Prone Positioning for Successful Gamma Knife Radiosurgical Treatment of Far Anterior Skull Base Lesions: A Technical Note

Background: The minimally invasive approaches to the anterior skull base region through fronto-orbital craniotomy remain a highly accepted option that gains countenance and predilection over time. The transpalpebral “eyelid” incision is an under-utilized and more recent technique that offers a safe efficient corridor to manage a wide variety of lesions. Methods: We carried a retrospective study of 44 patients operated on by the fronto-orbital craniotomy through transpalpebral “eyelid” incision for intracranial tumors, in the time period from March 2007 to July 2016. The results from surgeries were analyzed; extent of tumor resection, length of hospital stay, cosmetic outcome, and complications. Results: Out of the 44 intracranial tumor cases, we had 16 male and 28 female patients with median age 54 years. We had 19 anterior skull base lesions, 8 middle skull base lesions and 8 parasellar lesions. We also operated on four frontal intraparenchymal lesions and four other various lesions. Total resection was achieved in 32 cases (72.7%), with excellent cosmetic outcome in 43 cases (97.7%). Average hospital stay was 6 days. No major complications recorded. Three cases (6.8%) had complications that varied between pseudomeningocele, wound infections, and facial pain. Follow-up average period was 23.6 months. Conclusion: The fronto-orbital approach through eyelid incision remains a reliable approach to the skull base. It provides natural anatomical dissection planes through the eyelid incision and a fronto-orbital craniotomy, creating a wide surgical corridor to manage specific lesions with consistent surgical and cosmetic outcome.

Download Full-text

Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica

Neurosurgical FOCUS ◽

10.3171/foc.2005.19.1.4 ◽

2005 ◽

Vol 19 (1) ◽

pp. 1-12 ◽

Cited By ~ 70

Author(s):

Amin Kassam ◽

Carl H. Snyderman ◽

Arlan Mintz ◽

Paul Gardner ◽

Ricardo L. Carrau

Keyword(s):

Skull Base ◽

Sella Turcica ◽

Surgical Techniques ◽

Case Series ◽

Anterior Skull Base ◽

Anatomical Landmarks ◽

Endonasal Approach ◽

Appropriate Use ◽

Expanded Endonasal Approach ◽

Skull Base Lesions

Object Transsphenoidal approaches have been used for a century for the resection of pituitary and other sellar tumors. More recently, the standard endonasal approach has been expanded to provide access to other, parasellar lesions. With the addition of the endoscope, this expansion carries significant potential for the resection of skull base lesions. Methods The anatomical landmarks and surgical techniques used in expanded (extended) endoscopic approaches to the rostral, anterior skull base are reviewed and presented, accompanied by case illustrations of each segment (or module) of approach. The rostral half of the anterior skull base is divided into modules of approach: sellar/parasellar, transplanum/transtuberculum, and transcribriform. Case illustrations of successful resections of lesions with each module are presented and discussed. Conclusions Endoscopic, expanded endonasal approaches to rostral anterior skull base lesions are feasible and hold great potential for decreased morbidity. The effectiveness and appropriate use of these techniques must be evaluated by close examination of outcomes as case series expand.

Download Full-text

Efficacy of a new instrument for dural defect repair in anterior skull base reconstruction: a technical note

Acta Neurochirurgica ◽

10.1007/s00701-013-1630-3 ◽

2013 ◽

Vol 155 (4) ◽

pp. 733-736 ◽

Cited By ~ 2

Author(s):

Hiroyuki Jimbo ◽

Jun Muto ◽

Tatsuo Masubuchi ◽

Kouki Miura ◽

Shinetsu Kamata ◽

...

Keyword(s):

Skull Base ◽

Technical Note ◽

Anterior Skull Base ◽

Dural Defect ◽

Skull Base Reconstruction ◽

New Instrument ◽

Defect Repair ◽

Dural Defect Repair

Download Full-text

Transsphenoidal approaches to anterior skull base lesions

Operative Techniques in Neurosurgery ◽

10.1016/s1092-440x(99)80019-x ◽

1999 ◽

Vol 2 (4) ◽

pp. 191-200

Author(s):

G. Edward Vates ◽

Charles B. Wilson ◽

Michael W. McDermott

Keyword(s):

Skull Base ◽

Anterior Skull Base ◽

Skull Base Lesions

Download Full-text

Surgical Outcomes of the Endoscopic Endonasal Transsphenoidal Approach for Anterior Skull Base Lesions: Experience in Combined Military Hospital, Dhaka

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v14i1.42726 ◽

2019 ◽

Vol 14 (1) ◽

pp. 66-68

Author(s):

Md Al Amin Salek ◽

Md Hasnayen Faisal ◽

Md Abdul Hye Manik ◽

Ahmed Ul Mursalin Choudhury ◽

Rukun Uddin Chowdhury ◽

...

Keyword(s):

Skull Base ◽

Surgical Outcomes ◽

Cerebrospinal Fluid Leak ◽

Armed Forces ◽

Anterior Skull Base ◽

Military Hospital ◽

Cushing Disease ◽

Endoscopic Endonasal ◽

Cross Sectional ◽

Skull Base Lesions

Introduction:The endoscopic endonasal approach is a minimally invasive surgical technique for removal of skull base lesions by using nose and sinuses as natural corridors. This study represents our institutional experience with endoscopic endonasal trans-sphenoidal approach for anterior skull base lesions. Objective: To find out surgical outcomes of endoscopic endonasal trans-sphenoidal approach for treatment of anterior skull base lesions. Materials and Methods: Cross-sectional observational study of 38 consecutive patients who underwent endoscopic endonasal trans-sphenoidal surgery for anterior skull base lesions in Combined Military Hospital, Dhaka from July 2013 to June 2017. Results:This study included 16 men and 22 women, ranging from 24 to 68 years of age where median was 38 years. Common presentations were visual disorder (60%), headache (30%), features of pituitary apoplexy (5%), Cushing disease (0.35%), acromegaly (0.7 %), galactorrhoea (0.35%). Radiological evaluation revealed intrasellar (12), sellar and suprasellar (22), sellar and parasellar (1), tuberculum sella and planum sphenoidale (3), clival (1) lesions. Recurrent cases (3/38) were nonfunctioning pituitary macroadenoma, prolactinoma, and growth hormone secreting macroadenoma. The surgical resection in relation to post op imaging were 45% as gross total resection, near-total in 35%, subtotal in 15%, and partial in 5%. We found fifteen patients experienced improvement in visual acuity, while one patient worsened. Common complications were transient diabetes insipidus (53%), new pituitary deficit (35%), endonasal adhesions (20%), and cerebrospinal fluid leak (5%). Surgical mortality was (0.35%). The histological diagnoses included twenty-eight pituitary adenomas, five craniopharyngioma, three meningioma, one Rathke’s cleft cyst and one clival chordoma. Conclusion: Endoscopic endonasal transsphenoidal surgery is a valuable treatment option for an anterior skull base lesion. Journal of Armed Forces Medical College Bangladesh Vol.14(1) 2018: 66-68

Download Full-text