Expanded Endoscopic Endonasal Transtuberculum Approach for Tuberculum Sellae Meningioma: Operative Video With 360-Degree Fly-Through and Surgical Rehearsal in Virtual Reality: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (2) ◽  
pp. E179-E180 ◽  
Author(s):  
Walter C Jean ◽  
Ameet Singh
Keyword(s):  
Virtual Reality ◽  
Haptic Feedback ◽  
Tumor Resection ◽  
Three Dimensional ◽  
Early Career ◽  
Tissue Response ◽  
Endoscopic Endonasal ◽  
Tuberculum Sellae Meningioma ◽  
Patient Consent ◽  
Tuberculum Sellae

Abstract This video demonstrates the technique of the “Expanded Endoscopic Endonasal Transtuberculum Approach” and the utility of preoperative planning and surgical rehearsal in virtual reality (VR).  VR can be utilized to improve endoscopic skull base surgery in various ways. The patient is a 57-yr-old woman with sudden right abducens palsy. Transcranial surgery has been the gold-standard treatment of the tuberculum sellae meningioma that was found, but for suitable tumors, the endoscopic endonasal approach is equally effective for tumor resection with better visual outcomes.1-4  The three-dimensional, 360°, multicolored VR rendering (Surgical Theater SRP7.4.0, Cleveland, Ohio) of her tuberculum sellae meningioma clearly demonstrated that there was no encasement of the anterior cerebral arteries, the tumor did not extend lateral to the carotid arteries, and the surgical corridor was wide enough for endoscopic endonasal resection. The surgical exposure was then rehearsed with the sphenoidectomy and drilling of the sella floor and tuberculum performed in VR space. The step-by-step process of the endoscopic endonasal transtuberculum resection is demonstrated in the operative video.  Surgical planning in VR can be helpful to the early-career endoscopic surgeon. The three-dimensional renderings are quick to set up (15 min), and the examination of the anatomy is useful for choosing the surgical approach. Despite the lack of haptic feedback and tissue response such as vascularity and firmness in the current software, rehearsing the drilling for exposure can improve the efficiency in surgery.  Patient consent was obtained prior to the creation of the video and is available on request.

scholarly journals How I do it: endoscopic endonasal resection of tuberculum sellae meningioma

2021 ◽  
Author(s):  
Markus Wiedmann ◽  
Aslan Lashkarivand ◽  
Jon Berg-Johnsen ◽  
Daniel Dahlberg
Keyword(s):  
Team Approach ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Ongoing Debate ◽  
Endoscopic Endonasal ◽  
Microsurgical Technique ◽  
Tuberculum Sellae Meningioma ◽  
Tuberculum Sellae ◽  
Dedicated Team ◽  
Neurovascular Structures

Abstract Background Tuberculum sellae meningiomas (TSMs) adherent to neurovascular structures are particularly challenging lesions requiring delicate and precise microneurosurgery. There is an ongoing debate about the optimal surgical approach. Method We describe technical nuances and challenges in TSM resection using the endoscopic endonasal approach (EEA) in two cases of fibrous tumors with adherence to neurovascular structures. The cases are illustrated with a video (case 1) and figures (cases 1 and 2). Conclusion A dedicated team approach and precise microsurgical technique facilitate safe resection of complex TSMs through the EEA.

scholarly journals Supraorbital transciliary keyhole approach for removal of tuberculum sellae meningioma: 3D surgical video

2021 ◽  
Vol 12 ◽  
pp. 5
Author(s):  
J. Javier Cuellar-Hernandez ◽  
J. Ramon Olivas-Campos ◽  
Paulo M. Tabera-Tarello ◽  
Miracle Anokwute ◽  
Alan Valadez-Rodriguez
Keyword(s):  
Visual Field ◽  
Tumor Resection ◽  
Visual Fields ◽  
Optic Nerves ◽  
Tuberculum Sellae Meningioma ◽  
Primary Indication ◽  
Tuberculum Sellae ◽  
Surgical Corridor ◽  
Keyhole Approach ◽  
Supraorbital Craniotomy

Background: Tuberculum sellae meningiomas have an incidence from 5 to 10% of all intracranial meningiomas[2] and tend to be surgically difficult and challenging tumors given their proximity to important structures such as the internal carotid artery (ICA), anterior cerebral artery (ACA), and optic nerves.[3] Typically, their growth is posteriorly and superiorly oriented, thereby displacing the optic nerves and causing visual dysfunction, which is the primary indication for surgical treatment.[1] The main goals of the treatment are the preservation or restoration of visual abilities and a complete tumor resection.[1] Conventionally, surgical approaches to tuberculum meningiomas involve largely invasive extended bifrontal, interhemispheric, orbitozygomatic, pterional, and subfrontal eyebrow approaches. The supraorbital craniotomy, however, is a minimally invasive transcranial approach that offers a similar surgical corridor to conventional transcranial approaches, using a limited craniotomy and minimal brain retraction that can be used for tumoral and vascular pathologies,[4,5] offering added cosmetic outcomes.[1] We present the case of a patient undergoing a supraorbital transciliary craniotomy with a tuberculum sellae meningioma causing bitemporal hemianopsia. Case Description: A 70-year-old female with chronic headaches and progressive vision loss and visual field deficit for about 1 year. On ophthalmological evaluation, she was able to fixate and follow objects with each eye, light perception was only present in the right eye, and the vision in the left eye was 0.2 decimal units. Her visual fields demonstrated severe campimetric deficits. Her extraocular movements were intact and bilateral pupils were equal, round, and reactive to light. MRI of the brain demonstrated tuberculum sellae meningioma with bilateral optic canal invasion, displacing the chiasm, and extending ≥180° around the medial ICA wall and anterior ACA wall. The patient underwent supraorbital transciliary keyhole approach for total resection of the tumor. Postoperatively, visual acuity and visual field were significantly improved. Conclusion: Performing a supraorbital transciliary keyhole craniotomy for tuberculum sellae meningiomas requires an adequate and meticulous preoperative planning to determine the optimal surgical corridor to the lesion. The use of supraorbital craniotomy is safe with good cosmetic results and potentially lower morbidity allowing for adequate exposure, resection, and release of neurovascular structures.

scholarly journals Impact of Virtual Reality in Arterial Anatomy Detection and Surgical Planning in Patients with Unruptured Anterior Communicating Artery Aneurysms

2020 ◽  
Vol 10 (12) ◽  
pp. 963
Author(s):  
Samer Zawy Alsofy ◽  
Ioanna Sakellaropoulou ◽  
Makoto Nakamura ◽  
Christian Ewelt ◽  
Asem Salma ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Surgical Planning ◽  
Haptic Feedback ◽  
Three Dimensional ◽  
Vascular Anatomy ◽  
Anatomical Variations ◽  
Surgical Strategy ◽  
Anterior Communicating Artery ◽  
Head Positioning ◽  
Arterial Anatomy

Anterior-communicating artery (ACoA) aneurysms have diverse configurations and anatomical variations. The evaluation and operative treatment of these aneurysms necessitates a perfect surgical strategy based on review of three-dimensional (3D) angioarchitecture using several radiologic imaging methods. We analyzed the influence of 3D virtual reality (VR) reconstructions versus conventional computed tomography angiography (CTA) scans on the identification of vascular anatomy and on surgical planning in patients with unruptured ACoA aneurysms. Medical files were retrospectively analyzed regarding patient- and disease-related data. Preoperative CTA scans were retrospectively reconstructed to 3D-VR images and visualized via VR software to detect the characteristics of unruptured ACoA aneurysms. A questionnaire was used to evaluate the influence of VR on the identification of aneurysm morphology and relevant arterial anatomy and on surgical strategy. Twenty-six patients were included and 520 answer sheets were evaluated. The 3D-VR modality significantly influenced detection of the aneurysm-related vascular structure (p = 0.0001), the recommended head positioning (p = 0.005), and the surgical approach (p = 0.001) in the planning of microsurgical clipping. Thus, reconstruction of conventional preoperative CTA scans into 3D images and the spatial presentation in VR models enabled greater understanding of the anatomy and pathology, provided realistic haptic feedback for aneurysm surgery, and influenced operation planning and strategy.

scholarly journals The expanded endoscopic endonasal approach for treatment of tuberculum sellae meningiomas in a series of 40 consecutive cases

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Peng Yu ◽  
Tutu Xu ◽  
Xinyu Wu ◽  
Zhitong Liu ◽  
Yong Wang ◽  
...  
Keyword(s):  
Anterior Cerebral Artery ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Tuberculum Sellae Meningioma ◽  
Csf Leakage ◽  
Invasive Method ◽  
Tuberculum Sellae

AbstractCompared with traditional craniotomy, the expanded endoscopic endonasal approach (EEEA) may have some advantages for tuberculum sellae meningioma (TSM) treatment. We described our experience of the therapeutic effect of endoscopic TSM treatment. From August 2015 to December 2019, 40 patients with a TSM were treated by the EEEA in our institution. EEEA outcome in TSM treatment was analyzed. Among 39 patients with visual impairment, 38 (97.4%) improved their visual function to some extent after the EEEA, and one case had no significant change in visual acuity. Among all patients, 38 (95.0%) achieved gross total resection (GTR) and 2 (5.0%) achieved near-total resection (NTR). Cerebrospinal fluid (CSF) leakage occurred in three patients (7.5%) and meningitis (post-CSF leakage) in two patients (5.0%). Eight patients (20.0%) suffered postoperative hyposmia, three of whom developed long-term hyposmia. One patient (2.5%) suffered from bleeding of the branch of the anterior cerebral artery intraoperatively leading to postoperative acute cerebral infarction. The EEEA is a safe and reliable minimally invasive method for TSM removal. Compared with traditional craniotomy, the EEEA may have better visual outcomes and a higher prevalence of GTR, but carries the risk of CSF leakage.

scholarly journals Endoscopic Endonasal Resection of a Suprasellar Pituitary Adenoma Mimicking Tuberculum Sellae Meningioma in a Patient with an Intrasellar Persistent Trigeminal Artery

2018 ◽  
Vol 79 (S 03) ◽  
pp. S285-S286
Author(s):  
Alaa Montaser ◽  
Alexandre Todeschini ◽  
Juan Revuelta Barbero ◽  
Mostafa Shahein ◽  
E. Chiocca ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Persistent Trigeminal Artery ◽  
Trigeminal Artery ◽  
Endoscopic Endonasal ◽  
Skull Base Reconstruction ◽  
Tuberculum Sellae Meningioma ◽  
Tuberculum Sellae

AbstractA 50-year-old female with an incidentally diagnosed suprasellar lesion was initially managed conservatively due to the presence of an intrasellar persistent trigeminal artery going through the dorsum sellae and fundamentally forming the blood supply of the entire posterior circulation. Serial follow-up brain magnetic resonance imaging (MRI) revealed progressive enlargement of the suprasellar lesion over 4 years period. Surgery was indicated after the initial tumor growth; however, the patient refused surgery for fear of complications related to the persistent trigeminal artery. Two-and-a-half years later, she presented with deterioration of vision. Formal visual field testing revealed a right temporal field defect. Brain MRI demonstrated significantly enlarged suprasellar lesion, most consistent with tuberculum sellae meningioma, exerting mass effect on the optic apparatus.The patient underwent endoscopic endonasal resection of the lesion through a transplanum/transtuberculum approach. Intraoperatively, absence of hypertrophic McConnel arteries, hyperostosis, and the fact that the dura was soft and not under tension was against the diagnosis of tuberculum sellae meningioma. Additionally, the tumor consistency was similar to a pituitary adenoma. A complete resection was accomplished and multilayer skull base reconstruction was performed with no complications. On postoperative day 1 (POD 1), she was operated upon for the evacuation of small suprasellar hematoma associated with vision deterioration. Histopathological examination confirmed the diagnosis of atypical pituitary adenoma with K i-67 labeling index of 4 to 5%. The patient ultimately recovered well with improved vision, and was discharged on POD 4 with no new neurological deficits. At 4 years follow-up, her vision was normalized and brain MRI showed no residual or recurrent lesion.The link to the video can be found at: https://youtu.be/QZmzctjAEbw.

scholarly journals Introduction: surgical management of skull base meningiomas

2017 ◽  
Vol 43 (videosuppl2) ◽  
pp. Intro ◽  
Author(s):  
Gabriel Zada ◽  
Mustafa K Başkaya ◽  
Mitesh V. Shah
Keyword(s):  
Skull Base ◽  
Wide Spectrum ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Foramen Magnum ◽  
Surgical Approaches ◽  
Cerebrospinal Fluid Leakage ◽  
Endoscopic Endonasal ◽  
Tuberculum Sellae ◽  
Skull Base Meningiomas

Meningiomas represent the most common primary intracranial neoplasm treated by neurosurgeons. Although multimodal treatment of meningiomas includes surgery, radiation-based treatments, and occasionally medical therapy, surgery remains the mainstay of treatment for most symptomatic meningiomas. Because of the intricate relationship of the dura mater and arachnoid mater with the central nervous system and cranial nerves, meningiomas can arise anywhere along the skull base or convexities, and occasionally even within the ventricular system, thereby mandating a catalog of surgical approaches that neurosurgeons may employ to individualize treatment for patients. Skull base meningiomas represent some of the most challenging pathology encountered by neurosurgeons, on account of their depth, invasion, vascularity, texture/consistency, and their relationship to bony anatomy, cranial nerves, and blood vessels. Resection of complex skull base meningiomas often mandates adequate bony removal to achieve sufficient exposure of the tumor and surrounding region, in order to minimize brain retraction and optimally identify, protect, control, and manipulate sensitive neurovascular structures. A variety of traditional skull base approaches has evolved to address complex skull base tumors, of which meningiomas are considered the paragon in terms of both complexity and frequency.In this supplemental video issue of Neurosurgical Focus, contributing authors from around the world provide instructional narratives demonstrating resection of a variety of skull base meningiomas arising from traditionally challenging origins, including the clinoid processes, tuberculum sellae, dorsum sellae, petroclival region, falco-tentorial region, cerebellopontine angle, and foramen magnum. In addition, two cases of extended endoscopic endonasal approaches for tuberculum sellae and dorsum sellae meningiomas are presented, representing the latest evolution in accessing the skull base for selected tumors. Along with key pearls for safe tumor resection, an equally important component of open and endoscopic skull base operations for meningiomas addressed by the contributing authors is the reconstruction aspect, which must be performed meticulously to prevent delayed cerebrospinal fluid leakage and/or infections. This curated assortment of instructional videos represents the authors’ optimal treatment paradigms pertaining to the selection of approach, setup, exposure, and principles to guide tumor resection for a wide spectrum of complex meningiomas.

ENDOSCOPIC ENDONASAL RESECTION OF A SYNCHRONOUS PITUITARY ADENOMA AND A TUBERCULUM SELLAE MENINGIOMA

2007 ◽  
Vol 60 ◽  
pp. E401 ◽  
Author(s):  
Daniel M. Prevedello ◽  
Ajith Thomas ◽  
Paul Gardner ◽  
Carl H. Snyderman ◽  
Ricardo L. Carrau ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Endoscopic Endonasal ◽  
Tuberculum Sellae Meningioma ◽  
Tuberculum Sellae

scholarly journals Haptic Feedback to Guide Interactive Product Design

2009 ◽  
Author(s):  
Andrew Fischer ◽  
Judy M. Vance ◽  
Dao M. Vo
Keyword(s):  
Virtual Reality ◽  
Product Design ◽  
Haptic Feedback ◽  
Dimensional Space ◽  
Three Dimensional ◽  
Virtual Design ◽  
Design Changes ◽  
Analysis Computer ◽  
Interactive Product ◽  
Analysis Models

Virtual Reality (VR) allows engineers to naturally interact with three-dimensional digital models in a three-dimensional space. This provides a unique interface between users and computer models not found in traditional desktop environments. Common uses of virtual reality in product design include prototype evaluation, virtual assembly and visualization of engineering analysis results. This work described in this paper is based on a methodology for interactive design that uses virtual reality as an interface to product design and analysis. Computer analysis models coupled with fast reanalysis approximations and geometric models in a virtual environment are developed to facilitate shape design changes and updated analysis results in real-time. This combined design and analysis environment encourages the rapid investigation of many possible shape and design changes and how they affect the final product performance. The application developed to test this methodology is referred the Immersive Virtual Design Application (IVDA).

Evaluation of the 3-Dimensional Endoscope in Transsphenoidal Surgery

2013 ◽  
Vol 73 (suppl_1) ◽  
pp. ons74-ons79 ◽  
Author(s):  
Garni Barkhoudarian ◽  
Alicia Del Carmen Becerra Romero ◽  
Edward R. Laws
Keyword(s):  
Skull Base ◽  
Tumor Resection ◽  
Three Dimensional ◽  
Anterior Skull Base ◽  
High Definition ◽  
Endoscopic Endonasal ◽  
Endoscopic Techniques ◽  
Bony Landmarks ◽  
Significant Difference ◽  
Invaluable Tool

Abstract BACKGROUND: Three-dimensional (3-D) endoscopy is a recent addition to augment the transsphenoidal surgical approach for anterior skull-base and parasellar lesions. We describe our experience implementing this technology into regular surgical practice. OBJECTIVE: Retrospective review of clinical factors and outcomes. METHODS: All patients were analyzed who had endoscopic endonasal parasellar operations since the introduction of the 3-D endoscope to our practice. Over an 18-month period, 160 operations were performed using solely endoscopic techniques. Sixty-five of these were with the Visionsense VSII 3-D endoscope and 95 utilized 2-dimensional (2-D) high-definition (HD) Storz endoscopes. Intraoperative and postoperative findings were analyzed in a retrospective fashion. RESULTS: Comparing both groups, there was no significant difference in total or surgical operating room times comparing the 2-D HD and 3-D endoscopes (239 minutes vs 229 minutes, P = .47). Within disease-specific comparison, pituitary adenoma resection was significantly shorter utilizing the 3-D endoscope (surgical time 174 minutes vs 147 minutes, P = .03). These findings were independent of resident or fellow experience. There was no significant difference in the rate of complication, reoperation, tumor resection, or intraoperative cerebrospinal fluid leaks. Subjectively, the 3-D endoscope offered increased agility with 3-D techniques such as exposing the sphenoid rostrum, drilling sphenoidal septations, and identifying bony landmarks and suprasellar structures. CONCLUSION: The 3-D endoscope is a useful alternative to the 2-D HD endoscope for transnasal anterior skull-base surgery. Preliminary results suggest it is more efficient surgically and has a shorter learning curve. As 3-D technology and resolution improve, it should serve to be an invaluable tool for neuroendoscopy.

Sign in / Sign up

Export Citation Format

Share Document