Endoscopic Endonasal Interdural Posterior Clinoidectomy: A Key Step to Achieve Complete Resection in Clival Chordomas

Intracranial epidermoid cysts are benign lesions of epithelial origin that most frequently present with symptoms of mass effect. Although they are often associated with a high rate of residual tumor and recurrence, maximal safe resection usually leads to good outcomes. The authors report a complete resection of an uncommon pituitary stalk epidermoid cyst with intrasellar extension using a combined suprasellar and infrasellar interpituitary, endoscopic endonasal transsphenoidal approach. The patient, a 54-year-old woman, presented with headache, visual disturbance, and diabetes insipidus. Postoperatively, she reported improvement in her visual symptoms and well-controlled diabetes insipidus using 0.1 mg of desmopressin at bedtime and normal anterior pituitary gland function. One year later, she continues to receive the same dosage of desmopressin and is also taking 50 mcg of levothyroxine daily after developing primary hypothyroidism unrelated to the surgical procedure. A combined infrasellar interpituitary and suprasellar approach to this rare location for an epidermoid cyst can lead to a safe and complete resection with good clinical outcomes.

Download Full-text

ENDOSCOPIC ENDONASAL RESECTION OF ANTERIOR CRANIAL BASE MENINGIOMAS

Neurosurgery ◽

10.1227/01.neu.0000335069.30319.1e ◽

2008 ◽

Vol 63 (1) ◽

pp. 36-54 ◽

Cited By ~ 258

Author(s):

Paul A. Gardner ◽

Amin B. Kassam ◽

Ajith Thomas ◽

Carl H. Snyderman ◽

Ricardo L. Carrau ◽

...

Keyword(s):

Cerebrospinal Fluid Leak ◽

Tumor Location ◽

Cranial Base ◽

Complete Resection ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Petroclival Meningiomas ◽

Anterior Cranial Base ◽

Fluid Leak

ABSTRACT OBJECTIVE The endonasal route may be feasible for the resection of anterior cranial base tumors that abut the paranasal sinuses. There are several case reports and mixed case series discussing this approach. Other than pituitary adenomas, there is a lack of literature describing the outcomes of endonasal approaches for single-tumor types such as meningiomas. METHODS In this study, we describe our current endoscopic endonasal technique and demonstrate the feasibility of using it to access anterior cranial base meningiomas from the back wall of the frontal sinus to the sella and laterally to the region of the midorbit. After this discussion, which includes key technical considerations and nuances, we address safety and efficacy by reporting the outcomes of our early experience with endoscopic endonasal resection of 35 anterior cranial base meningiomas. RESULTS A total of 35 patients underwent endoscopic endonasal resection of anterior cranial base meningiomas from October 2002 to October 2005. Degree of resection by tumor location was as follows: 10 of the 12 (83%) patients with olfactory groove meningiomas planned for complete resection underwent gross total (seven of 12) or near-total (>95%) (three of 12) resection (67% of all 15 olfactory tumors); 12 of 13 patients (92%) with tuberculum meningiomas underwent gross (11 of 13) or near (>95%) (one of 13) total resection; five patients diagnosed with petroclival meningiomas had successful resection of the parasellar portion of their tumors with relief of visual symptoms (no patients underwent complete resection of their tumors via the endoscopic, endonasal approach); two giant petroclival meningiomas were debulked with 63 and 89% resection, respectively. All patients experienced resolution or improvement of visual symptoms. No patient experienced permanent worsening of vision after surgery. Only one (3%) patient without preoperative endocrine dysfunction experienced a new, permanent pituitary deficit, diabetes insipidus. One (3%) patient experienced a new neurological deficit after experiencing a hemorrhage 3 weeks after surgery. The postoperative cerebrospinal fluid leak rate was 40% (14 of 35) and varied by tumor location. All leaks were resolved without craniotomy. There were no cases of bacterial meningitis. One patient developed a superinfection of a sterile granuloma from a sinusitis 2 years after surgery. There were two cases of deep venous thrombosis and one pulmonary embolus. There were no operative or perioperative deaths. CONCLUSION Cranial base meningiomas can be successfully managed via a purely endoscopic endonasal approach with acceptable morbidity and mortality rates. The extent of resection is guided by patient factors and symptoms, not by approach. This series had a high cerebrospinal fluid leak rate. With the evolution of new reconstruction techniques, these rates have been substantially reduced.

Download Full-text

Long-term Results of Endonasal Endoscopic Transsphenoidal Resection of Nonfunctioning Pituitary Macroadenomas

Neurosurgery ◽

10.1227/neu.0000000000000563 ◽

2014 ◽

Vol 76 (1) ◽

pp. 42-53 ◽

Cited By ~ 70

Author(s):

Robert F. Dallapiazza ◽

Yuval Grober ◽

Robert M. Starke ◽

Edward R. Laws ◽

John A. Jane

Keyword(s):

Surgical Procedures ◽

Transsphenoidal Surgery ◽

Complete Resection ◽

Long Term Results ◽

Endoscopic Endonasal ◽

Long Term Outcome ◽

Endoscopic Endonasal Transsphenoidal Surgery ◽

Pituitary Macroadenomas

Abstract BACKGROUND: Several studies report early results of endoscopic endonasal transsphenoidal surgery; however, none discuss long-term outcome measures such as tumor recurrence rates and the need for additional surgical procedures. OBJECTIVE: To discuss the long-term outcomes after endoscopic endonasal transsphenoidal surgery for nonfunctioning pituitary macroadenomas. METHODS: This is a retrospective study. Patients were included only if they had at least 5 years of clinical and imaging follow-up after surgery. RESULTS: Eighty patients met the study criteria. Grossly complete resection was achieved in 71% of patients. Knosp grade 0 to 2 tumors and tumor with volumes <10 cm3 were significantly more likely to have received a grossly complete resection. There were 7 recurrences (12%) in patients who had received grossly complete resections, with a mean time to recurrence of 53 months. Among the 23 patients who had subtotal resections, 11 (61%) progressed radiographically, and 3 (17%) had symptomatic progression. Knosp score, surgical and radiographic evidence of invasion, and preoperative visual deficits were predictive of recurrence in a univariate analysis, but Knosp grade was the only independent predictor in a multivariate analysis. Kaplan-Meier analysis projected a 10-year progression-free survival rate of 80% and 21% for patients with gross total resections and subtotal resections, respectively. CONCLUSION: At the long-term follow-up, 12% of patients had recurrent tumors after grossly complete resection. Recurrent or residual tumors were treated with either repeat surgery or Gamma Knife radiosurgery. Rates of complete resection, postoperative surgical and endocrinological complications, and additional surgical procedures are similar to previously published reports after microscopic transsphenoidal surgery.

Download Full-text

Endoscopic endonasal approach for resection of pediatric chordoma with brainstem invasion

Neurosurgical Focus: Video ◽

10.3171/2019.10.focusvid.19421 ◽

2019 ◽

Vol 1 (2) ◽

pp. V20

Author(s):

Kumar Abhinav ◽

David Hong ◽

Carol H. Yan ◽

Peter Hwang ◽

Juan C. Fernandez-Miranda ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid ◽

Abducens Nerve ◽

Complete Resection ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Surveillance Imaging ◽

Pontine Lesion ◽

Postoperative Diagnosis

A 14-year-old boy had undergone an orbitozygomatic craniotomy for a pontine lesion. There was growth on surveillance imaging with involvement of posterior clinoids, clivus, and left pons suggestive of chordoma (Fernandez-Miranda et al., 2014b). An endoscopic endonasal approach was undertaken involving full upper and midclival exposure including bilateral posterior clinoidectomy (Fernandez-Miranda et al., 2014a; Truong et al., 2019a, 2019b). The internal carotid artery was skeletonized to maximize exposure and facilitate safe resection. The tumor was removed from between the dural layers of the midclivus while preserving the interdural abducens nerve (Barges-Coll et al., 2010). The brainstem component was resected while preserving the pontine perforators. Postoperative diagnosis was chordoma with MRI demonstrating complete resection. The patient was intact postoperatively.The video can be found here: https://youtu.be/g6SQ5JVK0Ko.

Download Full-text

Endoscopic endonasal transclival approach for resection of a pontine cavernous malformation

Neurosurgical Focus: Video ◽

10.3171/2019.7.focusvid.19212 ◽

2019 ◽

Vol 1 (1) ◽

pp. V3

Author(s):

Lucas Ramos Lima ◽

Jarbas Carvalhais Reis ◽

Gerival Vieira Junior ◽

Tiago Fraga Vieira ◽

Lucidio Duarte de Souza Filho ◽

...

Keyword(s):

Cavernous Malformation ◽

Brain Mri ◽

Complete Resection ◽

Csf Leak ◽

Motor Deficit ◽

Ventral Region ◽

Endoscopic Endonasal ◽

Cavernous Malformations ◽

Prepontine Cistern ◽

History Of

Symptomatic cavernous malformations in the ventral region of the pons are difficult to access surgically. The authors present a case of a 46-year-old woman with a 10-year history of sudden and transitory diplopia and right hemiparesis, followed by five more episodes of mild right hemiparesis. Brain MRI showed a 2.6-cm cavernous malformation in the pons with an exophytic portion in the prepontine cistern. The patient underwent an endoscopic endonasal transclival approach for a complete resection of the lesion. CSF leak was noted and corrected on the sixth postoperative day. The patient progressed with complete motor deficit recovery.The video can be found here: https://youtu.be/ePgpyij2Wpo.

Download Full-text

Endonasal Endoscopic Approach for Skull Base Neurofibroma: Is It Viable?

Clinical Rhinology An International Journal ◽

10.5005/jp-journals-10013-1237 ◽

2015 ◽

Vol 8 (2) ◽

pp. 72-75

Author(s):

Neha Chauhan ◽

MK Tiwari ◽

Vaiphei Kim

Keyword(s):

Skull Base ◽

Complete Resection ◽

Anterior Skull Base ◽

Craniofacial Surgery ◽

Endoscopic Approach ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Success Rates ◽

Endoscopic Endonasal

ABSTRACT Anterior skull base and sinonasal schwannomas are rare entities. Earlier, safest way to remove these tumors, with best success rates, was open craniofacial surgery but recently with introduction of endoscopic endonasal approach; complete resection of these rare entities is possible. We present one such case of skull base neurofibroma which was resected in entirety via a purely endoscopic endonasal approach. How to cite this article Gupta A, Tiwari MK, Chauhan N, Kaur N, Kim V. Endonasal Endoscopic Approach for Skull Base Neurofibroma: Is It Viable?. Clin Rhinol An Int J 2015;8(2):72-75.

Download Full-text