Endoscopic Endonasal Minimal Access Approach to the Clivus: Case Series and Technical Nuances

2010 ◽  
Vol 67 (3) ◽  
pp. ons150-ons158 ◽  
Author(s):  
Justin F. Fraser ◽  
Gurston G. Nyquist ◽  
Nicholas Moore ◽  
Vijay K. Anand ◽  
Theodore H. Schwartz
Keyword(s):  
Skull Base ◽  
Case Series ◽  
Extent Of Resection ◽  
Csf Leak ◽  
Minimal Access ◽  
Endoscopic Endonasal ◽  
Vein Thrombosis ◽  
Lumbar Drain ◽  
Deep Vein

Abstract BACKGROUND: The endoscopic endonasal transclival approach is a novel minimal-access method of managing clival pathology. Limited cases have been published. OBJECTIVE: To summarize our clinical experience with this approach and discuss technical nuances. METHODS: We retrospectively reviewed a prospective database of 250 endoscopic, endonasal skull base surgeries. Patients in whom a transclival approach was performed were identified. Extent of resection, complications, and clinical outcome were analyzed. RESULTS: Seventeen patients underwent 21 procedures. Pathology included chordoma, meningioma, hemangiopericytoma, enterogenous cyst, epidermoid, and metastasis. Lumbar drain was placed intraoperatively in 9 cases and maintained for goal. The risk of postoperative CSF leak was 4.8% for all procedures, 9.1% for procedures with large skull base defect, and 0% if a gasket-seal closure was achieved. A nasoseptal flap was used in 2 patients. There was one perioperative infarct, one case of deep vein thrombosis, and one postoperative pulmonary embolus. Mean follow-up was 8.5 months. All but one patient with preoperative cranial nerve deficits improved at last follow-up. All patients were free of disease progression at last follow-up. CONCLUSIONS: The endonasal endoscopic transclival approach provides a minimal-access approach to the ventral midline posterior fossa skull base. The risk of CSF leak is low if appropriate closure techniques are applied.

scholarly journals Does lumbar drainage reduce postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery? A prospective, randomized controlled trial

2019 ◽  
Vol 131 (4) ◽  
pp. 1172-1178 ◽  
Author(s):  
Nathan T. Zwagerman ◽  
Eric W. Wang ◽  
Samuel S. Shin ◽  
Yue-Fang Chang ◽  
Juan C. Fernandez-Miranda ◽  
...  
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Controlled Trial ◽  
Csf Leak ◽  
Inclusion Criteria ◽  
Endoscopic Endonasal ◽  
Randomized Controlled ◽  
Lumbar Drain ◽  
Prospective Randomized Controlled Trial ◽  
Csf Leaks

OBJECTIVEBased on a null hypothesis that the use of short-term lumbar drainage (LD) after endoscopic endonasal surgery (EES) for intradural pathology does not prevent postoperative CSF leaks, a trial was conducted to assess the effect of postoperative LD on postoperative CSF leak following standard reconstruction.METHODSA prospective, randomized controlled trial of lumbar drain placement after endoscopic endonasal skull base surgery was performed from February 2011 to March 2015. All patients had 3-month follow-up data. Surgeons were blinded to which patients would or would not receive the drain until after closure was completed. An a priori power analysis calculation assuming 80% of power, 5% postoperative CSF leak rate in the no-LD group, and 16% in the LD group determined a planned sample size of 186 patients. A routine data and safety check was performed with every 50 patients being recruited to ensure the efficacy of randomization and safety. These interim tests were run by a statistician who was not blinded to the arms they were evaluating. This study accrued 230 consecutive adult patients with skull base pathology who were eligible for endoscopic endonasal resection. Inclusion criteria (high-flow leak) were dural defect greater than 1 cm2 (mandatory), extensive arachnoid dissection, and/or dissection into a ventricle or cistern. Sixty patients were excluded because they did not meet the inclusion criteria. One hundred seventy patients were randomized to either receive or not receive a lumbar drain.RESULTSOne hundred seventy patients were randomized, with a mean age of 51.6 years (range 19–86 years) and 38% were male. The mean BMI for the entire cohort was 28.1 kg/m2. The experimental cohort with postoperative LD had an 8.2% rate of CSF leak compared to a 21.2% rate in the control group (odds ratio 3.0, 95% confidence interval 1.2–7.6, p = 0.017). In 106 patients in whom defect size was measured intraoperatively, a larger defect was associated with postoperative CSF leak (6.2 vs 2.9 cm2, p = 0.03). No significant difference was identified in BMI between those with (mean 28.4 ± 4.3 kg/m2) and without (mean 28.1 ± 5.6 kg/m2) postoperative CSF leak (p = 0.79). Furthermore, when patients were grouped based on BMI < 25, 25–29.9, and > 30 kg/m2, no difference was noted in the rates of CSF fistula (p = 0.97).CONCLUSIONSAmong patients undergoing intradural EES judged to be at high risk for CSF leak as defined by the study’s inclusion criteria, perioperative LD used in the context of vascularized nasoseptal flap closure significantly reduced the rate of postoperative CSF leaks.Clinical trial registration no.: NCT03163134 (clinicaltrials.gov).

Surgical Outcomes of Endoscopic Endonasal Surgery in 29 Patients with Craniopharyngioma

2020 ◽  
Author(s):  
Arad Iranmehr ◽  
Mostafa Esmaeilnia ◽  
Khashayar Afshari ◽  
Seyed Mousa Sadrehosseini ◽  
Azin Tabari ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Visual Outcome ◽  
Extent Of Resection ◽  
Csf Leak ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Pituitary Dysfunction ◽  
Before And After

Abstract Background Recently the endoscopic endonasal surgery (EES) has been introduced as a modality for the treatment of patients with craniopharyngiomas. In this study, we describe our initial experience in treatment of 29 patients with craniopharyngiomas using this approach. Methods Twenty-nine consecutive patients with craniopharyngiomas who had undergone EES in a 5-year period were studied retrospectively. Patients underwent preoperative and postoperative endocrinologic and ophthalmologic evaluations. Radiologic characteristics of tumors and extent of resection were determined. The recurrence and complications were evaluated. Results Pituitary and visual dysfunction were observed preoperatively in 89.7 and 86% of patients, respectively. After EES, visual outcome either showed an improvement or else remained unchanged in 92.3% of the cases; however, pituitary function remained unchanged and even got worsened in 34.6% of the cases. Prevalence of diabetes insipidus before and after surgery was 58.6 and 69.2%. The rate of gross total resection was 62%. Moreover, 86.2% of the tumors were almost totally resected (more than 95% of the tumor size resected). After surgery, cerebrospinal fluid (CSF) leak and meningitis occurred in four (13.8%) and two (6.9%) patients, respectively. Perioperative mortality was seen in two of the cases (6.9%). The mean follow-up was 25 months and tumor recurrence was discovered in four patients (15.3%). Conclusion The EES with the goal of maximal and safe tumor resection could be used for the treatment of most craniopharyngiomas. Although the rates of visual improvement and gross tumor resection are high, CSF leak, pituitary dysfunction, and meningitis are serious concerns.

scholarly journals Endoscopic endonasal resection of midline cranial base tumors

2018 ◽  
Vol 19 (2) ◽  
pp. 7-17
Author(s):  
Enrico De Divitiis ◽  
Felice Esposito ◽  
Paolo Cappabianca ◽  
Luigi M. Cavallo ◽  
Oreste De Divitiis ◽  
...  
Keyword(s):  
Skull Base ◽  
Cranial Base ◽  
Transsphenoidal Approach ◽  
Csf Leak ◽  
Endoscopic Endonasal ◽  
Visual Deficits ◽  
Extended Transsphenoidal Approach ◽  
Anterior Cranial Base ◽  
Subtotal Removal

Objective: The advent of the endoscope in transsphenoidalsurgery has permitted to expand the indications of such approach also for the treatment of on tumors located in supra, para, retro and infrasellar regions, enabling the neurosurgeon to work under direct visual control in a minimally invasive way. Since 2004 we have started to use the extended endonasal transsphenoidal approach for a variety of lesions involving the midline skull base and, in particular, the suprasellar area, the cavernous sinus and the retroclival prepontine region. Methods: Over a 36-month period, sixty-four procedures have been performed. The series consisted of 29 males and 35 females, aged from 24 to 80 years (median 49.8 years). The mean follow-up was of 18 months (ranging from 3 to 36 months). Among the patients with midline lesions, who were 90.6 % of the total, seven patients had a pituitary adenoma, sixteen patients were affected by a craniopharyngioma, six patients had a suprasellar Rathke’s cleft cyst, seven subjects had a tuberculum sellae meningioma, four had an olfactorygroove meningioma, and six a clival tumor. Other lesions ofthe midline skull base were, 1 chiasmatic astrocytoma, 1 neuroendocrine tumor, 4 post-traumatic cerebro-spinal fluid rhinorrhea, and one optic nerve glioma. Three other patients had anterior cranial base meningoencephaloceles. Results: Overall, gross total removal of the lesion was achieved in 30/49 tumoral lesions (61.2%); subtotal removal was achieved in 12/49 cases (24.5%). The three cases of meningoencephaloceles were all successfully treated. Among the patients with preoperative visual deficits, most of them fully recovered or improved and only two worsened in one eye. Major complications consisted in 2 deaths (one not directly related with the surgical procedure), 6 postoperative CSF leak (one complicated with bacterial meningitis), one ICA injury, and 6 cases of permanent diabetes insipidus.Conclusion: The extended transsphenoidal approach tothe supra and parasellar lesions seems Endoscopy; Transsphenoidal surgery; Extended approach; Parasellar; Tumors; Anterior skull base. A promising minimally invasivetechnique for the removal of lesions affecting these areas,once thought to be suitable only of the transcranial routes.Concerning the lesion removal and the recurrence rate compared with the transcranial routes, it is too early to pose a definitive word, since the follow-up is still too short.

scholarly journals Nasoseptal Flap for Skull Base Reconstruction in Children

2018 ◽  
Vol 79 (01) ◽  
pp. 037-041 ◽  
Author(s):  
Oded Ben-Ari ◽  
Anat Wengier ◽  
Barak Ringel ◽  
Narin Carmel Neiderman ◽  
Zvi Ram ◽  
...  
Keyword(s):  
Skull Base ◽  
Medical Center ◽  
Negative Influence ◽  
Csf Leak ◽  
Malignant Neoplasms ◽  
Craniofacial Growth ◽  
Endoscopic Endonasal ◽  
Skull Base Reconstruction ◽  
Female Ratio ◽  
Lumbar Drain

Objective The endoscopic endonasal approach is being increasingly used for the resection and reconstruction of anterior skull base (ASB) lesions. Vascularized nasoseptal flaps (NSF) have become the workhorse for the reconstruction of ASB defects, resulting in a significant decrease in the incidence of cerebrospinal fluid (CSF) leaks. The objective of this study was to investigate the efficacy and safety of NSF in children. Methods This is a retrospective analysis of the medical records of all patients under the age of 18 years who underwent endoscopic repair of ASB lesions with the use of NSF at our tertiary medical center between 1/2011 and 8/2016. Results Twelve children underwent ASB defect repair for both benign and malignant neoplasms using the endoscopic endonasal NSF technique. Four children had previously undergone ASB surgery. The male-to-female ratio was 1:1, the average age was 12.3 years, the average hospitalization time was 8.3 days, and the maximum follow-up period was 24 months, during which craniofacial growth appeared to be unimpaired. A lumbar drain was used postoperatively in six cases. Crust formation and synechia were observed in two cases. There was one case of a major long-term complication (a CSF leak followed by meningitis). Conclusions Endoscopic endonasal NSF was both an effective and a safe technique for ASB defect reconstruction in 12 children for both benign and malignant neoplasms. It had a high success rate and a low complication rate. No apparent negative influence on craniofacial growth was observed in our series.

P37 Do all notochordal lesions require proton beam radiotherapy? A case series of ecchordosis physaliphora

2019 ◽  
Vol 90 (3) ◽  
pp. e34.3-e33
Author(s):  
A Sooltangos ◽  
A Giamouriadis ◽  
S Barazi ◽  
K Barkas ◽  
N Thomas ◽  
...  
Keyword(s):  
Proton Beam ◽  
Clinical Course ◽  
Case Series ◽  
Proliferation Index ◽  
Csf Leak ◽  
Endoscopic Endonasal ◽  
Proton Beam Radiotherapy ◽  
Csf Fistula ◽  
Ecchordosis Physaliphora

ObjectivesEcchordosis physaliphora (EP) is a benign, usually asymptomatic, notochord tumour but may also present with a spontaneous CSF fistula. Differentiating EP from its more aggressive counterpart, chordoma is challenging but important as the clinical course and management differ significantly, with the latter requiring proton beam radiotherapy. This case series aims to further inform this discussion.DesignCase series.SubjectsPatients with suspected EP from 2015–2018.MethodsRetrospective analysis.ResultsSix patients were identified. Four presented with suspected CSF leak. MRI revealed a T1-hypointense and T2-hyperintense clival lesion without enhancement. CT showed pneumocephalus, a clival defect and no mass lesion. All underwent endoscopic endonasal repair of CSF fistula with biopsy. Histology revealed physaliphorous cells with no mitoses; immunohistochemistry confirmed notochord origin (EMA, S100, CD10 and/or MNF116) and low proliferation index. In 2 patients, EP was found incidentally on imaging and these lesions have remained static on follow-up.ConclusionsIn the absence of a clival mass, notochord remnant lesions with benign histopathology can be treated as EP and patients can avoid radiotherapy. The diagnosis of EP, however, remains challenging as no distinctive histopathological marker exists to differentiate it from chordoma and until a genetic or immunohistochemical marker is identified, the diagnosis rests solely on the presence or absence of a mass on imaging.

Endoscopic, Endonasal Resection of Craniopharyngiomas

Neurosurgery ◽  
2011 ◽  
Vol 70 (1) ◽  
pp. 110-124 ◽  
Author(s):  
Lewis Z. Leng ◽  
Jeffrey P. Greenfield ◽  
Mark M. Souweidane ◽  
Vijay K. Anand ◽  
Theodore H. Schwartz
Keyword(s):  
Csf Leak ◽  
Subtotal Resection ◽  
Consecutive Series ◽  
Tumor Diameter ◽  
Minimal Access ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Extended Transsphenoidal Approach

Abstract BACKGROUND The endoscopic, endonasal, extended transsphenoidal approach is a minimal-access technique for managing craniopharyngiomas. Outcome measures such as return to employment and body mass index (BMI) have not been reported and are necessary for comparison with open transcranial approaches. Most prior reports of the endoscopic, endonasal approach have reported unacceptably high cerebrospinal fluid (CSF) leak rates. OBJECTIVE To assess the outcome of endoscopic, endonasal surgery in a consecutive series of craniopharyngiomas with special attention to extent of resection, CSF leak, return to employment, and BMI. METHODS Twenty-six surgeries were performed on 24 patients at Weill Cornell Medical College-New York Presbyterian Hospital. Five patients had recurrent lesions. Gross-total resection (GTR) was attempted in 21 surgeries. Indications for intended subtotal resection were advanced age, medical comorbidities, preservation of pituitary function, and hypothalamic invasion. RESULTS Mean tumor diameter was 2.9 cm. GTR (18 surgeries) or near-total (&gt;95%) resection (2 surgeries) was achieved in 95% when GTR was the goal. Seven patients received postoperative radiation therapy. Mean follow-up was 35 months with no recurrences in GTR cases and stable disease in all patients at last follow-up. Vision improved in 77%. Diabetes insipidus and panhypopituitarism developed in 42% and 38%, respectively. A more than 9% increase in BMI occurred in 39%; 69% returned to their preoperative profession/schooling. The postoperative CSF leak rate was 3.8%. CONCLUSION Minimal-access, endoscopic, endonasal surgery for craniopharyngioma can achieve high rates of GTR with low rates of CSF leak. Return to employment and obesity rates are comparable to microscope-assisted transcranial and transsphenoidal reports.

The Use of Polydioxanone Plates for Endoscopic Skull Base Repair

2017 ◽  
Vol 31 (2) ◽  
pp. 122-126 ◽  
Author(s):  
Fahad Al-Asousi ◽  
Christopher Okpaleke ◽  
Anali Dadgostar ◽  
Amin Javer
Keyword(s):  
Skull Base ◽  
Tumor Resection ◽  
Case Series ◽  
Sinus Surgery ◽  
Csf Leak ◽  
Skull Base Tumor ◽  
Patient Reported ◽  
Sinonasal Tumor ◽  
Skull Base Defects

Background Many reconstructive techniques and materials have been reported for repair of skull base defects after sinonasal tumor excision, cerebrospinal fluid (CSF) leaks, and coverage of denuded bone. Synthetic materials have been developed for endoscopic skull base repair to avoid donor-site morbidity. Polydioxanone plate is a bioabsorbable implant designed for nasal septal reconstruction and has the ability to retain strength for at least 10 weeks and absorbs in 6 months. Objectives This study aimed to describe the use of polydioxanone plates in endoscopic skull base defect and CSF leak repair, and to describe our experience with the surgical technique and postoperative management. Methods This was a retrospective case series of patients who, between May 2013 and December 2015, underwent endoscopic sinus surgery and skull base repair for CSF leak or after excision of a skull base tumor by using polydioxanone plates. Patients who presented with sinonasal inflammatory disease or skull base tumors underwent endoscopic skull base repair by using polydioxanone plates in an underlay fashion and mucosal membrane grafts with or without adjuvant materials in an overlay fashion. The patients were reviewed at 6 days, 6 weeks, and 3 months after surgery. Postoperative adverse events, including CSF leak, infection, bleeding, headache, and graft failure, were recorded. Results The cases of seven patients (five women, two men; mean age, 53.9 years) were reviewed. Five patients underwent sinonasal tumor resection and two underwent repair for CSF leak. The mean (standard deviation) defect size was 16.4 ± 11.4 mm. There was no evidence of postoperative CSF leak, and lumbar drains were not used. One patient reported transient headache and facial pressure at the 6-week follow-up visit. The surgeons’ experience with polydioxanone plate placement, postoperative healing, and follow-up was satisfactory. Conclusion Polydioxanone could be used to achieve rigid repair of endoscopic skull base defects. These early results, although promising, require validation in clinical trials.

scholarly journals RARE-03. AGGRESSIVE RESECTION FOR PEDIATRIC CRANIOPHARYNGIOMAS VIA ENDOSCOPIC ENDONASAL APPROACH

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii442-iii442
Author(s):  
Hiroki Morisako ◽  
Takeo Goto ◽  
Hiroki Ohata ◽  
Hiroaki Sakamoto ◽  
Kenji Ohata
Keyword(s):  
Extent Of Resection ◽  
Cognitive Outcomes ◽  
Csf Leak ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Transcranial Approach ◽  
Surgical Modality

Abstract OBJECTIVE In recent years, the endoscopic endonasal approach (EEA) has been increasingly used for pediatric craniopharyngiomas. We here present our experience and the outcomes of the EEA resection of pediatric craniopharyngiomas. MATERIALS AND METHODS Between April 2014 and December 2019, 16 cases of pediatric craniopharyngiomas were operated at the Osaka city university (OCU) hospital. Eight patients were diagnosed with primary craniopharyngiomas while 8 had a recurrent tumor. There were 5 males and 11 females, with a mean age of 10.7 years (3–17 years). EEA was selected in all patients and a case of large muti-lobulated tumor was resected by combination of microscopic transcranial approach. RESULTS Gross total resection was achieved in 14 patients and near total resection in other 2. Post-op CSF leak occurred in 3 patients, which was treated with re-exploration. Pituitary stalk was preserved intraoperatively in 4 cases, and 15 patients developed diabetes insipidus and anterior hormonal replacement therapy was required in 15 patients at last follow-up. Visual improvement was noted in 4 patients while vision remained unchanged in the rest. Neuropsychological function status was preserved in all patients, and there was no new-onset obesity postoperatively. The mean follow-up duration was 35.1 months (2 – 69 months) and 4 of 8 recurrent cases had re-recurrence during this period, however there was no recurrent in 8 primary cases. CONCLUSIONS EEA should be the surgical modality of choice for treating pediatric craniopharyngiomas. It results in better visual and cognitive outcomes with a significantly increased extent of resection.

scholarly journals How long is the tail end of the learning curve? Results from 1000 consecutive endoscopic endonasal skull base cases following the initial 200 cases

2020 ◽  
pp. 1-11 ◽  
Author(s):  
Iyan Younus ◽  
Mina M. Gerges ◽  
Rafael Uribe-Cardenas ◽  
Peter F. Morgenstern ◽  
Mahmoud Eljalby ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Learning Curve ◽  
Skull Base ◽  
Case Series ◽  
Clinical Trial Design ◽  
Basilar Invagination ◽  
Csf Leak ◽  
Tumor Diameter ◽  
Endoscopic Endonasal ◽  
Dural Closure

OBJECTIVEEndoscopic endonasal approaches (EEAs) to the skull base have evolved over the last 20 years to become an essential component of a comprehensive skull base practice. Many case series show a learning curve from the earliest cases, in which the authors were inexperienced or were not using advanced closure techniques. It is generally accepted that once this learning curve is achieved, a plateau is reached with little incremental improvement. Cases performed during the early steep learning curve were eliminated to examine whether the continued improvement exists over the “tail end” of the curve.METHODSA prospectively acquired database of all EEA cases performed by the senior authors at Weill Cornell Medicine/NewYork-Presbyterian Hospital was reviewed. The first 200 cases were eliminated and the next 1000 consecutive cases were examined to avoid the bias created by the early learning curve.RESULTSOf the 1000 cases, the most common pathologies included pituitary adenoma (51%), meningoencephalocele or CSF leak repair (8.6%), meningioma (8.4%), craniopharyngioma (7.3%), basilar invagination (3.1%), Rathke’s cleft cyst (2.8%), and chordoma (2.4%). Use of lumbar drains decreased from the first half to the second half of our series (p <0.05) as did the authors’ use of fat alone (p <0.005) or gasket alone (p <0.005) for dural closure, while the use of a nasoseptal flap increased (p <0.005). Although mean tumor diameter was constant (on average), gross-total resection (GTR) increased from 60% in the first half to 73% in the second half (p <0.005). GTR increased for all pathologies but most significantly for chordoma (56% vs 100%, p <0.05), craniopharyngioma (47% vs 0.71%, p <0.05) and pituitary adenoma (67% vs 75%, p <0.05). Hormonal cure for secreting adenomas also increased from 83% in the first half to 89% in the second half (p <0.05). The rate of any complication was unchanged at 6.4% in the first half and 6.2% in the latter half of cases, and vascular injury occurred in only 0.6% of cases. Postoperative CSF leak occurred in 2% of cases and was unchanged between the first and second half of the series.CONCLUSIONSThis study demonstrates that contrary to popular belief, the surgical learning curve does not plateau but can continue for several years depending on the complexity of the endpoints considered. These findings may have implications for clinical trial design, surgical education, and patient safety measures.

scholarly journals Extended Endoscopic Endonasal Surgery to Ventral Skull Base Lesions

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A S Montaser ◽  
M S Ismail ◽  
O Y Hammad ◽  
Z Y Fayed ◽  
D M Prevedello
Keyword(s):  
Skull Base ◽  
Skull Base Surgery ◽  
Direct Access ◽  
Csf Leak ◽  
Endoscopic Endonasal ◽  
Invasive Approach ◽  
Skull Base Lesions ◽  
The Mean ◽  
Ventral Skull Base

Abstract Introduction In the last two decades, Endoscopic endonasal approaches (EEAs) have undergone a significant evolution with a major shift from a transsellar approach to a variety of approaches that can directly access the midline and paramedian ventral skull base. Once the technical feasibility of any surgical approach is established; its safety (assessed through complications), and treatment outcomes (assessed through long-term follow-up) should be addressed. Aim of the Study To assess the feasibility, safety, and efficacy of EEA as a minimally invasive approach to ventral skull base lesions. Methodology and Materials this is a prospective observational study of group of 30 patients with ventral skull base lesions that were managed via endoscopic endonasal approaches. All patients’ clinical data, radiographic evaluations, procedural detail, complications, and follow-up data were recorded and analyzed. Results The mean age of patients was 50.8 years (range: 18-74 years), with a male:female ration of 1:1.72. The most commonly encountered pathological entities in the cohort was meningiomas (43.3%), pituitary adenomas (23.3%). and craniopharyngiomas (13.3%). Postoperative CSF leak was observed in 6.6% of cases and was managed successfully. There were no cases with postoperative infection in the cohort. Other procedure-related complications include transient diabetes insipidus (10%), pneumocephaly (3.3%), Syndrome of inappropriate ADH secretion (3.3%). Gross total resection was achieved in 93.3% of cases. Improvement of preoperative symptoms was recorded in 89.2% of cases. The mean follow-up duration was 17.8 ± 2.7 months. Conclusion EEAs provide direct access and better visualization to the ventral skull base without brain retraction and with minimal neurovascular manipulation, leading to less morbidity and mortality. EEA can be considered a feasible, safe, and effective tool on the armamentarium of skull base surgery. EEAs should not be considered as a replacement to the traditional transcranial approaches; rather. EEAs are deemed as a complementary route and a potential alternative to conventional skull base surgery in select cases.

Sign in / Sign up

Export Citation Format

Share Document