Adoption of Endoscopic Endonasal Resection of Skull Base Tumors: Early Results in 85 Patients

Abstract BACKGROUND Near-infrared (NIR) tumor contrast is achieved through the “second-window ICG” technique, which relies on passive accumulation of high doses of indocyanine green (ICG) in neoplasms via the enhanced permeability and retention effect. OBJECTIVE To report early results and potential challenges associated with the application of second-window ICG technique in endonasal endoscopic, ventral skull-base surgery, and to determine potential predictors of NIR signal-to-background ratio (SBR) using endoscopic techniques. METHODS Pituitary adenoma (n = 8), craniopharyngioma (n = 3), and chordoma (n = 4) patients received systemic infusions of ICG (5 mg/kg) approximately 24 h before surgery. Dual-channel endoscopy with visible light and NIR overlay were photodocumented and analyzed post hoc. RESULTS All tumors (adenoma, craniopharyngioma, chordoma) demonstrated NIR positivity and fluoresced with an average SBR of 3.9 ± 0.8, 4.1 ± 1.7, and 2.1 ± 0.6, respectively. Contrast-enhanced T1 signal intensity proved to be the single best predictor of observed SBR (P = .0003). For pituitary adenomas, the sensitivity, specificity, positive predictive value, and negative predictive value of NIR-guided identification of tumor was 100%, 20%, 71%, and 100%, respectively. CONCLUSION In this preliminary study of a small set of patients, we demonstrate that second-window ICG can provide NIR optical tumor contrast in 3 types of ventral skull-base tumors. Chordomas demonstrated the weakest NIR signal, suggesting limited utility in those patients. Both nonfunctional and functional pituitary adenomas appear to accumulate ICG, but utility for margin detection for the adenomas is limited by low specificity. Craniopharyngiomas with third ventricular extension appear to be a particularly promising target given the clean brain parenchyma background and strong SBR.

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Challenges and Surgical Nuances in Reconstruction of Large Planum Sphenoidale Tuberculum Sellae Defects After Endoscopic Endonasal Resection of Parasellar Skull Base Tumors

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0033-1336182 ◽

2013 ◽

Vol 74 (S 01) ◽

Author(s):

Jean Eloy ◽

Smruti Patel ◽

Qasim Husain ◽

Pratik Shukla ◽

Osamah Choudhry ◽

...

Keyword(s):

Skull Base ◽

Skull Base Tumors ◽

Endoscopic Endonasal ◽

Tuberculum Sellae ◽

Planum Sphenoidale

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Cranial nerve monitoring in endoscopic endonasal surgery of skull base tumors (observing of 23 cases)

Chinese Neurosurgical Journal ◽

10.1186/s41016-018-0146-3 ◽

2018 ◽

Vol 4 (1) ◽

Author(s):

A. N. Shkarubo ◽

I. V. Chernov ◽

A. A. Ogurtsova ◽

V. E. Chernov ◽

O. V. Borisov ◽

...

Keyword(s):

Skull Base ◽

Cranial Nerve ◽

Skull Base Tumors ◽

Endoscopic Endonasal Surgery ◽

Endonasal Surgery ◽

Endoscopic Endonasal ◽

Nerve Monitoring

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Endoscopic endonasal skull base surgery in the pediatric population

Journal of Neurosurgery Pediatrics ◽

10.3171/2012.10.peds12160 ◽

2013 ◽

Vol 11 (3) ◽

pp. 227-241 ◽

Cited By ~ 65

Author(s):

Srinivas Chivukula ◽

Maria Koutourousiou ◽

Carl H. Snyderman ◽

Juan C. Fernandez-Miranda ◽

Paul A. Gardner ◽

...

Keyword(s):

Skull Base ◽

Pituitary Adenomas ◽

Skull Base Surgery ◽

Pediatric Population ◽

Skull Base Tumors ◽

Endoscopic Endonasal Surgery ◽

Endonasal Surgery ◽

Endoscopic Endonasal ◽

The Mean

Object The use of endoscopic endonasal surgery (EES) for skull base pathologies in the pediatric population presents unique challenges and has not been well described. The authors reviewed their experience with endoscopic endonasal approaches in pediatric skull base surgery to assess surgical outcomes and complications in the context of presenting patient demographics and pathologies. Methods A retrospective review of 133 pediatric patients who underwent EES at our institution from July 1999 to May 2011 was performed. Results A total of 171 EESs were performed for skull base tumors in 112 patients and bony lesions in 21. Eighty-five patients (63.9%) were male, and the mean age at the time of surgery was 12.7 years (range 2.3–18.0 years). Skull base tumors included angiofibromas (n = 24), craniopharyngiomas (n = 16), Rathke cleft cysts (n = 12), pituitary adenomas (n = 11), chordomas/chondrosarcomas (n = 10), dermoid/epidermoid tumors (n = 9), and 30 other pathologies. In total, 19 tumors were malignant (17.0%). Among patients with follow-up data, gross-total resection was achieved in 16 cases of angiofibromas (76.2%), 9 of craniopharyngiomas (56.2%), 8 of Rathke cleft cysts (72.7%), 7 of pituitary adenomas (70%), 5 of chordomas/chondrosarcomas (50%), 6 of dermoid/epidermoid tumors (85.7%), and 9 cases of other pathologies (31%). Fourteen patients received adjuvant radiotherapy, and 5 received chemotherapy. Sixteen patients (15.4%) showed tumor recurrence and underwent reoperation. Bony abnormalities included skull base defects (n = 12), basilar invagination (n = 4), optic nerve compression (n = 3) and trauma (n = 2); preexisting neurological dysfunction resolved in 12 patients (57.1%), improved in 7 (33.3%), and remained unchanged in 2 (9.5%). Overall, complications included CSF leak in 14 cases (10.5%), meningitis in 5 (3.8%), transient diabetes insipidus in 8 patients (6.0%), and permanent diabetes insipidus in 12 (9.0%). Five patients (3.8%) had transient and 3 (2.3%) had permanent cranial nerve palsies. The mean follow-up time was 22.7 months (range 1–122 months); 5 patients were lost to follow-up. Conclusions Endoscopic endonasal surgery has proved to be a safe and feasible approach for the management of a variety of pediatric skull base pathologies. When appropriately indicated, EES may achieve optimal outcomes in the pediatric population.

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Triple-Layer Reconstruction Technique for Large Cribriform Defects after Endoscopic Endonasal Resection of Anterior Skull Base Tumors

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0032-1312201 ◽

2012 ◽

Vol 73 (S 01) ◽

Author(s):

Smruti Patel ◽

Mickey Smith ◽

Osamah Choudhry ◽

Jean Eloy ◽

James Liu

Keyword(s):

Skull Base ◽

Anterior Skull Base ◽

Reconstruction Technique ◽

Skull Base Tumors ◽

Endoscopic Endonasal ◽

Triple Layer

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The Difficult Airway after Endoscopic Endonasal Skull Base Surgery: A Case Series and Management Algorithm

Otolaryngology ◽

10.1177/0194599818789099 ◽

2018 ◽

Vol 159 (5) ◽

pp. 927-932

Author(s):

Courtney Chou ◽

Carl Snyderman ◽

Dennis Phillips ◽

Joseph Darby

Keyword(s):

Laryngeal Mask Airway ◽

Airway Management ◽

Difficult Airway ◽

Skull Base ◽

Case Series ◽

Dural Defect ◽

Mask Ventilation ◽

Skull Base Tumors ◽

Endoscopic Endonasal ◽

Management Algorithm

Objectives To analyze difficult airway situations affecting patients after endoscopic endonasal surgery (EES) for skull base tumors and to develop an airway management algorithm. Study Design Case series with chart review. Setting Single tertiary care center. Subjects and Methods Eleven difficult airway events occurred among patients after EES for skull base tumors, as identified through a retrospective review of our institutional Difficult Airway Management Team registry from January 2008 to March 2016. Data from these events included patient demographics, event characteristics, airway management techniques, and outcomes. Results were used to design a difficult airway protocol. Results The majority of patients were obese (63.6%) and had a dural defect (90.9%), each of which was repaired with a vascularized flap. The most common reasons for the difficult airway call were concern for using mask ventilation in a patient with a dural defect (27.3%) and difficult airway anatomy (27.3%). Two patients did not require airway intervention; 8 were intubated; and 1 underwent cricothyroidotomy. Videolaryngoscopy was the most common first-attempt intubation technique, followed by conventional direct laryngoscopy. Effective adjunctive techniques included intubation through a laryngeal mask airway and bougie-guided intubation. As compared with simple mask ventilation, laryngeal mask airway–assisted ventilation was associated with a decreased incidence of postevent cerebrospinal fluid leak. There were no incidences of postevent pneumocephalus, cardiopulmonary arrest, or mortality. Conclusions We propose a difficult airway algorithm for patients following EES of the skull base, with sequential recommendations for airway management methods and commentary on adjunctive techniques.

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