scholarly journals Extradural Extranasal Combined Transmaxillary Transsphenoidal Approach to the Cavernous Sinus: A Minimally Invasive Microsurgical Model

2000 ◽  
Vol 110 (2) ◽  
pp. 286-286 ◽  
Author(s):  
Ibrahim Sabit ◽  
Steven D. Schaefer ◽  
William T. Couldwell
Keyword(s):  
Minimally Invasive ◽  
Cavernous Sinus ◽  
Transsphenoidal Approach

scholarly journals Endoscopic Endonasal Transethmoidal-Transsphenoidal Approach to a Cavernous Sinus Chondrosarcoma

2021 ◽  
Author(s):  
Gianluca Agresta ◽  
Alberto Campione ◽  
Fabio Pozzi ◽  
Pierlorenzo Veiceschi ◽  
Martina Venturini ◽  
...  
Keyword(s):  
Skull Base ◽  
Cavernous Sinus ◽  
Conformal Radiotherapy ◽  
Residual Tumor ◽  
Complete Recovery ◽  
Tumor Location ◽  
Transsphenoidal Approach ◽  
Low Grade ◽  
Endoscopic Endonasal ◽  
Skull Base Reconstruction

Abstract Objective We illustrate a cavernous sinus chondrosarcoma treated with an endoscopic endonasal transethmoidal-transsphenoidal approach. Design Case report of a 15-year-old girl with diplopia and esotropia due to complete abducens palsy. Preoperative images showed a right cavernous sinus lesion with multiple enhanced septa and intralesional calcified spots (Fig. 1). Considering tumor location and the lateral dislocation of the carotid artery, an endoscopic endonasal approach was performed to relieve symptoms and to optimize the target geometry for adjuvant conformal radiotherapy. Setting The study was conducted at University of Insubria, Department of Neurosurgery, Varese, Italy. Participants Skull base team was participated in the study. Main Outcome Measures A transethmoidal-transsphenoidal approach was performed by using a four-hand technique. We used a route lateral to medial turbinate to access ethmoid and the sphenoid sinus. During the sphenoid phase, we exposed the medial wall of the cavernous sinus (Fig. 2) and the lesion was then removed using curette. Skull base reconstruction was performed with fibrin glue and nasoseptal flap. Results No complications occurred after surgery, and the patient experienced a complete recovery of symptoms. A postoperative magnetic resonance imaging showed a small residual tumor inside the cavernous sinus (Fig. 1). After percutaneous proton-bean therapy, patient experienced only temporary low-grade toxicity with local control within 2 years after treatment completion. Conclusion Endoscopic endonasal extended approach is a safe and well-tolerated procedure that is indicated in selected cases (intracavernous tumors, soft tumors not infiltrating the vessels and/or the nerves). A tailored approach according to tumor extension is crucial for the best access to the compartments involved.The link to the video can be found at: https://youtu.be/TsqXjqpuOws.

scholarly journals Transorbital penetrating injury of the skull base and cavernous sinus - defining a minimal invasive treatment

2020 ◽  
pp. 106-106
Author(s):  
Bojan Jelaca ◽  
Djula Djilvesi ◽  
Papic Vladimir ◽  
Filip Pajicic ◽  
Milan Lepic ◽  
...  
Keyword(s):  
Foreign Body ◽  
Minimally Invasive ◽  
Skull Base ◽  
Cavernous Sinus ◽  
Penetrating Trauma ◽  
Minimal Invasive ◽  
Surgical Approaches ◽  
Invasive Treatment ◽  
Minimal Invasive Treatment ◽  
Therapeutic Problem

Introduction. A transorbital intracranial injury with a foreign body can be a very complex and controversial therapeutic problem. The orbit's content is susceptible to penetrating trauma, and neurovascular skull base structures are at high risk from injury. There are some traditional cranial surgical approaches, and more recently reported different endoscopic approaches for treating this kind of injury. Case report. We present a case of a 30-year-old male who had an accident at work when a piece of wood hit him in his head and entered through the medial aspect of his left orbit with skull base and cavernous sinus injury. Rapid and complete radiological and clinical assessments were performed, and the patient was treated in a minimally invasive manner. The foreign body was manually extracted with an endoscopic and endovascular team ready to treat adverse events. No postoperative complications were reported, and visual acuity increased at one month follow up. Conclusion. Penetrating wounds of the orbit represent a challenge that requires a multidisciplinary assessment and well-organized management. Combined endoscopic minimally invasive approaches should be considered during the treatment of this kind of injury.

Endoscopic Transsphenoidal, Transclival Resection of an Enterogenous Cyst Located Ventral to the Brainstem: Case Report

2010 ◽  
Vol 67 (suppl_2) ◽  
pp. onsE522-onsE526
Author(s):  
William S. Cobb ◽  
Gregor Makosch ◽  
Vijay K. Anand ◽  
Theodore H. Schwartz
Keyword(s):  
Minimally Invasive ◽  
Posterior Fossa ◽  
Cranial Nerves ◽  
Transsphenoidal Approach ◽  
Direct Access ◽  
Invasive Technique ◽  
Enterogenous Cyst ◽  
Gadolinium Contrast ◽  
Endoscopic Endonasal ◽  
Prepontine Cistern

ABSTRACT BACKGROUND AND IMPORTANCE: Enterogenous cysts are rare tumors found most commonly in the spine, but they have also been reported intracranially. Cases of enterogenous cysts located within the posterior fossa have traditionally been resected via difficult craniotomies that require prolonged retraction and risk injury to cranial nerves. We describe a method for resection of an enterogenous cyst located anterior to the brainstem via the endoscopic transsphenoidal approach. CLINICAL PRESENTATION: A 37-year-old man was found to have a 2-cm mass anterior to the brainstem during routine screening after a trauma. The mass was located within the prepontine cistern, enhanced with gadolinium contrast, and showed no restrictive diffusion. This lesion was most consistent with an enterogenous cyst. A minimally invasive endoscopic endonasal transsphenoidal transclival approach was performed for gross total resection of the tumor. CONCLUSION: We discuss the endoscopic transsphenoidal approach used for the resection of an enterogenous cyst in the posterior fossa anterior to the brainstem. The transsphenoidal approach provides direct access to lesions in this location using a minimally invasive technique while avoiding excessive brain retraction or injury to cranial nerves. In addition, we provide an updated review of the literature for enterogenous cysts located within the posterior fossa.

scholarly journals Minimally Invasive Subtemporal Intradural Approach for Penetrating Orbitocranial Injury by Wooden Foreign Body Into the Lateral Wall of the Cavernous Sinus

2020 ◽  
Vol 7 ◽  
Author(s):  
Elad Avraham ◽  
Alexander Smolikov ◽  
Rozalia Smolyakov ◽  
Amit Azriel ◽  
Yuval Sufaro ◽  
...  
Keyword(s):  
Foreign Body ◽  
Minimally Invasive ◽  
Cavernous Sinus ◽  
Lateral Wall ◽  
Wooden Foreign Body

Extended transsphenoidal approach for pituitary adenomas invading the anterior cranial base, cavernous sinus, and clivus: a single-center experience with 126 consecutive cases

2010 ◽  
Vol 112 (1) ◽  
pp. 108-117 ◽  
Author(s):  
Bing Zhao ◽  
Yu-Kui Wei ◽  
Gui-Lin Li ◽  
Yong-Ning Li ◽  
Yong Yao ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Tumor Resection ◽  
Cranial Base ◽  
Transsphenoidal Approach ◽  
Preoperative Imaging ◽  
Surgical Removal ◽  
Extended Transsphenoidal Approach ◽  
Anterior Cranial Base

Object The standard transsphenoidal approach has been successfully used to resect most pituitary adenomas. However, as a result of the limited exposure provided by this procedure, complete surgical removal of pituitary adenomas with parasellar or retrosellar extension remains problematic. By additional bone removal of the cranial base, the extended transsphenoidal approach provides better exposure to the parasellar and clival region compared with the standard approach. The authors describe their surgical experience with the extended transsphenoidal approach to remove pituitary adenomas invading the anterior cranial base, cavernous sinus (CS), and clivus. Methods Retrospective analysis was performed in 126 patients with pituitary adenomas that were surgically treated via the extended transsphenoidal approach between September 1999 and March 2008. There were 55 male and 71 female patients with a mean age of 43.4 years (range 12–75 years). There were 82 cases of macroadenoma and 44 cases of giant adenoma. Results Gross-total resection was achieved in 78 patients (61.9%), subtotal resection in 43 (34.1%), and partial resection in 5 (4%). Postoperative complications included transient cerebrospinal rhinorrhea (7 cases), incomplete cranial nerve palsy (5), panhypopituitarism (5), internal carotid artery injury (2), monocular blindness (2), permanent diabetes insipidus (1), and perforation of the nasal septum (2). No intraoperative or postoperative death was observed. Conclusions The extended transsphenoidal approach provides excellent exposure to pituitary adenomas invading the anterior cranial base, CS, and clivus. This approach enhances the degree of tumor resection and keeps postoperative complications relatively low. However, radical resection of tumors that are firm, highly invasive to the CS, or invading multidirectionally remains a big challenge. This procedure not only allows better visualization of the tumor and the neurovascular structures but also provides significant working space under the microscope, which facilitates intraoperative manipulation. Preoperative imaging studies and new techniques such as the neuronavigation system and the endoscope improve the efficacy and safety of tumor resection.

Ultrasonic aspiration in neuroendoscopy: first results with a new tool

2008 ◽  
Vol 109 (5) ◽  
pp. 908-911 ◽  
Author(s):  
Joachim Oertel ◽  
Joachim Kurt Krauss ◽  
Michael Robert Gaab
Keyword(s):  
Minimally Invasive ◽  
Endoscopic Resection ◽  
Obstructive Hydrocephalus ◽  
Time Frame ◽  
Brain Parenchyma ◽  
Transsphenoidal Approach ◽  
Endoscopic Procedures ◽  
First Results ◽  
Endoscopic Application ◽  
Pituitary Macroadenomas

Neuroendoscopic techniques are often considered inapplicable to lesion resection because most lesions are too large for effective endoscopic resection in an appropriate time frame. To evaluate the potential of ultrasonic aspiration in neuroendoscopic procedures, the authors developed a new handpiece for endoscopic application. The instrument was subsequently tested in 10 cadaveric pig brains and applied in 5 clinical cases. In the pig brain, a precise and accurate aspiration of ventricular ependyma and brain parenchyma was obtained. Clinically, the device was applied in 3 patients with obstructive hydrocephalus, and via an endonasal transsphenoidal approach in 2 patients with pituitary macroadenomas. In all cases, the lesion was effectively aspirated without complications. Ultrasonic aspiration can be applied safely and successfully in selected endoscopic procedures. The use of this technique could expand the indications for endoscopic approaches to include intraventricular lesions and in minimally invasive transsphenoidal endonasal approaches.

Transsphenoidal approach to infrasellar tumors involving the cavernous sinus

1990 ◽  
Vol 73 (4) ◽  
pp. 513-517 ◽  
Author(s):  
Nobuo Hashimoto ◽  
Haruhiko Kikuchi
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Cranial Nerves ◽  
Transsphenoidal Approach ◽  
Skull Base Tumors ◽  
Content Type ◽  
Operating Field ◽  
Cranial Nerve Palsies ◽  
Operative Complications ◽  
Fine Print

✓ The authors review their 2-year experience with a rhinoseptal transsphenoidal approach to skull-base tumors of various pathologies involving both the sphenoid and cavernous sinuses. Eight patients with cranial nerve palsies attributable to compression of the contents of the cavernous sinus and/or optic canal are included in this report. Among these patients, a total of 17 cranial nerves were affected. Postoperative normalization was achieved in eight nerves, significant improvement in seven nerves, and no improvement in two nerves. There were no operative complications of aggravation of cranial nerve palsies in this series. In spite of the limited operating field, the results demonstrate the effectiveness and safety of this approach. The authors recommend that this approach be considered before more aggressive surgery is undertaken.

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