scholarly journals Expanded Endoscopic Endonasal Resection of Retrochiasmatic Craniopharyngioma

2018 ◽  
Vol 79 (S 02) ◽  
pp. S194-S195
Author(s):  
Justin Davanzo ◽  
Neerav Goyal ◽  
Brad Zacharia
Keyword(s):  
Optic Chiasm ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Nasoseptal Flap ◽  
Endoscopic Endonasal ◽  
Expanded Endonasal Approach ◽  
Close Proximity ◽  
Dural Opening ◽  
Neurologically Intact ◽  
Video Abstract

AbstractThis video abstract demonstrates the use of the expanded endoscopic endonasal approach for the resection of a retrochiasmatic craniopharyngioma. These tumors are notoriously difficult to treat, and many approaches have been tried to facilitate safe and effective resection. The endoscopic endonasal approach has been increasingly utilized for selected sellar/suprasellar pathology. We present the case of a 39-year-old man who was found to have a cystic, partially calcified suprasellar mass consistent with a craniopharyngioma. To facilitate robust skull base repair, a vascularized nasoseptal flap was harvested. A wide sphenoidotomy was performed and the sella and tuberculum were exposed. After the dural opening and arachnoid dissection, the stalk was identified, merging seamlessly with the tumor capsule. The lesion was then internally debulked with the use of an ultrasonic aspirator. The capsule was then dissected off of the optic chiasm, thalamus, and hypothalamus. The cavity was inspected with an angled endoscope to ensure complete resection. A multilayered reconstruction was performed using autologous fascia lata, the previously harvested nasoseptal flap, and dural sealant. Postoperatively, the patient did have expected panhypopituitarism but remained neurologically intact and had improvement in his vision. In conclusion, this video demonstrates how an expanded endonasal approach can be used to safely resect a craniopharyngioma, even when in close proximity to delicate structures such as the optic chiasm.The link to the video can be found at: https://youtu.be/tahjHmrXhc4.

scholarly journals Endoscopic Endonasal Approach for Resection of a Pediatric Craniopharyngioma: Operative Video and Technical Nuances

2018 ◽  
Vol 79 (S 03) ◽  
pp. S245-S246 ◽  
Author(s):  
James Liu ◽  
Jean Eloy
Keyword(s):  
Skull Base ◽  
Visual Fields ◽  
Optic Chiasm ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Suprasellar Region ◽  
Skull Base Defect ◽  
Neurologically Intact ◽  
Neurovascular Structures

AbstractWe present a pediatric case of a retrochiasmatic craniopharyngioma in the suprasellar region with third ventricular extension that was resected through a purely endoscopic endonasal approach (EEA) via the transplanum transtuberculum corridor. The patient is a 12-year-old boy who presented with progressive visual loss and panhypopituitarism. The EEA allows direct visualization of the undersurface of the optic chiasm and hypothalamus so that safe and meticulous tumor dissection can be performed to preserve these critical neurovascular structures. This video atlas demonstrates the operative technique and surgical nuances of the endoscopic skull base approach, microdissection of the tumor from the critical neurovascular structures, and multilayered reconstruction of the skull base defect with a nasoseptal flap. A gross total resection was achieved, and the patient was neurologically intact with improved visual acuity and visual fields. In summary, the EEA via the transplanum transtuberculum corridor is an important strategy in the armamentarium for surgical management of pediatric craniopharyngiomas.The link to the video can be found at: https://youtu.be/bmgO_PMRHPk.

scholarly journals Extended Endoscopic Endonasal Resection of a Suprasellar and Third Ventricular Retrochiasmatic Craniopharyngioma with a Narrow Pituitary Gland–Optic Chiasm Interval: Techniques to Optimize Resection

2018 ◽  
Vol 79 (S 03) ◽  
pp. S252-S253
Author(s):  
Tyler Kenning ◽  
Carlos Pinheiro-Neto
Keyword(s):  
Pituitary Gland ◽  
Third Ventricle ◽  
Mass Effect ◽  
Optic Chiasm ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Posterior Aspect ◽  
Endoscopic Endonasal ◽  
The Third ◽  
Extended Endoscopic Approach

AbstractThe extended endoscopic endonasal approach can be utilized to surgically treat pathology within the suprasellar space. This relies on a sufficient corridor and interval between the superior aspect of the pituitary gland and the optic chiasm. Tumors located in the retrochiasmatic space and within the third ventricle, however, may not have a widened interval through which to work. With mass effect on the superior and posterior aspect of the optic chiasm, the corridor between the chiasm and the pituitary gland might even be further narrowed. This may negate the possibility of utilizing the endoscopic endonasal approach for the management of pathology in this location. We present a case of a retrochiasmatic craniopharyngioma with a narrow resection corridor that was treated with the extended endoscopic approach and we review techniques to potentially overcome this limitation.The link to the video can be found at: https://youtu.be/ogRZj-aBqeQ.

Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based on the infundibulum

2008 ◽  
Vol 108 (4) ◽  
pp. 715-728 ◽  
Author(s):  
Amin B. Kassam ◽  
Paul A. Gardner ◽  
Carl H. Snyderman ◽  
Ricardo L. Carrau ◽  
Arlan H. Mintz ◽  
...  
Keyword(s):  
Classification Scheme ◽  
Third Ventricle ◽  
Optic Chiasm ◽  
Tumor Classification ◽  
Type I ◽  
Endonasal Approach ◽  
Transnasal Approach ◽  
Endoscopic Endonasal ◽  
The Third ◽  
Expanded Endonasal Approach

Object Craniopharyngiomas are notoriously difficult to treat. Surgeons must weigh the risks of aggressive resection against the long-term challenges of recurrence. Because of their parasellar location, often extending well beyond the sella, these tumors challenge vision and pituitary and hypothalamic function. New techniques are needed to improve outcomes in patients with these tumors while decreasing treatment morbidity. An endoscopic expanded endonasal approach (EEA) is one such technique that warrants understanding and evaluation. The authors explain the techniques and approach used for the endoscopic endonasal resection of suprasellar craniopharyngiomas and introduce a tumor classification scheme. Methods The techniques and approach used for the endoscopic, endonasal resection of suprasellar craniopharyngiomas is explained, including the introduction of a tumor classification scheme. This scheme is helpful for understanding both the appropriate expanded approach as well as relevant involved anatomy. Results The classification scheme divides tumors according to their suprasellar extension: Type I is preinfundibular; Type II is transinfundibular (extending into the stalk); Type III is retroinfundibular, extending behind the gland and stalk, and has 2 subdivisions (IIIa, extending into the third ventricle; and IIIb, extending into the interpeduncular cistern); and Type IV is isolated to the third ventricle and/or optic recess and is not accessible via an endonasal approach. Conclusions The endoscopic EEA requires a thorough understanding of both sinus and skull base anatomy. Moreover, in its application for craniopharyngiomas, an understanding of tumor growth and extension with respect to the optic chiasm and infundibulum is critical to safely approach the lesion via an endonasal route.

scholarly journals Combined strategy of maximal endoscopic endonasal resection and early radiation therapy for complex cystic and solid craniopharyngioma: operative video

2020 ◽  
Vol 2 (2) ◽  
pp. V7
Author(s):  
James K. Liu ◽  
Kevin Zhao ◽  
Jean Anderson Eloy
Keyword(s):  
Radiation Therapy ◽  
Optic Chiasm ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Suprasellar Region ◽  
Early Radiation ◽  
The Right ◽  
Combined Strategy ◽  
Neurovascular Structures

Craniopharyngioma is a rare and benign intracranial tumor of the sellar and suprasellar region. Historically, these tumors were mostly accessed through transcranial corridors and resected with microsurgical techniques. Endoscopic endonasal surgery has recently gained popularity in the treatment of these tumors and has shown at least comparable results to transcranial approaches. The endoscopic endonasal approach provides direct midline access through a transplanum transtuberculum corridor and gives excellent visualization of the undersurface of the optic chiasm to allow safe bimanual sharp dissection of the tumor from the hypothalamus. In this operative video, we demonstrate the case of a 56-year-old female who had a complex craniopharyngioma with solid and cystic components extending superolaterally into the right frontal lobe. This lesion was invasive and partially encased the right optic nerve, optic chiasm, and anterior communicating artery complex. Although a traditional transcranial approach could have been utilized, we elected for an endoscopic endonasal approach for a maximal safe near-total resection, preserving the neurovascular structures. The patient underwent radiation therapy with favorable regression of the residual tumor on subsequent imaging studies. This case illustrates the feasibility of a combined strategy of maximal safe endoscopic endonasal resection followed by early radiation therapy for a complex, invasive cystic and solid craniopharyngioma. The technical nuances of safe bimanual microsurgical dissection of tumor adhesions off of critical neurovascular structures are demonstrated.The video can be found here: https://youtu.be/z0AINLpRZGs.

Bilateral Smell Preservation is Routinely Possible following Endoscopic Endonasal Approach for Sellar/Suprasellar Lesions

2019 ◽  
Author(s):  
Kuan-Chung Ting ◽  
Wei-Hsin Wang ◽  
Edward C. Kuan ◽  
Yung-Yang Lin ◽  
Ming-Ying Lan
Keyword(s):  
Effective Means ◽  
Tertiary Care ◽  
Pituitary Tumors ◽  
Olfactory Function ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Nasoseptal Flap ◽  
Endoscopic Endonasal ◽  
Skull Base Reconstruction ◽  
The Impact

Abstract Objective The endoscopic endonasal approach (EEA) has been shown to be an effective means to access sellar lesions. However, there are limited studies centered on evaluating olfactory function after surgery. In this study, we assessed the pre- and postoperative olfactory function of patients who underwent EEA for sellar and suprasellar lesions. The impact of nasoseptal flap use on olfaction was further analyzed. Study Design A retrospective study. Setting A tertiary-care referral center in Taiwan. Participants Patients with sellar and suprasellar lesions who underwent EEA and pre- and postoperative olfaction assessment from August 2015 to March 2018 were included in the study. Main Outcome Measures The patients' olfactory function was examined pre-and postoperatively using the Sniffin' Sticks odor identification test. Data regarding demographics, olfactory scores, pathology, reconstructive technique, graft usage, and extent of resection were retrieved. Results A total of 106 patients (36 males and 70 females) were enrolled, with a mean age of 51 years. There were 76 pituitary tumors, 12 Rathke's cleft cysts, 7 craniopharyngiomas, 7 meningiomas, and 4 other lesions. The nasoseptal flap was used in 39 patients for skull base reconstruction, and these patients had no statistically significant change between pre- and postoperative olfactory scores (p = 0.283). Moreover, a statistically significant improvement of olfactory scores was found in patients in whom the nasoseptal flap was not used. Conclusions Olfactory function may be reliably preserved after EEA, with or without nasoseptal flap harvest and use.

scholarly journals Abducens Nerve Schwannoma: First Case to Be Treated With an Expanded Endonasal Approach

2020 ◽  
pp. 014556132096054
Author(s):  
Syed Mohammad Imran Zaidi ◽  
Paresh Naik ◽  
Shahzada K. Ahmed
Keyword(s):  
Histological Analysis ◽  
Abducens Nerve ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Case Review ◽  
Endoscopic Endonasal ◽  
Benign Schwannoma ◽  
First Case ◽  
Expanded Endonasal Approach ◽  
Sixth Nerve

Abducens nerve schwannomas are incredibly rare, with very few cases being reported previously. Our patient is the first to have been treated through use of an endoscopic endonasal approach. A 61-year-old woman presented with diplopia over a 1-year period. Magnetic resonance imaging identified a 2.8-cm lesion expanding into her right sphenoid sinus. She underwent an endoscopic endonasal approach for histological diagnosis and clearance of the lesion. Intraoperative exploration found the lesion to be originating from Dorello canal. Histological analysis confirmed a benign schwannoma. Following a multidisciplinary case review, we have followed a conservative approach and she remains well on radiological surveillance. In patients presenting with a sixth nerve palsy/paresis and a concomitant sphenoid lesion, clinicians should consider an abducens schwannoma as a possible diagnosis.

scholarly journals Endoscopic endonasal resection of giant pediatric craniopharyngioma: impact on hypothalamic edema

2020 ◽  
Vol 2 (2) ◽  
pp. V6
Author(s):  
Mina M. Gerges ◽  
Brett Youngerman ◽  
Vijay K. Anand ◽  
Jeffrey P. Greenfield ◽  
Theodore H. Schwartz
Keyword(s):  
Weight Loss ◽  
Pediatric Patients ◽  
Optic Chiasm ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Visual Deterioration ◽  
Hypothalamic Nuclei ◽  
The Impact ◽  
Optic Radiations

An 8-year-old child presented with fatigue, weight loss, and visual deterioration. MRI demonstrated a craniopharyngioma with compression of the optic chiasm and extensive edema on the hypothalamus and optic radiations. The tumor was completely removed via an endoscopic endonasal approach. Postoperatively, vision improved and hypothalamic edema completely resolved within 5 days. This video demonstrates the technical nuances of the surgery and discusses the impact of surgery on the hypothalamic nuclei in pediatric patients.The video can be found here: https://youtu.be/wxkBmhTPi6c.

Sign in / Sign up

Export Citation Format

Share Document