Endoscopic Transnasal Approach for Urgent Decompression of the Craniocervical Junction in Acute Skull Base Osteomyelitis

AbstractIntroduction:Ossifying fibromyxoid tumour is a recently described, rare but morphologically distinctive soft tissue neoplasm characterised by a combination of myxoid and/or fibrous stroma with areas of ossification. Although most authors postulate a neuroectodermal origin for this peculiar tumour, there is no agreement in the literature regarding its histopathogenesis. To our knowledge, this is the first reported case of ossifying fibromyxoid tumour involving the sphenoid sinus.Histological findings:Tumour of low cell density, composed of small, spindle-shaped or stellate cells with small, irregular nuclei set in a fibromyxoid stroma.Management:Following discussion at the skull base multidisciplinary team meeting, a combined surgical team including an otorhinolaryngologist and a neurosurgeon carried out resection of the lesion, using an endoscopic transnasal approach, followed by reconstruction of the defect.Conclusions:An awareness of the distinctive histopathological features of ossifying fibromyxoid tumour, and of its clinical effects, is crucial to establishing a definitive diagnosis and thereby instituting appropriate management. This case report also reinforces the evolving role of the endoscopic transnasal approach in the management of inflammatory and neoplastic disease involving the skull base. This is increasingly being made possible by close collaboration between multiple surgical specialties, including otorhinolaryngology and neurosurgery.

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Resection of a Pontine Cavernous Malformation via an Endoscopic Endonasal Approach

Operative Neurosurgery ◽

10.1227/neu.0b013e31824cabb1 ◽

2012 ◽

Vol 71 (suppl_1) ◽

pp. onsE186-onsE194 ◽

Cited By ~ 4

Author(s):

Matthew M. Kimball ◽

Stephen B. Lewis ◽

John W. Werning ◽

J D. Mocco

Keyword(s):

Skull Base ◽

Surgical Resection ◽

Conservative Management ◽

Cavernous Malformation ◽

Gross Total Resection ◽

Total Resection ◽

Transnasal Approach ◽

Acute Hemorrhage ◽

Cavernous Malformations ◽

Endoscopic Transnasal Approach

Abstract BACKGROUND AND IMPORTANCE: Cavernous malformations of the brainstem are a dilemma in terms of deciding when to operate, and they remain difficult to access surgically. We present a novel approach for the resection of a brainstem cavernous malformation CLINICAL PRESENTATION: A 59-year-old woman presented with a 1-month history of intermittent dysarthria, right facial weakness, and left arm and leg weakness. A magnetic resonance image revealed a 2-cm mass in the pons with blood products of differing ages, consistent with a cavernous malformation. We discussed with her the risks of surgical resection and conservative management. She decided to pursue conservative management. Two weeks later, she returned to the emergency room with diplopia and left-sided hemiplegia. Acute hemorrhage within the right pons was seen. She then chose to undergo surgical resection. CONCLUSION: The patient underwent an endoscopic transnasal approach for resection of a pontine cavernous malformation. Image guidance was used to identify key anatomic landmarks. A gross total resection was achieved without new neurological deficits. With physical and occupational therapy, the patient developed antigravity strength in her left upper and lower extremities before discharge. At her 4-week follow-up, she was ambulating independently with the assistance of a cane. We report the successful gross total resection of a pontine cavernous malformation via an endoscopic transnasal approach. This patient had improvement in neurological symptoms after surgical resection with minimal surgical morbidity. Technologic advances in endoscopic skull base approaches have provided access to lesions of the skull base previously requiring more invasive approaches.

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Surgical Anatomy of the Nasal Cavity for Endoscopic Transnasal Approach to the Skull Base

Japanese Journal of Neurosurgery ◽

10.7887/jcns.22.357 ◽

2013 ◽

Vol 22 (5) ◽

pp. 357-361

Author(s):

Takayuki Nakagawa

Keyword(s):

Nasal Cavity ◽

Skull Base ◽

Surgical Anatomy ◽

Transnasal Approach ◽

Endoscopic Transnasal Approach

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Endoscopic Transnasal Resection of Midline Skull Base Meningiomas: Tumor Consistency and Surgical Outcomes

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1714111 ◽

2020 ◽

Author(s):

Hissah K. Al Abdulsalam ◽

Aljohara K. Aldahish ◽

Abdulrahman Albakr ◽

Sajjad Hussain ◽

Ahmad Alroqi ◽

...

Keyword(s):

Skull Base ◽

Surgical Outcomes ◽

Transnasal Approach ◽

Weighted Magnetic Resonance Imaging ◽

Endoscopic Transnasal Approach ◽

Cerebellar Peduncle ◽

Magnetic Resonance Imaging Mri ◽

Skull Base Meningiomas ◽

Tumor Consistency ◽

Traditional Approaches

Abstract Background The endoscopic transnasal approach (ETA) has proven to be of great value in the resection of midline skull base meningiomas when compared with traditional approaches. Our objective was to assess tumor consistency in relation to surgical outcomes for midline meningiomas (MMs) resected using ETA. Methods Radiological preoperative features, including the tumor to cerebellar peduncle T2-weighted magnetic resonance imaging (MRI) ratio (TCTI), were evaluated. The intraoperative consistency assessment was performed by the surgeon, which determined if the tumor was soft (resectable by suction) or firm (required a cavitation ultrasonic aspirator). Surgical resection and postoperative complications were evaluated in relation to tumor consistency. Results Twenty patients were evaluated; 6 were classified as firm and 14 were classified as soft. The mean TCTI ratio was 1.7 and the median was 1.7 (range: 1.3–2.4). Three firm tumors had a ratio of <1.6. All soft tumors had a ratio of ≥1.6 with three outliers. Additionally, 66.7% of patients with firm tumors had complications compared with 35.7% of patients with soft tumors. Only 33.3% of firm tumors underwent gross total resection (GTR) in comparison to 79.0% of tumors with a soft consistency. Conclusion In our analysis, we found that tumor consistency was significantly related to short-term surgical outcomes in MMs resected using the ETA. The TCTI ratio was found to be the most reliable predictor with a sensitivity of 76.9% and a specificity of 40.0%. Our findings suggest that traditional cranial approaches should be considered as the first surgical option for managing firm MMs.

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Endoscopic Transnasal Approach to the Craniocervical Junction

Skull Base ◽

10.1055/s-0029-1246220 ◽

2010 ◽

Vol 20 (03) ◽

pp. 199-205 ◽

Cited By ~ 33

Author(s):

Annesse Lee ◽

Doron Sommer ◽

Kesava Reddy ◽

Naresh Murty ◽

Thorsteinn Gunnarsson

Keyword(s):

Craniocervical Junction ◽

Transnasal Approach ◽

Endoscopic Transnasal Approach

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Endoscopic Transnasal Approach for Resection of a Recurring Anterior Skull Base Aneurysmal Bone Cyst: A Case Report and Review of the Literature

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0033-1336276 ◽

2013 ◽

Vol 74 (S 01) ◽

Author(s):

Sandra Ho ◽

Tyler Kenning ◽

James Evans

Keyword(s):

Case Report ◽

Skull Base ◽

Aneurysmal Bone Cyst ◽

Bone Cyst ◽

Anterior Skull Base ◽

Review Of The Literature ◽

Transnasal Approach ◽

Endoscopic Transnasal Approach

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The Virtual Endoscope of Neurosurgery Used for Transnasal Approach

Applied Mechanics and Materials ◽

10.4028/www.scientific.net/amm.416-417.1282 ◽

2013 ◽

Vol 416-417 ◽

pp. 1282-1288

Author(s):

Jun Cong Mo ◽

De Min Yao

Keyword(s):

Skull Base ◽

Skull Base Surgery ◽

Three Dimensional ◽

Dimensional Structure ◽

Transnasal Approach ◽

Endoscopic Neurosurgery ◽

Anatomical Structures ◽

Endoscopic Transnasal Approach ◽

Linear Effects ◽

Mutual Relations

This paper presents and implements an automatic roaming and fast virtual endoscopic neurosurgery system for transsexual approach, which can be compatible with the fiber-optic endoscopic transnasal approach in the skull base surgery, and accurately locate the position and their mutual relations among the lesions, tumors and surrounding vital anatomical structures. The system uses a multithreaded RayCasting volume-rendering algorithm based on the graphics processor (GPU). It reconstructs the nasal three-dimensional structure in the skull base surgery, and optimizes the centerline extraction that can be carried out automatically. In real-time display, it improves the translucent rendering optical model, taking into account lighting model important parameter - the image gradient translucent degree of non-linear effects, and can fully display the skull surface and internal implied the interface and internal details.

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Anatomic study of the anterior skull base via an endoscopic transnasal approach

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2010.11.019 ◽

2011 ◽

Vol 113 (4) ◽

pp. 281-284 ◽

Cited By ~ 3

Author(s):

Ming Song ◽

Xuyi Zong ◽

Xinsheng Wang ◽

Ao Pei ◽

Peng Zhao ◽

...

Keyword(s):

Skull Base ◽

Anterior Skull Base ◽

Anatomic Study ◽

Transnasal Approach ◽

Endoscopic Transnasal Approach

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Anatomic Study of Endoscopic Transnasal Approach to Petrous Apex

E3S Web of Conferences ◽

10.1051/e3sconf/202021803016 ◽

2020 ◽

Vol 218 ◽

pp. 03016

Author(s):

Wenyuan He ◽

Qingying Qin ◽

Guxian Wang

Keyword(s):

Skull Base ◽

Sphenoid Sinus ◽

Lateral Wall ◽

Anterior Wall ◽

Surgical Anatomy ◽

Petrous Apex ◽

Transnasal Approach ◽

Long Time ◽

Endoscopic Transnasal Approach ◽

Micro Drill

With the development of Neurosurgery technology, there has been a qualitative leap forward with the appearance of microanatomy, which makes the deep brain tumors which were hard to be achieved in the past, and effectively reduces the mortality of patients. Petrous apex is a cone-shaped part of the anteromedial part of the temporal bone, which is deep. It has been a challenging area for surgical anatomy for a long time. In this paper, fresh adult perfused cadaveric head specimens and dry adult cadaveric head specimens were taken as the experimental objects. The anterior wall of sphenoid sinus and the internal septum of sphenoid sinus were excised under neuroendoscope. The structures of the lateral wall of sphenoid sinus were identified and dissected. The lateral wall of sphenoid sinus and the bone of skull base were opened with micro drill, The meninges were exposed and cut open, and the related structures were dissected, observed and photographed. The experimental results show that it is relatively safe to operate in the range of less than 8mm, and the rock tip can be found accurately. The measurement of the bony structure of the skull base is helpful for the surgeon to judge the course of the internal carotid artery and its adjacent structure.

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