The Caudal Expanded Endonasal Approach: A Fully Endoscopic Endonasal Approach for Resection of Lower Clival, Foramen Magnum, and Atlantoaxial Pathologies

Skull Base ◽  
2007 ◽  
Vol 16 (S 1) ◽  
Author(s):  
Amin Kassam ◽  
Paul Gardner ◽  
Carl Snyderman ◽  
Ricardo Carrau ◽  
Richard Spiro
Keyword(s):  
Foramen Magnum ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Expanded Endonasal Approach

Endoscopic Endonasal Approaches to the Clivus with No Violation of the Nasopharynx: Surgical Anatomy and Clinical Illustration

2021 ◽  
Author(s):  
Carlos D. Pinheiro-Neto ◽  
Laura Salgado-Lopez ◽  
Luciano C.P.C. Leonel ◽  
Serdar O. Aydin ◽  
Maria Peris-Celda
Keyword(s):  
Posterior Fossa ◽  
Cerebrospinal Fluid Leak ◽  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Surgical Anatomy ◽  
Csf Leak ◽  
Surgical Approaches ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

Abstract Background Despite the use of vascularized intranasal flaps, endoscopic endonasal posterior fossa defects remain surgically challenging with high rates of postoperative cerebrospinal fluid leak. Objective The aim of the study is to describe a novel surgical technique that allows complete drilling of the clivus and exposure of the craniovertebral junction with preservation of the nasopharynx. Methods Two formalin-fixed latex-injected anatomical specimens were used to confirm feasibility of the technique. Two surgical approaches were used: sole endoscopic endonasal approach and transnasion approach. The sole endonasal approach was used in a patient with a petroclival meningioma. Results In both anatomical dissections, the inferior clivectomy with exposure of the foramen magnum was achieved with a sole endoscopic endonasal approach. The addition of the transnasion approach helped to complete drilling of the inferior border of the foramen magnum and exposure of the arch of C1. Conclusion This study shows the anatomical feasibility of total clivectomy and exposure of the craniovertebral junction with preservation of the nasopharynx. A more favorable anatomical posterior fossa defect for the reconstruction is achieved with this technique. Further clinical studies are needed to assess if this change would impact the postoperative CSF leak rate.

Endoscopic Endonasal Approach to Foramen Magnum Meningioma: Two-Dimensional Surgical Video

2020 ◽  
Vol 137 ◽  
pp. 362
Author(s):  
Raíssa Mansilla ◽  
Daniel Monte Serrat Prevedello ◽  
Lázaro de Lima ◽  
Ricardo L. Carrau ◽  
José Alberto Landeiro
Keyword(s):  
Foramen Magnum ◽  
Two Dimensional ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Surgical Video

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.

The Anterior (Endoscopic Endonasal) Approach and Outcomes for Foramen Magnum Tumors

2019 ◽  
pp. 395-402
Author(s):  
Nathan T. Zwagerman ◽  
Juan C. Fernandez-Miranda ◽  
Eric W. Wang ◽  
Carl H. Snyderman ◽  
Paul A. Gardner
Keyword(s):  
Foramen Magnum ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

scholarly journals Endoscopic Endonasal Approach to Foramen Magnum Meningioma—Technical Note and Case Example

2018 ◽  
Vol 37 (04) ◽  
pp. 362-366
Author(s):  
Flavio Romero ◽  
Rodolfo Vieira ◽  
Bruno Ancheschi
Keyword(s):  
Cranial Nerves ◽  
Craniocervical Junction ◽  
Foramen Magnum ◽  
Technical Note ◽  
Open Approach ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Midline Approach ◽  
Lower Cranial Nerves

AbstractForamen magnum (FM) tumors represent one of the most complex cases for the neurosurgeon, due to their location in a very anatomically complex region surrounded by the brainstem and the lower cranial nerves, by bony elements of the craniocervical junction, and by the vertebrobasilar vessels. Currently, the open approach of choice is a lateral extension of the posterior midline approach including far lateral, and extreme lateral routes. However, the transoraltranspharyngeal approach remains the treatment of choice in cases of diseases affecting the craniocervical junction. For very selective cases, the endoscopic endonasal route to this region is another option. We present a case of a ventral FM meningioma treated exclusively with the endoscopic endonasal approach.

Atlanto-occipital Instability Following Endoscopic Endonasal Approach for Lower Clival Lesions

Neurosurgery ◽  
2015 ◽  
Vol 77 (6) ◽  
pp. 888-897 ◽  
Author(s):  
Ali Kooshkabadi ◽  
Phillip A. Choi ◽  
Maria Koutourousiou ◽  
Carl H. Snyderman ◽  
Eric W. Wang ◽  
...  
Keyword(s):  
Foramen Magnum ◽  
Open Approach ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Combined Approach ◽  
Endoscopic Endonasal ◽  
Primary Bone Tumors ◽  
Far Lateral Approach ◽  
Lower Clivus ◽  
Occipital Condyles

BACKGROUND: The endoscopic endonasal approach (EEA) for craniocervical lesions involving the lower clivus and occipital condyles carries an unclear risk of atlanto-occipital (AO) instability requiring arthrodesis. OBJECTIVE: Elucidate risk factors for AO instability following EEA for clival lesions. METHODS: We reviewed patients with clival tumors who underwent EEA at our institution between 2002 and 2012. Resection of the lower clivus, foramen magnum, AO joint, and occipital condyles were evaluated on fine-cut postoperative computed tomography. RESULTS: Two hundred twelve patients (mean age 47.9 years, 57.1% male) underwent transclival EEA for lower clival lesions. In addition to the lower clivus, resection involved the condyle in 14.2% of patients, the foramen magnum in 16.5%, and the AO joint in 1.4%. Quantification of condyle resection revealed complete resection in 3 cases, 75% resection in 8 cases, 50% resection in 6 cases, and 25% resection in 13 cases. Seven of these patients had EEA combined with an open, far-lateral approach. In total, 7 patients required arthrodesis following EEA (3.3%), 4 of them after a combined approach. All patients who underwent arthrodesis had primary bone tumors such as chordoma, chondrosarcoma, or osteosarcoma (P = .022). Degree of condyle resection was a significant factor predisposing to occipitocervical instability (P = .001 and P < .001 for 75% and 100% condyle resection, respectively). Use of a combined approach was significantly associated with arthrodesis (P < .001). CONCLUSION: EEA resection of the occipital condyles that results in greater than 75% condyle resection or EEA in combination with an open approach significantly increases the risk of AO instability and likely necessitates AO fixation.

The Endoscopic Endonasal Approach to the Inferior Clivus and Foramen Magnum: Anatomical Landmarks in the Surgical Window

2015 ◽  
Vol 76 (S 01) ◽  
Author(s):  
Satyan Sreenath ◽  
Benjamin McClintock ◽  
Benjamin Huang ◽  
Kibwei McKinney ◽  
Brian Thorp ◽  
...  
Keyword(s):  
Foramen Magnum ◽  
Anatomical Landmarks ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

“Far-Medial” Expanded Endonasal Approach to the Inferior Third of the Clivus

2010 ◽  
Vol 66 (suppl_2) ◽  
pp. ons211-ons220 ◽  
Author(s):  
Victor A. Morera ◽  
Juan C. Fernandez-Miranda ◽  
Daniel M. Prevedello ◽  
Ricky Madhok ◽  
Juan Barges-Coll ◽  
...  
Keyword(s):  
Cranial Nerves ◽  
Foramen Magnum ◽  
Direct Access ◽  
Occipital Condyle ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Hypoglossal Canal ◽  
Expanded Endonasal Approach ◽  
Surgical Corridor ◽  
Lower Cranial Nerves

Abstract OBJECTIVE The endoscopic endonasal transclival approach is a valid alternative for treatment of lesions in the clivus. The major limitation of this approach is a significant lateral extension of the tumor. We aim to identify a safe corridor through the occipital condyle to provide more lateral exposure of the foramen magnum. METHODS Sixteen parameters were measured in 25 adult skulls to analyze the exact extension of a safe corridor through the condyle. Endonasal endoscopic anatomic dissections were carried out in nine colored latex–injected heads. RESULTS Drilling at the lateral inferior clival area exposed two compartments divided by the hypoglossal canal: the jugular tubercle (superior) and the condylar (inferior). Completion of a unilateral ventromedial condyle resection opens a 3.5 mm (transverse length) * 10 mm (vertical length) lateral surgical corridor, facilitating direct access to the vertebral artery at its dural entry point into the posterior fossa. The supracondylar groove is a reliable landmark for locating the hypoglossal canal in relation to the condyle. The hypoglossal canal is used as the posterior limit of the condyle removal to preserve more than half of the condylar mass. The transjugular tubercle approach is accomplished by drilling above the hypoglossal canal, and increases the vertical length of the lateral surgical corridor by 8 mm, allowing for visualization of the distal cisternal segment of the lower cranial nerves. CONCLUSION The transcondylar and transjugular tubercle “far medial” expansions of the endoscopic endonasal approach to the inferior third of the clivus provide a unique surgical corridor to the ventrolateral surface of the ponto- and cervicomedullary junctions.

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 surgery of the midline skull base: anatomical study and clinical considerations

2005 ◽  
Vol 19 (1) ◽  
pp. 1-14 ◽  
Author(s):  
Luigi M. Cavallo ◽  
Andrea Messina ◽  
Paolo Cappabianca ◽  
Felice Esposito ◽  
Enrico de Divitiis ◽  
...  
Keyword(s):  
Skull Base ◽  
Dura Mater ◽  
Cranial Nerves ◽  
Foramen Magnum ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Lateral Direction ◽  
Endoscopic Endonasal ◽  
Fresh Cadaver ◽  
Csf Leakage

Object The midline skull base is an anatomical area that extends from the anterior limit of the cranial fossa down to the anterior border of the foramen magnum. Resection of lesions involving this area requires a variety of innovative skull base approaches. These include anterior, anterolateral, and posterolateral routes, performed either alone or in combination, and resection via these routes often requires extensive neurovascular manipulation. The goals in this study were to define the application of the endoscopic endonasal approach and to become more familiar with the views and skills associated with the technique by using cadaveric specimens. Methods To assess the feasibility of the endonasal route for the surgical management of lesions in the midline skull base, five fresh cadaver heads injected with colored latex were dissected using a modified endoscopic endonasal approach. Full access to the skull base and the cisternal space around it is possible with this route. From the crista galli to the spinomedullary junction, with incision of the dura mater, a complete visualization of the carotid and vertebrobasilar arterial systems and of all 12 of the cranial nerves is obtainable. Conclusions The major potential advantage of the endoscopic endonasal approach to the skull base is that it provides a direct anatomical route to the lesion without traversing any major neurovascular structures, obviating brain retraction. Many tumors grow in a medial-to-lateral direction, displacing structures laterally as they expand, creating natural corridors for their resection via an anteromedial approach. Potential disadvantages of this procedure include the relatively restricted working space and the danger of an inadequate dural repair with cerebrospinal fluid (CSF) leakage and potential for meningitis resulting. These approaches often require a large opening of the dura mater over the tuberculum sellae and posterior planum sphenoidale, or retroclival space. In addition, they typically involve large intraoperative CSF leaks, which necessitate precise and effective dural closure.

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