The Rostral Mucosa: The Door to Open and Close for Targeted Endoscopic Endonasal Approaches to the Clivus

2021 ◽  
Author(s):  
Paolo di Russo ◽  
Arianna Fava ◽  
Lorenzo Giammattei ◽  
Thibault Passeri ◽  
Atsushi Okano ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Tumor Resection ◽  
Skin Incision ◽  
Reconstruction Technique ◽  
Endoscopic Endonasal ◽  
Invasive Approach ◽  
Mucosal Incision ◽  
Reconstruction Strategy ◽  
Further Development ◽  
Targeted Approach

Abstract BACKGROUND Extended endoscopic endonasal approaches (EEAs) have progressively widened the armamentarium of skull base surgeons. In order to reduce approach-related morbidity of EEAs and closure techniques, the development of alternative strategies that minimize the resection of normal tissue and alleviate the use of naso-septal flap (NSF) is needed. We report on a novel targeted approach to the clivus, with incision and closure of the mucosa of the rostrum, as the initial and final step of the approach. OBJECTIVE To present an alternative minimally invasive approach and reconstruction technique for selected clival chordomas. METHODS Three cases of clival chordomas illustrating this technique are provided, together with an operative video. RESULTS The mucosa of the rostrum is incised and elevated from the underlying bone, as first step of surgery. Following tumor resection with angled scope and instruments, the mucosa of the sphenoid sinus (SS) is removed and the tumor cavity and SS are filled with abdominal fat. The mucosal incision of the rostrum is then sutured. A hangman knot is prepared outside the nasal cavity and tightened after the first stitch and a running suture is performed. CONCLUSION We propose, in this preliminary report, a new targeted approach and reconstruction strategy, applying to EEAs the classic concept of skin incision and closure for transcranial approaches. With further development in the instrumentations and visualization tools, this technique may become a valuable minimally invasive endonasal approach for selected lesions.

Endoscopy-Assisted Achilles Tendon Reconstruction With a Central Turndown Flap and Semitendinosus Augmentation

2016 ◽  
Vol 37 (12) ◽  
pp. 1333-1342 ◽  
Author(s):  
Prashant N. Gedam ◽  
Faizaan M. Rushnaiwala
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Wound Complication ◽  
Reconstruction Technique ◽  
Level Of Evidence ◽  
Invasive Approach ◽  
Perioperative Morbidity ◽  
The Mean

Background: The objective of this study was to report the results of a new minimally invasive Achilles reconstruction technique and to assess the perioperative morbidity, medium- to long-term outcomes, and functional results. Methods: Our series was comprised 14 patients (11 men and 3 women), with a mean age of 45.6 years at surgery. Each patient had a chronic Achilles tendon rupture. The mean interval from rupture to surgery was 5.5 months (range, 2-10). The mean total follow-up was 30.1 months (range, 12-78). All patients were operated with a central turndown flap augmented with free semitendinosus tendon graft and percutaneous sutures in a minimally invasive approach assisted by endoscopy. The patients underwent retrospective assessment by clinical examination, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score, and the Achilles Tendon Total Rupture Score (ATRS). Paired t tests were used to assess the preoperative and postoperative AOFAS scores, ATRS scores, and ankle range of motion. Results: The length of the defect ranged from 3 to 8 cm (mean, 5.1), while the length of the turndown flap ranged from 8 to 13 cm (mean, 10.1). The mean AOFAS score improved from 64.5 points preoperatively to 96.9 points at last follow-up. The mean ATRS score improved from 49.4 preoperatively to 91.4 points at last follow-up. None of the patients developed a wound complication. No patient had a rerupture or sural nerve damage. Conclusion: All patients in our study had a favorable outcome with no complications. We believe that with this triple-repair technique, one can achieve a strong and robust repair such as in open surgery while at the same time reducing the incidence of complications. Level of Evidence: Level III, retrospective comparative study.

Minimally invasive resection of spinal hemangioblastoma: feasibility and clinical results in a series of 18 patients

2019 ◽  
Vol 31 (6) ◽  
pp. 880-889 ◽  
Author(s):  
Marie T. Krüger ◽  
Christine Steiert ◽  
Sven Gläsker ◽  
Jan-Helge Klingler
Keyword(s):  
Postoperative Complications ◽  
Minimally Invasive ◽  
Tumor Resection ◽  
Clinical Results ◽  
Vascular Tumors ◽  
Open Approach ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Spinal Hemangioblastoma ◽  
Vhl Disease

OBJECTIVEHemangioblastomas are benign, highly vascularized tumors that can occur sporadically or as part of von Hippel-Lindau (VHL) disease. Traditionally, spinal hemangioblastomas have been surgically treated via an open approach. In recent years, however, minimally invasive techniques using tubular retractors have been increasingly applied in spine surgery. Such procedures involve less tissue trauma but are also particularly demanding for the surgeon, especially in cases of highly vascular tumors such as hemangioblastomas. The object of this study was to evaluate the safety and efficacy of minimally invasive resection of selected spinal hemangioblastomas.METHODSThe authors conducted a retrospective single-center study of all patients who, between January 2010 and January 2018, had been operated on for spinal hemangioblastoma via a minimally invasive approach performed at the surgeon’s discretion. The surgical technique is described and the pre- and postoperative neurological and imaging results were analyzed descriptively. The primary outcome was the postoperative compared to preoperative neurological condition (McCormick grade). The secondary outcomes were the extent of tumor resection and postoperative complications.RESULTSEighteen patients, 12 female and 6 male, harboring a total of 19 spinal hemangioblastomas underwent surgery in the study period. Seventeen patients had stable neurological findings with stable or improved McCormick grades (94.5%) at a mean of 4.3 months after surgery. One (5.5%) of the 18 patients developed progressive neurological symptoms with a worsened McCormick grade that did not improve in the long-term follow-up. Sixteen of the 18 patients had VHL disease, whereas 2 patients had sporadic spinal hemangioblastomas. In all patients, postoperative MRI showed complete resection of the tumors. No other surgery-related perioperative or postoperative complications were recorded.CONCLUSIONSA minimally invasive approach for the resection of selected spinal hemangioblastomas is safe and allows complete tumor resection with good clinical results in experienced hands.

Minimally Invasive Approach for Dorsal Arachnoid Web: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Corentin Dauleac ◽  
Henri-Arthur Leroy ◽  
Richard Assaker
Keyword(s):  
Spinal Cord ◽  
Minimally Invasive ◽  
Skin Incision ◽  
Minimally Invasive Approach ◽  
Tubular Retractor ◽  
Invasive Approach ◽  
Spinal Cord Herniation ◽  
Muscle Sparing ◽  
Magnetic Resonance Imaging Mri ◽  
Spinal Cord Decompression

Abstract A 67-yr-old patient presented with severe paraparesis and lower limb spasticity. The spinal cord magnetic resonance imaging (MRI) revealed the “scalpel sign” 1,2 at the T7 level, suggesting a diagnosis of a dorsal arachnoid web. This video demonstrates a microsurgical technique for the excision of a dorsal arachnoid web with a minimally invasive approach. A paramedian skin incision, understanding the muscular aponeurosis, was performed from T7 to T8. Then, we inserted the tubular dilators until the lamina, to perform a muscle-sparing approach. An expandable tubular retractor of adequate length was passed over the widest dilator and docked into place along the subperiosteal plane. The T7 lamina was drilled, and the resection of the superior and inferior adjacent spine levels was completed with a rongeur. Additional contralateral bone resection was performed after tubular retractor tilt to the midline.3 After dura mater opening, it was carefully suspended and the dorsal arachnoid leaflet was cut to drain the dorsolateral and lateral spinal cisterns.4 The dorsal arachnoid web was, first, disconnected from its lateral anchorages. It was then gently removed with microsurgical forceps, to help its microdissection from the spinal cord surface. At this step, peculiar attention was paid to limit the traction or displacements of the spinal cord and surrounding vessels. Once the dorsal arachnoid web was removed, the quality of the spinal cord decompression was confirmed by its re-expansion. In conclusion, the minimally invasive approach is a safe and appropriate technique for dorsal arachnoid web excision.2,5,6-7  The patient gave her informed and signed consent for the writing and publication of this article.  Image at 1:00 reused with permission from Castelnovo G et al, Spontaneous transdural spinal cord herniation, Neurology, 2014;82(14):1290.

Mini Fronto-Orbital Approach: “Window Opening” Towards the Superomedial Orbit – A Virtual Reality-Planned Anatomic Study

2020 ◽  
Vol 19 (3) ◽  
pp. 330-340 ◽  
Author(s):  
Carmine Antonio Donofrio ◽  
Jody Filippo Capitanio ◽  
Lucia Riccio ◽  
Aalap Herur-Raman ◽  
Anthony J Caputy ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Minimally Invasive ◽  
Three Dimensional ◽  
Skin Incision ◽  
Surgical Approaches ◽  
Target Area ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Window Opening ◽  
Dissection Technique

Abstract BACKGROUND Surgical approaches to the orbit are challenging and require combined multispecialist skills. Considering its increasing relevance in neurosurgical practice, keyhole surgery could be also applied to this field. However, mastering a minimally invasive approach necessitates an extended learning curve. For this reason, virtual reality (VR) can be effectively used for planning and training in this demanding surgical technique. OBJECTIVE To validate the mini fronto-orbital (mFO) approach to the superomedial orbit, using VR planning and specimen dissections, conjugating the principles of skull base and keyhole neurosurgery. METHODS Three-dimensional measurements were performed thanks to Surgical Theater (Surgical Theater© LLC), and then, simulated craniotomies were implemented on cadaver specimens. RESULTS The mFO approach affords optimal exposure and operability in the target area and reduced risks of surrounding normal tissue injuries. The eyebrow skin incision, the minimal soft-tissue retraction, the limited temporalis muscle dissection and the single-piece craniotomy, as planned with VR, are the key elements of this minimally invasive approach. Furthermore, the “window-opening” cotton-tip intraorbital dissection technique, based on widening surgical corridors between neuromuscular bundles, provides a safe orientation and a deep access inside the orbit, thereby significantly limiting the risk of jeopardizing neurovascular structures. CONCLUSION The mFO approach associated to the window-opening dissection technique can be considered safe, effective, suitable, and convenient for treating lesions located in the superomedial orbital aspect, up to the orbital apex.

Minimally invasive lumbar intradural extramedullary tumor resection

2012 ◽  
Vol 33 (Suppl1) ◽  
pp. 1 ◽  
Author(s):  
Brian Lee ◽  
Patrick C. Hsieh
Keyword(s):  
Minimally Invasive ◽  
Tumor Resection ◽  
Surgical Techniques ◽  
Csf Leak ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Extramedullary Tumor ◽  
Intradural Extramedullary ◽  
Dural Opening ◽  
Invasive Techniques

Intradural, extramedullary schwannomas have long been treated with open midline incision, laminectomy, and dural opening to expose and resect the lesion. While this technique is well established, today new surgical techniques can be utilized to perform the same procedure while minimizing pain, size of incision, and trauma to adjacent tissues. In cases of intradural surgery, minimally invasive surgery limits the degree of soft tissue disruption. As a result, there is significant decreased dead space within the surgical cavity that may decrease the rate of CSF leak complications. Minimally invasive techniques have continuously improved over the years and have reached a point where they can be used for intradural surgeries. In this case presentation, we demonstrate a minimally invasive approach to the lumbar spine with resection of an intradural schwannoma. Surgical techniques and the nuances of the minimally invasive approach to intradural tumors compared to the standard open procedure will be discussed. The video can be found here: http://youtu.be/XXrvAIq_H48.

The Endoscopic Endonasal Approach to the Lateral Recess of the Sphenoid Sinus Via the Pterygopalatine Fossa: Comparison Of Endoscopic and Radiological Landmarks

2006 ◽  
Vol 59 (suppl_4) ◽  
pp. ONS-237-ONS-243 ◽  
Author(s):  
Francesco Magro ◽  
Domenico Solari ◽  
Luigi M. Cavallo ◽  
Amir Samii ◽  
Paolo Cappabianca ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Sphenoid Sinus ◽  
Pterygopalatine Fossa ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Anatomic Landmarks ◽  
Endoscopic Endonasal ◽  
Invasive Approach ◽  
Lateral Recess ◽  
Radiological Images

Abstract OBJECTIVE: The endoscopic endonasal approach offers the opportunity to reach the ptery-gopalatine fossa, the lateral recess of the sphenoid sinus, and other areas of the cranial base through a minimally invasive approach. This study compares the anatomy of these areas when observed through an endoscopic endonasal view with the anatomy of the same regions as they appear in computed tomographic scans. The aim was to identify and correlate the corresponding anatomic structures, providing the surgeons with anatomic landmarks to guide them when operating in these areas through an endoscopic endonasal approach. METHODS: An anatomic dissection of six fixed cadaver heads was performed by an endoscopic endonasal approach. A step-by-step comparison of endoscopic and radiological images was made to identify the landmarks of the surgical field. RESULTS: The step-by-step comparison of endoscopic and radiological images acquired during the endoscopic endonasal approach to the lateral recess of the sphenoid sinus via the pterygopalatine fossa allowed the identification of all the relevant anatomic landmarks of the procedure. CONCLUSION: The endoscopic endonasal approach via the pterygopalatine fossa offers direct, minimally invasive access to the lateral recess of the sphenoid sinus, which can be monitored in each phase through consistent radiological imagery.

scholarly journals Endoscopic endonasal approaches to the skull base tumors: minimally-invasive approach with achievement of radicality. Our experience

2020 ◽  
Vol 26 (2) ◽  
pp. 46-52
Author(s):  
Orest I. Palamar ◽  
Andriy P. Huk ◽  
Ruslan V. Aksyonov ◽  
Dmytro I. Okonskyi ◽  
Dmytro S. Teslenko
Keyword(s):  
Minimally Invasive ◽  
Skull Base ◽  
Skull Base Tumors ◽  
Minimally Invasive Approach ◽  
Endoscopic Endonasal ◽  
Invasive Approach

scholarly journals How I do it: the trans-laminar, facet-joint sparing minimal invasive approach for ventral dural repair in spontaneous intracranial hypotension—a 2-dimensional operative video

2021 ◽  
Author(s):  
Marco V. Corniola ◽  
Torstein R. Meling
Keyword(s):  
Minimally Invasive ◽  
Intracranial Hypotension ◽  
Facet Joint ◽  
Spontaneous Intracranial Hypotension ◽  
Skin Incision ◽  
Lateral Approach ◽  
Dural Defect ◽  
Dural Repair ◽  
Invasive Approach ◽  
Minimal Invasive Approach

Abstract Background We describe the minimally invasive, facet-sparing postero-lateral approach to the thoracic spine for a ventral dural repair in a patient with intracranial hypotension secondary to a spontaneous dural breach. Methods We performed a minimally invasive approach using a short paramedian posterior skin incision followed by a 10 × 10 mm targeted trans-laminar approach, to achieve a microsurgical repair of a symptomatic ventral dural defect causing severe disability. Conclusion The facet-sparing postero-lateral approach is safe and effective in the surgical management of thoracic dural tears, even in the most anterior ones, and avoids the traditional costotransversectomy.

Placement of cesium-131 permanent brachytherapy seeds using the endoscopic endonasal approach for recurrent anaplastic skull base meningioma: case report and technical note

2020 ◽  
Vol 132 (3) ◽  
pp. 921-926 ◽  
Author(s):  
Asif Raza Shafiq ◽  
A. Gabriella Wernicke ◽  
Charles Alex Riley ◽  
Peter F. Morgenstern ◽  
Lucy Nedialkova ◽  
...  
Keyword(s):  
Skull Base ◽  
Local Control ◽  
Tumor Resection ◽  
External Beam Radiation ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Beam Radiation ◽  
Invasive Approach ◽  
Skull Base Meningioma

There are few therapeutic options available for the treatment of recurrent meningiomas that have failed treatment with surgery and external-beam radiation therapy (EBRT). As additional EBRT is clinically risky, brachytherapy offers an important alternative for optimizing local control. In skull base meningiomas, the endoscopic endonasal approach (EEA) has demonstrated an excellent extent of resection. However, in the case of recurrent, atypical, or residual meningiomas, the EEA alone may not be adequate to address microscopic, residual, highly proliferative disease. In this situation, local radioactive seed brachytherapy has been shown to improve control, but few reports of this technique exist. A 48-year-old right-handed man presented on multiple occasions with recurrence of an anaplastic skull base meningioma, after multiple prior gross-total resections and multiple rounds of radiotherapy had failed. The authors performed a maximally safe neurosurgical tumor resection via EEA supplemented by the intraoperative implantation of 131Cs low-dose permanent brachytherapy seeds. They describe a technique for permanent implantation of brachytherapy seeds and provide operative video of this technique. The authors submit that utilizing this technique in combination with EEA tumor resection renders a minimally invasive approach to improving local control in a patient with a recurrent anaplastic or atypical meningioma of the skull base.

Minimally Invasive Resection of a Cervical Anterolateral Meningioma: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (4) ◽  
pp. 520-520
Author(s):  
Federico Landriel ◽  
Santiago Hem ◽  
Eduardo Vecchi ◽  
Claudio Yampolsky
Keyword(s):  
Spinal Cord ◽  
Minimally Invasive ◽  
Neck Pain ◽  
Video Recording ◽  
Tumor Resection ◽  
Spinal Tumors ◽  
Minimally Invasive Approach ◽  
En Bloc ◽  
Invasive Approach ◽  
Intradural Extramedullary

Abstract Intradural extramedullary spinal tumors were historically managed through traditional midline approaches. Although conventional laminectomy or laminoplasty provides a wide tumor and spinal cord exposure, they may cause prolonged postoperative neck pain and late kyphosis deformity. Minimally invasive ipsilateral hemilaminectomy preserves midline structures, reduces the paraspinal muscle disruption, and could avoid postoperative kyphosis deformity. A safe tumor resection through this approach could be complicated in large sized or anteromedullary located lesions. We present a surgical video of C3 antero located meningioma removed en bloc through a minimally invasive approach. The patient signed a written consent to publish video, recording, photograph, image, illustration, and/or information about him.

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