Corridor-Based Endonasal Endoscopic Surgery for Pediatric Skull Base Pathology With Detailed Radioanatomic Measurements

2013 ◽  
Vol 10 (2) ◽  
pp. 273-293 ◽  
Author(s):  
Matei A. Banu ◽  
Allison Rathman ◽  
Kunal S. Patel ◽  
Mark M. Souweidane ◽  
Vijay K. Anand ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Pediatric Population ◽  
Visual Fields ◽  
Age Groups ◽  
Cerebrospinal Fluid Leak ◽  
Gross Total Resection ◽  
Benign Tumors ◽  
Minimal Risk ◽  
Total Resection

Abstract BACKGROUND: Pediatric anatomy is more restricted, and the propagation of endonasal endoscopic approaches in the pediatric population has been limited. OBJECTIVE: To demonstrate the feasibility of the endonasal endoscopic approach in a variety of age groups and to perform measurements of the corridors and spaces available for surgery as a guide for case selection. METHODS: Only patients <18 years were included. The choice of operative corridor/approach is described in relation to pathological entity and location. Preoperative/postoperative visual fields and endocrine panels, extent of resection, as well as postoperative long-term complications are described. Prospective magnetic resonance image-based anatomic measurements of key distances were performed to determine age-dependent surgical indications and limitations. RESULTS: Forty purely endoscopic procedures were performed in 33 pediatric patients (5-18 years of age) harboring a variety of skull base lesions, from benign tumors to congenital malformations. For the 20 patients in whom gross total resection was the intended goal of surgery, gross total resection was attained in 15 (75%). There were 2 infections (5%) and no cerebrospinal fluid leaks. Significant improvement was shown in 58.3% of patients with visual deficits. Hormone overproduction resolved in 75% of patients, while preoperative hormone insufficiency only improved in 29.2%. Wider intercarotid distance at the superior clivus (P = .01) and shorter nare-dens working distance (P = .001) predicted improved outcomes and fewer postoperative complications. CONCLUSION: Endonasal endoscopic skull base approaches are viable in the pediatric population, they are not impeded by sphenoid sinus aeration, and they have minimal risk of cerebrospinal fluid leak and meningitis. Outcomes and complications can be predicted based on specific radio anatomical skull base measurements rather than age.

scholarly journals 795 Trends in Cerebrospinal Fluid Leak Rates Following the Extended Endoscopic Endonasal Approach for Anterior Skull Base Meningioma: A Meta-Analysis Over the Last 20 Years

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A H Zamanipoor Najafabadi ◽  
D Z Khan ◽  
I S Muskens ◽  
M L D Broekman ◽  
N L Dorward ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Arterial Injury ◽  
Gross Total Resection ◽  
Csf Leak ◽  
Total Resection ◽  
Visual Improvement ◽  
The Impact ◽  
Reconstructive Techniques ◽  
Over Time

Abstract Introduction The extended endoscopic approach (EEA) provides direct access for resection of tuberculum sellae (TSM) and olfactory groove meningiomas (OGM) but is associated with cerebrospinal fluid (CSF) leak in up to 25% of patients. To evaluate the impact of improved skull base reconstructive techniques, we assessed published CSF leak percentages in EEA over the last two decades. Method Random-effects meta-analyses were performed for studies published between 2004-2020. Outcomes assessed were CSF leak, gross total resection, visual improvement, intraoperative arterial injury and 30-day mortality. For the main analyses, publications were pragmatically grouped based on publication year in three categories: 2004-2010, 2011-2015, and 2016-2020. Results We included 29 studies describing 540 TSM and 115 OGM patients. CSF leak incidence dropped over time from 22% (95% CI: 6-43%) in studies published between 2004 and 2010, to 16% (95% CI: 11-23%) between 2011 and 2015, and 4% (95% CI: 1-9%) between 2016 and 2020. Outcomes of gross total resection, visual improvement, intraoperative arterial injury, and 30-day mortality remained stable over time Conclusions We report a noticeable decrease in CSF leak over time, which might be attributed to the development of reconstructive techniques (e.g., hadad bassagasteguy flap, and gasket seal), refined multilayer repair protocols, and selected lumbar drain usage.

scholarly journals Resection of a Lumbar Intradural Extramedullary Schwannoma: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Michael J Strong ◽  
Timothy J Yee ◽  
Siri Sahib S Khalsa ◽  
Yamaan S Saadeh ◽  
Whitney E Muhlestein ◽  
...  
Keyword(s):  
Spinal Nerve ◽  
Gross Total Resection ◽  
Preoperative Imaging ◽  
Benign Tumors ◽  
Total Resection ◽  
Intradural Tumor ◽  
Key Points ◽  
Intraoperative Fluoroscopy ◽  
Patient Consent ◽  
Intradural Extramedullary

Abstract Schwannomas are typically benign tumors that arise from the sheaths of nerves in the peripheral nervous system. In the spine, schwannomas usually arise from spinal nerve roots and are therefore extramedullary in nature. Surgical resection-achieving a gross total resection, is the main treatment modality and is typically curative for patients with sporadic tumors. In this video, we present the case of a 38-yr-old male with worsening left leg radiculopathy, found to have a lumbar schwannoma. Preoperative imaging demonstrated that the tumor was at the level of L4-L5. A laminectomy at this level was performed with gross total resection of the tumor. The key points of the video include use of intraoperative fluoroscopy to confirm surgical level and help plan surgical exposure, use of ultrasound for intradural tumor localization, and advocating for maximum safe resection using neurostimulation. The patient tolerated the surgery well without any complications. He was discharged home with no additional therapy needed. Appropriate patient consent was obtained.

scholarly journals Transcavernous Resection of a Giant Extensive Chondrosarcoma with Endoscopic Assistance

2021 ◽  
Author(s):  
Walid Elshamy ◽  
Burcak Soylemez ◽  
Sima Sayyahmelli ◽  
Nese Keser ◽  
Mustafa K. Baskaya
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Gross Total Resection ◽  
Petrous Apex ◽  
Left Internal Carotid Artery ◽  
Total Resection ◽  
Complete Occlusion ◽  
Grade Ii

AbstractChondrosarcomas are one of the major malignant neoplasms which occur at the skull base. These tumors are locally invasive. Gross total resection of chondrosarcomas is associated with longer progression-free survival rates. The patient is a 55-year-old man with a history of dysphagia, left eye dryness, hearing loss, and left-sided facial pain. Magnetic resonance imaging (MRI) showed a giant heterogeneously enhancing left-sided skull base mass within the cavernous sinus and the petrous apex with extension into the sphenoid bone, clivus, and the cerebellopontine angle, with associated displacement of the brainstem (Fig. 1). An endoscopic endonasal biopsy revealed a grade-II chondrosarcoma. The patient was then referred for surgical resection. Computed tomography (CT) scan and CT angiogram of the head and neck showed a left-sided skull base mass, partial destruction of the petrous apex, and complete or near-complete occlusion of the left internal carotid artery. Digital subtraction angiography confirmed complete occlusion of the left internal carotid artery with cortical, vertebrobasilar, and leptomeningeal collateral development. The decision was made to proceed with a left-sided transcavernous approach with possible petrous apex drilling. During surgery, minimal petrous apex drilling was necessary due to autopetrosectomy by the tumor. Endoscopy was used to assist achieving gross total resection (Fig. 2). Surgery and postoperative course were uneventful. MRI confirmed gross total resection of the tumor. The histopathology was a grade-II chondrosarcoma. The patient received proton therapy and continues to do well without recurrence at 4-year follow-up. This video demonstrates steps of the combined microsurgical skull base approaches for resection of these challenging tumors.The link to the video can be found at: https://youtu.be/WlmCP_-i57s.

scholarly journals Transcavernous Approach for Gross Total Resection of a Dumbbell-Shaped Giant Trigeminal Schwannoma

2021 ◽  
Author(s):  
Sima Sayyahmelli ◽  
Emel Avci ◽  
Burak Ozaydin ◽  
Mustafa K. Başkaya
Keyword(s):  
Skull Base ◽  
Cavernous Sinus ◽  
Tumor Resection ◽  
Mass Effect ◽  
World Health ◽  
Gross Total Resection ◽  
Petrous Apex ◽  
Total Resection ◽  
Who Grade ◽  
Trigeminal Schwannoma

AbstractTrigeminal schwannomas are rare nerve sheet tumors that represent the second most common intracranial site of occurrence after vestibular nerve origins. Microsurgical resection of giant dumbbell-shaped trigeminal schwannomas often requires complex skull base approaches. The extradural transcavernous approach is effective for the resection of these giant tumors involving the cavernous sinus.The patient is a 72-year-old man with headache, dizziness, imbalance, and cognitive decline. Neurological examination revealed left-sided sixth nerve palsy, a diminished corneal reflex, and wasting of temporalis muscle. Magnetic resonance imaging (MRI) showed a giant homogeneously enhancing dumbbell-shaped extra-axial mass centered within the left cavernous sinus, Meckel's cave, and the petrous apex, with extension to the cerebellopontine angle. There was a significant mass effect on the brain stem causing hydrocephalus. Computed tomography (CT) scan showed erosion of the petrous apex resulting in partial anterior autopetrosectomy (Figs. 1 and 2).The decision was made to proceed with tumor resection using a transcavernous approach. Gross total resection was achieved. The surgery and postoperative course were uneventful, and the patient woke up the same as in the preoperative period. MRI confirmed gross total resection of the tumor. The histopathology was a trigeminal schwannoma, World Health Organization (WHO) grade I. The patient continues to do well without any recurrence at 15-month follow-up.This video demonstrates important steps of the microsurgical skull base techniques for resection of these challenging tumors.The link to the video can be found at https://youtu.be/TMK5363836M

scholarly journals Crayon in the Orbit and Sinuses in a Pediatric Patient

2021 ◽  
pp. 014556132110185
Author(s):  
Michela Borrelli ◽  
Kristen A. Echanique ◽  
Jeffrey Koempel ◽  
Elisabeth H. Ference
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Pediatric Patient ◽  
Cerebrospinal Fluid Leak ◽  
Ethmoid Sinus ◽  
Rare Occurrence ◽  
Lamina Papyracea ◽  
The Right ◽  
Fluid Leak ◽  
Type Of Injury

Penetrating transorbital injury with skull base involvement is a rare occurrence from a crayon. We report a case of a 2-year-old male who sustained a penetrating crayon injury through the right orbit and lamina papyracea into the posterior ethmoid sinus complicated by cerebrospinal fluid leak. There have been no other reported cases of this type of injury by a crayon.

The Challenge of Skull Base Closure: Methods for Reducing Postoperative Cerebrospinal Fluid Leak

2019 ◽  
Vol 124 ◽  
pp. 502-512
Author(s):  
Christian P. Soneru ◽  
Charles A. Riley ◽  
Abtin Tabaee ◽  
Ashutosh Kacker ◽  
Vijay K. Anand ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Cerebrospinal Fluid Leak ◽  
Base Closure ◽  
Fluid Leak

scholarly journals Pediatric skull base reconstruction: case report of a tunneled temporoparietal fascia flap

2016 ◽  
Vol 17 (3) ◽  
pp. 371-377 ◽  
Author(s):  
Jeffrey C. Rastatter ◽  
Patrick C. Walz ◽  
Tord D. Alden
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
Cerebrospinal Fluid Leak ◽  
Nasoseptal Flap ◽  
Pediatric Case ◽  
Clival Chordoma ◽  
Temporoparietal Fascia ◽  
Temporoparietal Fascia Flap ◽  
Fluid Leak ◽  
Fascia Flap

The authors of this report present a pediatric case involving the use of a tunneled temporoparietal fascia flap to reconstruct a skull base defect for a multiply recurrent clival chordoma and cerebrospinal fluid leak, demonstrate the surgical technique through illustrations and intraoperative photos, and review the pertinent literature. A 9-year-old female patient underwent extensive clival chordoma resection via both the endoscopic and open approaches, which ultimately exhausted the bilateral nasoseptal flaps and other intranasal reconstructive options. Following proton beam radiation and initiation of chemotherapy, tumor recurrence was managed with further endoscopic resection, which was complicated by a recalcitrant cerebrospinal fluid leak. A tunneled temporoparietal fascia flap was used to provide vascular tissue to augment an endoscopic repair of the leak and reconstruction of the skull base. While the nasoseptal flap remains the workhorse for many pediatric and adult endoscopic skull base reconstructions, the tunneled temporoparietal fascia flap has a demonstrated efficacy in adults when the nasoseptal flap and other intranasal flaps are unavailable. This report documents a pediatric case, serving as a step toward establishing this technique in the pediatric population.

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