Endoscopic Transsphenoidal Approach for Resection of Malignant Pituitary Blastoma in an 18-Month-Old Infant: A Technical Note

2014 ◽  
Vol 10 (4) ◽  
pp. 649-653 ◽  
Author(s):  
Malik Zaben ◽  
Mohsin Zafar ◽  
Shafqat Bukhari ◽  
Paul Leach ◽  
Charoline Hayhurst
Keyword(s):  
Malignant Tumor ◽  
Intraoperative Complications ◽  
Tumor Resection ◽  
Cerebrospinal Fluid Leak ◽  
Technical Note ◽  
Transsphenoidal Approach ◽  
Nasoseptal Flap ◽  
Endoscopic Endonasal ◽  
One Year ◽  
Fluid Leak

Abstract BACKGROUND: Sella and suprasellar tumors are increasingly managed via an endoscopic transsphenoidal approach, but infant endoscopic surgery has not been reported. Pituitary blastoma is a rare sellar malignant tumor that primarily occurs in infants and is managed by surgical resection (cytoreduction) followed by adjuvant therapy. OBJECTIVE: To describe the technique and feasibility of resection of a pituitary blastoma via endoscopic endonasal transsphenoidal approach in an 18-month-old infant. METHODS: Endoscopic endonasal transsphenoidal approach for resection of a pituitary malignant tumor in an infant. RESULTS: Near-total tumor resection was achieved. The skull base was reconstructed by using a nasoseptal flap with no cerebrospinal fluid leak or any other intraoperative complications. The postoperative course was uneventful. One-year follow-up showed complete resolution of the tumor. CONCLUSION: The endoscopic endonasal transsphenoidal approach with nasoseptal flap reconstruction could be used as a safe, yet minimally invasive and innovative technique for the resection of pituitary blastoma in infants.

scholarly journals Concerns of cerebrospinal fluid leak in aggressive expanded endonasal endoscopic approach for craniopharyngiomas

2020 ◽  
Vol 10 (4) ◽  
pp. 154-156
Author(s):  
Marlon Ortiz Machín ◽  
Omar López Arbolay
Keyword(s):  
Cerebrospinal Fluid ◽  
Third Ventricle ◽  
Cerebrospinal Fluid Leak ◽  
Endoscopic Approach ◽  
Csf Leak ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Nasoseptal Flap ◽  
Endoscopic Endonasal ◽  
Fluid Leak

Cerebrospinal fluid leak represents a frequent complication in Craniopharyngioma´s Endoscopic Endonasal Approach. A descriptive observational investigation was performed in 50 adult patients operated of Craniopharyngiomas by aggressive Expanded Endonasal Endoscopic Approach (EEEA) in “Hermanos Ameijeiras” Hospital since 2010 to 2019 using nasoseptal flap. The 14% of all patients develop CSF leak and 85,7 % of these cases had a great communication into third ventricle creating a cisternoventricular space. Was identified relation with tumor size, hypothalamic invasion and adhesion strength of tumour. Surgical cavity suffered hydrostatic and hydrodynamic pression than lead to CSF leak independent of multilayer reparation.

The Endoscopic Extended Transsphenoidal Approach for Craniopharyngiomas

2006 ◽  
Vol 59 (suppl_1) ◽  
pp. ONS-75-ONS-83 ◽  
Author(s):  
Giorgio Frank ◽  
Ernesto Pasquini ◽  
Francesco Doglietto ◽  
Diego Mazzatenta ◽  
Vittorio Sciarretta ◽  
...  
Keyword(s):  
Case Reports ◽  
Cerebrospinal Fluid Leak ◽  
Endocrine Function ◽  
Transsphenoidal Approach ◽  
Endoscopic Endonasal ◽  
Extended Transsphenoidal Approach ◽  
Radical Removal ◽  
The Mean ◽  
Fluid Leak

Abstract OBJECTIVE: The endoscope has recently been applied to the supradiaphragmatic transsphenoidal approach, but only case reports dealing with different pathological features have been described. The authors present their experience with this technique in 10 patients with craniopharyngiomas. METHODS: A pure endoscopic endonasal technique was used. From November 1998 through May 2005, four males and six females with a craniopharyngioma, either purely supradiaphragmatic (six patients) or with a significant suprasellar component (four patients), were treated. The tumors had a mean diameter of 2.9 cm (range, 1–4 cm); four patients had a major prechiasmatic component and six had a retrochiasmatic one. RESULTS: Seven total, one subtotal, and two partial resections were obtained. Vision symptoms improved significantly in six out of eight patients. Endocrine function did not improve after surgery, and diabetes insipidus was the most frequent deficit, although it was transient in five out of eight patients. Cerebrospinal fluid leak was the most frequent complication and required reoperation in two patients. Postoperative obesity occurred in two patients. No recurrence has yet been documented in the total resection group. The mean follow-up period is 37 months (range, 3–75 mo). CONCLUSION: The endoscopic technique allows results comparable with the best microscopic series. We think that this technique increases the safety of the procedure because of improved vision. Further studies are required to better define the exact location of the tumor with respect to the arachnoidal plane, the extra-arachnoidal craniopharyngioma being the most suitable for a radical removal using a transsphenoidal supradiaphragmatic approach.

Ultrasonic BoneScalpel for Osteoplastic Laminoplasty in the Resection of Intradural Spinal Pathology: Case Series and Technical Note

2012 ◽  
Vol 73 (suppl_1) ◽  
pp. ons61-ons66 ◽  
Author(s):  
Scott L. Parker ◽  
Ryan M. Kretzer ◽  
Pablo F. Recinos ◽  
Camilo A. Molina ◽  
Jean-Paul Wolinsky ◽  
...  
Keyword(s):  
Soft Tissues ◽  
Spinal Cord Tumor ◽  
Tumor Resection ◽  
Case Series ◽  
Central Valley ◽  
Cerebrospinal Fluid Leak ◽  
Technical Note ◽  
Johns Hopkins Hospital ◽  
Incidental Durotomy ◽  
Fluid Leak

Abstract BACKGROUND: Osteoplastic laminoplasty is a well-described technique that may decrease the incidence of progressive kyphosis when used in the setting of intradural spinal cord tumor resection. OBJECTIVE: The BoneScalpel by Aesculap (Central Valley, Pennsylvania) is an ultrasonic osteotome that precisely cuts bone while preserving the underlying soft tissues, potentially reducing the risk of dural laceration during laminoplasty. By producing osteotomies as narrow as 0.5 mm, the device may also facilitate postoperative osteointegration. METHODS: A retrospective analysis was conducted of 40 patients (mean age, 38.0 years; range, 4.0-79.7 years) who underwent osteoplastic laminoplasty using the BoneScalpel for the treatment of intradural spinal pathology at the Johns Hopkins Hospital between January 2009 and December 2011. After lesion resection, titanium plates were used to reconstruct the lamina in all cases. The technical results and procedure-related complications were subsequently noted. RESULTS: Successful laminoplasty was carried out in all 40 patients. Intraoperatively, 1 case of incidental durotomy was noted after use of the device, which was repaired primarily without neurological or clinical sequelae. During the follow-up period (mean, 195 days; median, 144 days), there were 2 complications (1 cerebrospinal fluid leak, 1 seroma) and no cases of immediate postoperative instability. CONCLUSION: The BoneScalpel is a safe and technically feasible device for performing osteoplastic laminoplasty.

scholarly journals Surgical outcomes of the endoscopic endonasal transsphenoidal approach for large and giant pituitary adenomas: institutional experience with special attention to approach-related complications

2016 ◽  
Vol 74 (5) ◽  
pp. 388-395 ◽  
Author(s):  
Edson Rocha Constantino ◽  
Rafael Leal ◽  
Christian Cândido Ferreira ◽  
Marcus André Acioly ◽  
José Alberto Landeiro
Keyword(s):  
Pituitary Adenomas ◽  
Cerebrospinal Fluid Leak ◽  
Transsphenoidal Approach ◽  
Tumor Diameter ◽  
Endoscopic Endonasal ◽  
Valuable Treatment ◽  
Institutional Experience ◽  
Endoscopic Endonasal Transsphenoidal Surgery ◽  
Giant Pituitary Adenomas ◽  
Fluid Leak

ABSTRACT Objective In this study, we investigate our institutional experience of patients who underwent endoscopic endonasal transsphenoidal approach for treatment of large and giant pituitary adenomas emphasizing the surgical results and approach-related complications. Method The authors reviewed 28 consecutive patients who underwent surgery between March, 2010 and March, 2014. Results The mean preoperative tumor diameter was 4.6 cm. Gross-total resection was achieved in 14.3%, near-total in 10.7%, subtotal in 39.3%, and partial in 35.7%. Nine patients experienced improvement in visual acuity, while one patient worsened. The most common complications were transient diabetes insipidus (53%), new pituitary deficit (35.7%), endonasal adhesions (21.4%), and cerebrospinal fluid leak (17.8%). Surgical mortality was 7.1%. Conclusions Endoscopic endonasal transsphenoidal surgery is a valuable treatment option for large or giant pituitary adenomas, which results in high rates of surgical decompression of cerebrovascular structures.

Endoscopic transpterygoidal repair of a large cranial defect with cerebrospinal fluid leak in a patient with extensive osteoradionecrosis of the skull base: case report and technical note

2015 ◽  
Vol 129 (12) ◽  
pp. 1243-1247 ◽  
Author(s):  
Y Brand ◽  
E Lim ◽  
V Waran ◽  
N Prepageran
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Report ◽  
Cranial Nerves ◽  
Cerebrospinal Fluid Leak ◽  
Technical Note ◽  
Base Case ◽  
Endoscopic Endonasal ◽  
Cranial Defect ◽  
Cranial Fossa ◽  
Fluid Leak

AbstractBackground:Endoscopic endonasal techniques have recently become the method of choice in dealing with cerebrospinal fluid leak involving the anterior cranial fossa. However, most surgeons prefer an intracranial approach when leaks involve the middle cranial fossa. This case report illustrates the possibilities of using endoscopic techniques for cerebrospinal fluid leaks involving the middle fossa.Case report:A 37-year-old male patient presented with multiple areas of cranial defect with cerebrospinal fluid leak due to osteoradionecrosis following radiation for nasopharyngeal carcinoma 4 years earlier. Clinical examination showed involvement of all cranial nerves except the IInd and XIth nerves on the left side. A prior attempt to repair the cerebrospinal fluid leak with craniotomy was not successful.Conclusion:This case demonstrates the successful endoscopic repair of a large cranial defect with cerebrospinal fluid leak.

EXTENDED ENDOSCOPIC ENDONASAL TRANSSPHENOIDAL APPROACH FOR THE REMOVAL OF SUPRASELLAR TUMORS

Neurosurgery ◽  
2007 ◽  
Vol 60 (1) ◽  
pp. 46-59 ◽  
Author(s):  
Enrico de Divitiis ◽  
Luigi Maria Cavallo ◽  
Paolo Cappabianca ◽  
Felice Esposito
Keyword(s):  
Cerebrospinal Fluid ◽  
Pituitary Adenomas ◽  
Cerebrospinal Fluid Leak ◽  
Complete Removal ◽  
Transsphenoidal Approach ◽  
Endoscopic Endonasal ◽  
Rathke's Cleft Cysts ◽  
Tuberculum Sellae ◽  
Rathke's Cleft ◽  
Fluid Leak

Abstract OBJECTIVE The widespread use of the endoscope in transsphenoidal pituitary surgery has recently contributed to the extension of the approach beyond the tuberculum sellae and planum sphenoidale for the management of lesions located in the suprasellar area, either with an endoscope-assisted or purely endoscopic technique. Based on our previous experience with more than 450 standard endoscopic transsphenoidal operations, we have retrospectively evaluated the effectiveness of the extended endoscopic endonasal transsphenoidal approach in the management of lesions mainly located in the suprasellar area. METHODS Between January 2004 and December 2005, 20 consecutive patients underwent extended endoscopic endonasal transsphenoidal surgery for a total of 21 procedures. The series consisted of seven pituitary adenomas, seven craniopharyngiomas, three suprasellar Rathke's cleft cysts, two tuberculum sellae meningiomas, and one pilocytic astrocytoma of the chiasm. RESULTS Tumor removal, as assessed by postoperative magnetic resonance imaging, revealed complete removal of the lesion in four out of seven pituitary adenomas, five out of seven craniopharyngiomas, three out of three Rathke's cleft cysts, and two out of two tuberculum sellae meningiomas. One patient (5%) with craniopharyngioma had a postoperative cerebrospinal fluid leak that required reoperation. The same patient experienced a sphenoid mycosis, which was treated with medical therapy. Some specific conditions associated with the anatomy of the surgical route, as well as to the morphology of the lesion, have resulted to condition the feasibility of the approach. CONCLUSION Small and medium sized suprasellar lesions located in the midline, with or without a limited parasellar extension and without involvement of vascular structures, seem amenable to be resected through such extended endoscopic transsphenoidal approach. Improvements in closure techniques and the use of new materials and surgical glues seem to significantly reduce the postoperative cerebrospinal fluid leak rate and meningitis.

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