resection (12.5%), 2 near total resections (25.0%), and 5 subtotal resections (62.5%). Two patients (10%) had recurrences, and 5 patients (25%) progressed during the mean follow-up period of 13 months (range, 1–45 months). Five patients (25%) underwent re-resection, 1 patient was lost to follow-up, and 1 patient died secondary to progression of disease. There was 1 intraoperative vascular complication with no sequelae. The cerebrospinal fluid leak rate was 25%, and there were no cases of bacterial meningitis. The incidence of a new permanent neurological complication was 5%. A systematic review of the literature yielded a total of 26 cases of chordomas resected via a completely endoscopic endonasal technique. CONCLUSION Endoscopic endonasal resection of cranial base chordomas is safe once adequate experience is gained with the technique. This approach provides the potential for, at the least, similar resections compared with traditional cranial base approaches while potentially limiting morbidity.

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Endoscopic endonasal resection of congenital trans-sphenoidal meningoencephalocele with extension to the epipharynx in early childhood: a case report

African Health Sciences ◽

10.4314/ahs.v19i3.52 ◽

2019 ◽

Vol 19 (3) ◽

pp. 2764-2767

Author(s):

Karen Dzhambazov ◽

Ivo Kehayov ◽

Alexandrina Topalova ◽

Borislav Kitov ◽

Hristo Zhelyazkov ◽

...

Keyword(s):

Sphenoid Sinus ◽

Csf Leak ◽

Nasal Discharge ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Nasal Breathing ◽

Endoscopic Endonasal ◽

Insidious Onset ◽

History Of

Background: The clinical presentation of sphenoid sinus meningoencephaloceles (MEC) may have insidious onset and evolution. Contemporary treatment incorporates endoscopic resection via the endonasal route.Case description: We present a case of 3 year old girl who had been complaining of permanent nasal discharge, impeded nasal breathing and difficulty with feeding since she was 5 months old. There was no history of rhinoliquorrhea. Pre-operative magnetic resonance imaging demonstrated MEC that extended from the sellar region through the non-pneumatized sphenoid sinus to the nasopharynx. The lesion was resected via endoscopic endonasal approach. Follow-up rhinoscopy confirmed the absence of post-operative cerebrospinal fluid leak.Conclusion: Endoscopic endonasal approach can be an effective and a safe treatment option for resection of congenital transsphenoidal MEC in early childhood.Keywords: Sphenoid sinus; endoscopic endonasal approach; meningoencephalocele; CSF leak; congenital.

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RARE-03. AGGRESSIVE RESECTION FOR PEDIATRIC CRANIOPHARYNGIOMAS VIA ENDOSCOPIC ENDONASAL APPROACH

Neuro-Oncology ◽

10.1093/neuonc/noaa222.715 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii442-iii442

Author(s):

Hiroki Morisako ◽

Takeo Goto ◽

Hiroki Ohata ◽

Hiroaki Sakamoto ◽

Kenji Ohata

Keyword(s):

Extent Of Resection ◽

Cognitive Outcomes ◽

Csf Leak ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Total Resection ◽

Endoscopic Endonasal ◽

Transcranial Approach ◽

Surgical Modality

Abstract OBJECTIVE In recent years, the endoscopic endonasal approach (EEA) has been increasingly used for pediatric craniopharyngiomas. We here present our experience and the outcomes of the EEA resection of pediatric craniopharyngiomas. MATERIALS AND METHODS Between April 2014 and December 2019, 16 cases of pediatric craniopharyngiomas were operated at the Osaka city university (OCU) hospital. Eight patients were diagnosed with primary craniopharyngiomas while 8 had a recurrent tumor. There were 5 males and 11 females, with a mean age of 10.7 years (3–17 years). EEA was selected in all patients and a case of large muti-lobulated tumor was resected by combination of microscopic transcranial approach. RESULTS Gross total resection was achieved in 14 patients and near total resection in other 2. Post-op CSF leak occurred in 3 patients, which was treated with re-exploration. Pituitary stalk was preserved intraoperatively in 4 cases, and 15 patients developed diabetes insipidus and anterior hormonal replacement therapy was required in 15 patients at last follow-up. Visual improvement was noted in 4 patients while vision remained unchanged in the rest. Neuropsychological function status was preserved in all patients, and there was no new-onset obesity postoperatively. The mean follow-up duration was 35.1 months (2 – 69 months) and 4 of 8 recurrent cases had re-recurrence during this period, however there was no recurrent in 8 primary cases. CONCLUSIONS EEA should be the surgical modality of choice for treating pediatric craniopharyngiomas. It results in better visual and cognitive outcomes with a significantly increased extent of resection.

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