scholarly journals Endoscopic Transnasal Skull Base Surgery in Pediatric Patients

2019 ◽  
Vol 81 (05) ◽  
pp. 515-525
Author(s):  
Gokmen Kahilogullari ◽  
Cem Meco ◽  
Suha Beton ◽  
Murat Zaimoglu ◽  
Onur Ozgural ◽  
...  
Keyword(s):  
Skull Base ◽  
Pediatric Patients ◽  
Skull Base Surgery ◽  
Total Resection ◽  
Visual Deficits ◽  
Tertiary Center ◽  
Before And After ◽  
Effective Option ◽  
Transnasal Surgery ◽  
Visual Testing

Introduction In pediatric patients, endoscopic transnasal surgery (ETNS) poses challenges because of the small size of the developing skull and narrow endonasal corridors. Objective This study aimed to evaluate the efficacy of ETNS in children by assessing our experience of endoscopic skull base surgery. Materials and Methods All pediatric patients (n = 54) who were eligible for surgery using only the endonasal endoscopic approach at our tertiary center between 2012 and 2018 were included in this study. The surgeries were performed simultaneously by an endoscopic skull base team of neurosurgeons and otolaryngologists. Hormonal analyses were conducted before and after surgery in all patients with sellar/parasellar lesions. Patients older than 8 years underwent smell and visual testing. Results In the 54 patients aged 1 to 17 years who underwent surgery, craniopharyngioma was the most common pathology (29.6%), followed by pituitary adenoma (22.2%). Gross total resection was achieved in 33 (76.7%) of 41 patients who underwent surgery because of the presence of tumors. All visual deficits improved, although one patient sustained olfactory deterioration. Sixteen (29.6%) patients presented with complications such as transient diabetes insipidus and temporary visual loss. Conclusions Despite anatomy-related challenges in children, adequate results can be achieved with high rates of success, and the functional and anatomical integrity of the developing skull and nose of children can be preserved. In pediatric patients, ETNS is a safe and effective option for addressing various lesions along the skull base.

Anatomical considerations for endoscopic endonasal skull base surgery in pediatric patients

2010 ◽  
Vol 120 (9) ◽  
pp. 1730-1737 ◽  
Author(s):  
Jason R. Tatreau ◽  
Mihir R. Patel ◽  
Rupali N. Shah ◽  
Kibwei A. McKinney ◽  
Stephen A. Wheless ◽  
...  
Keyword(s):  
Skull Base ◽  
Pediatric Patients ◽  
Skull Base Surgery ◽  
Endoscopic Endonasal

Outcomes In Pediatric Endoscopic Skull Base Surgery: A Systematic Review

2021 ◽  
Author(s):  
Erin Mamuyac Lopez ◽  
Zainab Farzal ◽  
Kelly Marie Dean ◽  
Craig Miller ◽  
Justin Cates Morse ◽  
...  
Keyword(s):  
Systematic Review ◽  
Skull Base ◽  
Pediatric Patients ◽  
Skull Base Surgery ◽  
Tertiary Care ◽  
Case Series ◽  
Csf Leak ◽  
Inclusion Criteria ◽  
Endoscopic Skull Base Surgery ◽  
Tertiary Care Medical Center

Objectives: The frequency of endoscopic skull base surgery in pediatric patients is increasing. This study’s aim is to systematically review the literature for endoscopic skull base surgery outcomes in children/adolescents ages 0-18 years. Design: A systematic review of the literature was performed in PubMed and SCOPUS databases querying studies from 2000-2020 using PRISMA guidelines. Final inclusion criteria included: case series with 10+ patients with pediatric patients age ≤18 years, endoscopic or endoscopic-assisted skull base surgery, and outcomes reported. Setting: Tertiary care medical center Participants: Children/adolescents ages 0-18 years who underwent endoscopic skull base surgery Main Outcome Measures: Patient demographics, pathology, reconstructive technique, intra-operative findings, intra-operative and post-operative surgical complications. Results: Systematic literature search yielded 287 publications. Of these, 12 studies discussing a total of 399 patients age 0-18 years met inclusion criteria for final analysis. 7 of 12 studies discussed a single pathology. The most common pathology was a skull base defect causing CSF leak. The majority of skull base repairs were made with free tissue grafts. The most common post-operative complication was CSF leak (n=40). Twelve cases of meningitis occurred post-operatively with two of these episodes resulting in death. Conclusions: Endoscopic skull base surgery has been performed recently in the pediatric population in a variety of disease states. Inconsistent individual-level data and reporting standards are present in existing studies posing challenges for comparative analysis. Standardized reporting will aid future reviews and meta-analysis for rare skull base pathology.

The impact of expanded endonasal skull base surgery on midfacial growth in pediatric patients

2019 ◽  
Vol 130 (2) ◽  
pp. 338-342 ◽  
Author(s):  
Arjun K. Parasher ◽  
David K. Lerner ◽  
Jordan T. Glicksman ◽  
Phillip B. Storm ◽  
John Y.K. Lee ◽  
...  
Keyword(s):  
Skull Base ◽  
Pediatric Patients ◽  
Skull Base Surgery ◽  
The Impact

scholarly journals An Innovate Robotic Endoscope Guidance System for Transnasal Sinus and Skull Base Surgery: Proof of Concept

2017 ◽  
Vol 78 (06) ◽  
pp. 466-472 ◽  
Author(s):  
F. Sommer ◽  
M. Scheithauer ◽  
J. Greve ◽  
T. Hoffmann ◽  
P. Schuler ◽  
...  
Keyword(s):  
Skull Base ◽  
Paranasal Sinuses ◽  
Skull Base Surgery ◽  
Guidance System ◽  
Human Cadaver ◽  
Viewing Angle ◽  
Transnasal Surgery ◽  
Robotic Endoscope ◽  
Human Cadaver Model ◽  
Endoscope Guidance

Objective Advanced transnasal sinus and skull base surgery remains a challenging discipline for head and neck surgeons. Restricted access and space for instrumentation can impede advanced interventions. Thus, we present the combination of an innovative robotic endoscope guidance system and a specific endoscope with adjustable viewing angle to facilitate transnasal surgery in a human cadaver model. Materials and Methods The applicability of the robotic endoscope guidance system with custom foot pedal controller was tested for advanced transnasal surgery on a fresh frozen human cadaver head. Visualization was enabled using a commercially available endoscope with adjustable viewing angle (15–90 degrees). Results Visualization and instrumentation of all paranasal sinuses, including the anterior and middle skull base, were feasible with the presented setup. Controlling the robotic endoscope guidance system was effectively precise, and the adjustable endoscope lens extended the view in the surgical field without the common change of fixed viewing angle endoscopes. Conclusion The combination of a robotic endoscope guidance system and an advanced endoscope with adjustable viewing angle enables bimanual surgery in transnasal interventions of the paranasal sinuses and the anterior skull base in a human cadaver model. The adjustable lens allows for the abandonment of fixed-angle endoscopes, saving time and resources, without reducing the quality of imaging.

Management of surgical clinoidal meningiomas

2003 ◽  
Vol 14 (6) ◽  
pp. 1-7 ◽  
Author(s):  
Samuel Tobias ◽  
Chang-Hyun Kim ◽  
Gregory Kosmorsky ◽  
Joung H. Lee
Keyword(s):  
Skull Base ◽  
Visual Function ◽  
Visual Outcome ◽  
Extent Of Resection ◽  
Total Resection ◽  
Visual Deficits ◽  
The Past ◽  
Optic Canal Unroofing ◽  
Base Technique

Object Clinoidal meningiomas remain a major neurosurgical challenge. Surgery-related outcome has been less than desirable in the past, and little attention has been directed toward improving visual deficits. The authors advocate a skull base technique for the removal of these difficult tumors and describe its advantages in terms of improving extent of resection and enhancing overall outcome, particularly visual function. Methods A retrospective analysis was performed on data obtained in 26 consecutive patients with clinoidal meningiomas (including one patient with hemangiopericytoma) who underwent resection between June 1995 and January 2003. In 24 cases the skull base procedure involved extradural anterior clinoidectomy, optic canal unroofing, and optic sheath opening; in two cases a standard pterional craniotomy was performed. Fourteen of the 26 patients suffered significant preoperative visual deficits. All patients underwent thorough pre- and postoperative ophthalmological evaluations. The follow-up period ranged from 3 to 91 months (mean 42.3 months). Total resection was achieved in 20 patients (77%), and the majority (76.9%) of patients with preoperative visual impairment experienced significant improvement. Conclusions With the use of the skull base technique, total resection and excellent visual outcome may be achieved with minimal morbidity in most patients with clinoidal meningiomas.

scholarly journals The utility of high-resolution intraoperative MRI in endoscopic transsphenoidal surgery for pituitary macroadenomas: early experience in the Advanced Multimodality Image Guided Operating suite

2016 ◽  
Vol 40 (3) ◽  
pp. E18 ◽  
Author(s):  
Hasan A. Zaidi ◽  
Kenneth De Los Reyes ◽  
Garni Barkhoudarian ◽  
Zachary N. Litvack ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Skull Base ◽  
Residual Disease ◽  
Skull Base Surgery ◽  
Intraoperative Mri ◽  
Gross Total Resection ◽  
Inclusion Criteria ◽  
Total Resection ◽  
Image Guided ◽  
Multimodality Image ◽  
Pituitary Macroadenomas

OBJECTIVE Endoscopic skull base surgery has become increasingly popular among the skull base surgery community, with improved illumination and angled visualization potentially improving tumor resection rates. Intraoperative MRI (iMRI) is used to detect residual disease during the course of the resection. This study is an investigation of the utility of 3-T iMRI in combination with transnasal endoscopy with regard to gross-total resection (GTR) of pituitary macroadenomas. METHODS The authors retrospectively reviewed all endoscopic transsphenoidal operations performed in the Advanced Multimodality Image Guided Operating (AMIGO) suite from November 2011 to December 2014. Inclusion criteria were patients harboring presumed pituitary macroadenomas with optic nerve or chiasmal compression and visual loss, operated on by a single surgeon. RESULTS Of the 27 patients who underwent transsphenoidal resection in the AMIGO suite, 20 patients met the inclusion criteria. The endoscope alone, without the use of iMRI, would have correctly predicted extent of resection in 13 (65%) of 20 cases. Gross-total resection was achieved in 12 patients (60%) prior to MRI. Intraoperative MRI helped convert 1 STR and 4 NTRs to GTRs, increasing the number of GTRs from 12 (60%) to 16 (80%). CONCLUSIONS Despite advances in visualization provided by the endoscope, the incidence of residual disease can potentially place the patient at risk for additional surgery. The authors found that iMRI can be useful in detecting unexpected residual tumor. The cost-effectiveness of this tool is yet to be determined.

scholarly journals Use of a side-cutting aspiration device for resection of tumors during endoscopic endonasal approaches

2011 ◽  
Vol 30 (4) ◽  
pp. E13 ◽  
Author(s):  
Victor Garcia-Navarro ◽  
Guido Lancman ◽  
Amancio Guerrero-Maldonado ◽  
Vijay K. Anand ◽  
Theodore H. Schwartz
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
The Other ◽  
Skull Base Tumors ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Extracapsular Dissection ◽  
Recurrent Ependymoma ◽  
Narrow Area ◽  
Pituitary Macroadenomas

Object Accessing intra- and extradural tumors via an endonasal approach requires working safely in a relatively narrow area with unobstructed visibility. The authors describe their experience to highlight the utility of a side-cutting aspiration device for endoscopic endonasal resection of skull base tumors. Methods The authors used this device in 13 nonconsecutive endoscopic endonasal procedures for different skull base tumors (8 pituitary macroadenomas, 2 craniopharyngiomas, 1 chordoma, 1 recurrent ependymoma, and 1 lymphoma). Illustrative cases and video are presented to demonstrate its use. Results The instrument was easy to use and effective in the removal of the lesions presented in this series. In 10 patients (77%), gross-total resection was possible; in the other 3 patients (23%), more than 80% of the tumor was resected. No collateral tissue damage or any other complication resulted from device-related debulking or aspiration. Conclusions The side-cutting tissue resector is a safe, easy to use, and effective tool for internal debulking and extracapsular dissection of nonvascularized tumors that are too firm for bimanual suction or blunt ring curette dissection. It is particularly useful when working through a deep and narrow corridor such as is encountered in endoscopic endonasal skull base surgery.

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