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 Endoscopic endonasal optic nerve and orbital apex decompression for nontraumatic optic neuropathy: surgical nuances and review of the literature

2014 ◽  
Vol 37 (4) ◽  
pp. E19 ◽  
Author(s):  
Moncef Berhouma ◽  
Timothee Jacquesson ◽  
Lucie Abouaf ◽  
Alain Vighetto ◽  
Emmanuel Jouanneau ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Minimally Invasive ◽  
Invasive Technique ◽  
Ossifying Fibroma ◽  
Symptom Duration ◽  
Imaging Data ◽  
Orbital Apex ◽  
Endoscopic Endonasal ◽  
Nerve Decompression ◽  
Optic Nerve Decompression

Object While several approaches have been described for optic nerve decompression, the endoscopic endonasal route is gaining favor because it provides excellent exposure of the optic canal and the orbital apex in a minimally invasive manner. Very few studies have detailed the experience with nontraumatic optic nerve decompressions, whereas traumatic cases have been widely documented. Herein, the authors describe their preliminary experience with endoscopic endonasal decompression for nontraumatic optic neuropathies (NONs) to determine the procedure’s efficacy and delineate its potential indications and limits. Methods The medical reports of patients who had undergone endoscopic endonasal optic nerve and orbital apex decompression for NONs at the Lyon University Neurosurgical Hospital in the period from January 2012 to March 2014 were reviewed. For all cases, clinical and imaging data on the underlying pathology and the patient, including demographics, preoperative and 6-month postoperative ophthalmological assessment results, symptom duration, operative details with video debriefing, as well as the immediate and delayed postoperative course, were collected from the medical records. Results Eleven patients underwent endoscopic endonasal decompression for NON in the multidisciplinary skull base surgery unit of the Lyon University Neurosurgical Hospital during the 27-month study period. The mean patient age was 53.4 years, and there was a clear female predominance (8 females and 3 males). Among the underlying pathologies were 4 sphenoorbital meningiomas (36%), 3 optic nerve meningiomas (27%), and 1 each of trigeminal neuroma (9%), orbital apex meningioma (9%), ossifying fibroma (9%), and inflammatory pseudotumor of the orbit (9%). Fifty-four percent of the patients had improved visual acuity at the 6-month follow-up. Only 1 patient whose sphenoorbital meningioma had been treated at the optic nerve atrophy stage continued to worsen despite surgical decompression. The 2 patients presenting with preoperative papilledema totally recovered. One case of postoperative epistaxis was successfully treated using balloon inflation, and 1 case of air swelling of the orbit spontaneously resolved. Conclusions Endoscopic endonasal optic nerve decompression is a safe, effective, and minimally invasive technique affording the restoration of visual function in patients with nontraumatic compressive processes of the orbital apex and optic nerve. The timing of decompression remains crucial, and patients should undergo such a procedure early in the disease course before optic atrophy.

scholarly journals Endoscopic Endonasal Transsphenoidal Approach to Pituitary Adenoma: A Multi-disciplinary Approach

2017 ◽  
Vol 15 (2) ◽  
pp. 174-177 ◽  
Author(s):  
Deepak Regmi ◽  
Amit Thapa ◽  
Bidur KC ◽  
Bikram Shakya
Keyword(s):  
Pituitary Adenoma ◽  
Minimally Invasive ◽  
Endoscopic Approach ◽  
Transsphenoidal Approach ◽  
Sinus Surgery ◽  
Csf Leak ◽  
Technical Failure ◽  
Endoscopic Endonasal ◽  
Ablative Surgery ◽  
Surgical Cure

Background: The excellent visualization and minimally invasive approach employed in endoscopic endonasal procedures has now revolutionized the pituitary surgery, replacing the transnasal microscopic technique worldwide. However, it involves major shift in hand-eye co-ordination from static 3 dimensional images of microscope to 2 dimensional endoscopic images hence demands training and inter-disciplinary approach. Here we present our experiences in learning and developing a safe endonasal transsphenoidal endoscopic approach to resect pituitary adenomas.Methods: This prospective study was jointly conducted in the departments of ENT and Neurologicals surgery Kathmandu Medical College, Nepal, from September 2014 to August 2016. The endoscopic approach to the sphenoid sinus was performed by an Otolaryngologist and ablative surgery by Neurosurgeon. The ease of procedure, intra operative challenges, surgical cure, post-operative cerebro spinal fluid (CSF) leaks and postoperative complaints were analyzed.Results: Sixteen consecutive patients with pituitary adenoma (macro adenoma=13, micro adenoma =3) were analyzed. There were three intraoperative CSF leak, managed successfully. Two patients developed transient diabetes insipidus and surgical cure rate was 90%. No case had to be switched over to traditional microscopic route due to technical failure. There was no mortality.Conclusions: The endoscopic endonasal transsphenoidal approach to pituitary tumors is a safe and minimally invasive procedure, which can be employed safely in any of our centers in Nepal, equipped with endoscopic sinus surgery and endoscopically trained ENT and Neurosurgeons. A multi disciplinary approach provides good access, greater tumor excision and excellent postoperative follow up.Keywords: .

Anterior clivectomy: surgical technique and clinical applications

2008 ◽  
Vol 109 (5) ◽  
pp. 783-793 ◽  
Author(s):  
Ossama Al-Mefty ◽  
Paulo A. S. Kadri ◽  
David M. Hasan ◽  
Gustavo Rassier Isolan ◽  
Svetlana Pravdenkova
Keyword(s):  
Cerebrospinal Fluid ◽  
Cranial Nerves ◽  
Cerebrospinal Fluid Leak ◽  
Transsphenoidal Approach ◽  
Invasive Technique ◽  
Simple Extension ◽  
Anatomical Landmarks ◽  
Anterior Maxilla ◽  
Initial Exposure ◽  
Fluid Leak

Object Midline clival lesions, whether involving the clivus or simply situated anterior to the brainstem, present a technical challenge for adequate exposure and safe resection. The authors describe, as a minimally invasive technique, an anterior clivectomy performed via an expanded transsphenoidal approach coupled with the use of a neuronavigation on mobile head and endoscopic-assisted technique. Wide and direct exposure, with the ability to resect extra- and intradural tumors, was achieved without mortality and with a low rate of complications. Methods Cadaveric dissections were performed to outline the landmarks and measure the window that is created by resecting the clivus anteriorly. The technique was used in 43 patients to resect tumors located at or invading the clivus. The initial exposure of the clivus was obtained via the sublabial transsphenoidal approach. The wall of the anterior maxilla, often on 1 side, was removed to allow a wide side-to-side opening of the nasal speculum. Using neuronavigation, the authors made clivectomy windows by drilling the clivus between anatomical landmarks. Bilateral intraoperative neurophysiological monitoring was used (somatosensory evoked potentials, brainstem auditory evoked responses, and cranial nerves VI–XII). Results Of the 43 patients, 26 were female and 17 were male, and they ranged in age from 3.5 to 76 years (mean 41.5 years). Thirty-eight patients harbored a chordoma and 5 a giant invasive pituitary adenoma. Gross-total resection of the tumor was achieved in 34 cases (79%). Nine patients (21%) had residual tumor unreachable through the anterior clivectomy, and this required a second-stage resection. Four patients developed new transient extraocular movement deficits. One patient developed a permanent cranial nerve VI palsy. Twenty-seven patients with chordoma underwent postoperative proton-beam radiotherapy. Tumor recurred in 19% of these cases. In 3 patients a cerebrospinal fluid leak developed during hospitalization and was treated successfully. Two other patients presented with a delayed cerebrospinal fluid leak after radiotherapy. Only 1 patient, who had previously undergone Gamma Knife surgery, experienced postoperative hemiparesis. Conclusions A complete anterior clivectomy via a simple extension of the transsphenoidal approach allows the surgeon access to different lesions involving the clivus or situated anterior to the brainstem. The exposure is similar to that provided by more extensive transfacial approaches. Instrument manipulation is easy. Neuronavigation, endoscopy, and intraoperative monitoring are easily incorporated and enhance the capability and safety of this approach.

The Front Door to Meckel's Cave: An Anteromedial Corridor via Expanded Endoscopic Endonasal Approach—Technical Considerations and Clinical Series

2009 ◽  
Vol 64 (suppl_1) ◽  
pp. ONS71-ONS83 ◽  
Author(s):  
Amin B. Kassam ◽  
Daniel M. Prevedello ◽  
Ricardo L. Carrau ◽  
Carl H. Snyderman ◽  
Paul Gardner ◽  
...  
Keyword(s):  
Medical Center ◽  
Cranial Nerves ◽  
Abducens Nerve ◽  
Direct Access ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Meckel’S Cave ◽  
Endoscopic Endonasal ◽  
Clinical Series ◽  
Meckel's Cave

Abstract Objective: Tumors within Meckel's cave are challenging and often require complex approaches. In this report, an expanded endoscopic endonasal approach is reported as a substitute for or complement to other surgical options for the treatment of various tumors within this region. Methods: A database of more than 900 patients who underwent the expanded endoscopic endonasal approach at the University of Pittsburgh Medical Center from 1998 to March of 2008 were reviewed. From these, only patients who had an endoscopic endonasal approach to Meckel's cave were considered. The technique uses the maxillary sinus and the pterygopalatine fossa as part of the working corridor. Infraorbital/V2 and the vidian neurovascular bundles are used as surgical landmarks. The quadrangular space is opened, which is bound by the internal carotid artery medially and inferiorly, V2 laterally, and the abducens nerve superiorly. This offers direct access to the anteroinferomedial segment of Meckel's cave, which can be extended through the petrous bone to reach the cerebellopontine angle. Results: Forty patients underwent an endoscopic endonasal approach to Meckel's cave. The most frequent abnormalities encountered were adenoid cystic carcinoma, meningioma, and schwannomas. Meckel's cave and surrounding structures were accessed adequately in all patients. Five patients developed a new facial numbness in at least 1 segment of the trigeminal nerve, but the deficit was permanent in only 2. Two patients had a transient Vlth cranial nerve palsy. Nine patients (30%) showed improvement of preoperative deficits on Cranial Nerves III to VI. Conclusion: In selected patients, the expanded endoscopic endonasal approach to the quadrangular space provides adequate exposure of Meckel's cave and its vicinity, with low morbidity.

“Far-Medial” Expanded Endonasal Approach to the Inferior Third of the Clivus

2010 ◽  
Vol 66 (suppl_2) ◽  
pp. ons211-ons220 ◽  
Author(s):  
Victor A. Morera ◽  
Juan C. Fernandez-Miranda ◽  
Daniel M. Prevedello ◽  
Ricky Madhok ◽  
Juan Barges-Coll ◽  
...  
Keyword(s):  
Cranial Nerves ◽  
Foramen Magnum ◽  
Direct Access ◽  
Occipital Condyle ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Hypoglossal Canal ◽  
Expanded Endonasal Approach ◽  
Surgical Corridor ◽  
Lower Cranial Nerves

Abstract OBJECTIVE The endoscopic endonasal transclival approach is a valid alternative for treatment of lesions in the clivus. The major limitation of this approach is a significant lateral extension of the tumor. We aim to identify a safe corridor through the occipital condyle to provide more lateral exposure of the foramen magnum. METHODS Sixteen parameters were measured in 25 adult skulls to analyze the exact extension of a safe corridor through the condyle. Endonasal endoscopic anatomic dissections were carried out in nine colored latex–injected heads. RESULTS Drilling at the lateral inferior clival area exposed two compartments divided by the hypoglossal canal: the jugular tubercle (superior) and the condylar (inferior). Completion of a unilateral ventromedial condyle resection opens a 3.5 mm (transverse length) * 10 mm (vertical length) lateral surgical corridor, facilitating direct access to the vertebral artery at its dural entry point into the posterior fossa. The supracondylar groove is a reliable landmark for locating the hypoglossal canal in relation to the condyle. The hypoglossal canal is used as the posterior limit of the condyle removal to preserve more than half of the condylar mass. The transjugular tubercle approach is accomplished by drilling above the hypoglossal canal, and increases the vertical length of the lateral surgical corridor by 8 mm, allowing for visualization of the distal cisternal segment of the lower cranial nerves. CONCLUSION The transcondylar and transjugular tubercle “far medial” expansions of the endoscopic endonasal approach to the inferior third of the clivus provide a unique surgical corridor to the ventrolateral surface of the ponto- and cervicomedullary junctions.

scholarly journals Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Macroadenoma as Minimal Invasive Approach: Case Report

2019 ◽  
Vol 3 (1) ◽  
pp. 1
Author(s):  
Febyan Febyan ◽  
Handrianto Setiajaya
Keyword(s):  
Minimally Invasive ◽  
Transsphenoidal Surgery ◽  
Clinical Symptoms ◽  
Minimal Invasive ◽  
Invasive Technique ◽  
Endoscopic Endonasal ◽  
Invasive Approach ◽  
Minimal Invasive Approach ◽  
Endoscopic Endonasal Transsphenoidal Surgery ◽  
Visual Disturbances

Background: pituitary tumor accounted for 15% of benign intracranial tumors. Clinical symptoms found in the form of visual disturbances, and hormonal manifestations, surgery is one of the main managements. Endoscopic endonasal transsphenoidal surgery (EETS) is a minimally invasive approach for this case. The advantages of EETS is better efficacy than traditional technique, and shorter hospital stays, less mean blood loss, and earlier return to daily activities. Case: we reported a rare example of a male patient aged 37 years old with the main clinical features were visual disturbances, sexual malfunction and bitemporal hemianopsia on physical examination. Magnetic resonance imaging (MRI) showed macroadenoma pituitary, the size 2.41 x 2.98 x 3.20 cm. We explained about minimally invasive surgery such as EETS and the patient was agreed to performed EETS. Conclusion: endoscopic endonasal transsphenoidal surgery is a minimally invasive technique for tumor pituitary cases and safe when compared to traditional medicine.

Treatment of Sinonasal Aspergillosis by Debridement and Sinonasal Deposition Therapy with Clotrimazole Under Rhinoscopic Guidance

2018 ◽  
Vol 54 (2) ◽  
pp. 103-110 ◽  
Author(s):  
Bertrand Vedrine ◽  
Luc-André Fribourg-Blanc
Keyword(s):  
Minimally Invasive ◽  
Nasal Cavity ◽  
Frontal Sinus ◽  
Oral Medication ◽  
Minimally Invasive Technique ◽  
Direct Access ◽  
Invasive Technique ◽  
The Third ◽  
Endoscopic Debridement

ABSTRACT Rhinoscopy was performed on 10 dogs with sinonasal aspergillosis (SNA). Direct access to the sinus via the nasal ostium was possible with a flexible endoscope to allow sinuscopy. Debridement of fungal plaques in the frontal sinus and the nasal cavity was performed, and a sinus and nasal deposition therapy with clotrimazole (1%) cream was made under rhinoscopic guidance. No oral medication was administered following the procedure. A rhinoscopic follow-up was performed monthly until cure. Six of ten (60%) dogs presented fungal plaques in the nasal cavity and in the frontal sinus and 4/10 (40%) dogs presented fungal plaques only in the frontal sinus. Five of ten (50%) dogs were considered to be cured at the first follow-up rhinoscopy, 4/10 (40%) after the second follow-up, and 1/10 (10%) after the third. Two dogs had delayed recurrence of SNA rhinoscopically assessed 12 and 21 mo, respectively, after the last clotrimazole treatment. Endoscopic debridement of fungal plaques and clotrimazole (1%) cream deposition therapy seems to be a valuable minimally invasive technique for SNA treatment in dogs without the use of complementary oral medication. Delayed recurrence is a potential finding following treatment of SNA.

scholarly journals Combined endoscopic endonasal transtubercular and transclival approaches for large neurenteric cyst in posterior cranial fossa: A case report and literature review

2021 ◽  
Vol 12 ◽  
pp. 554
Author(s):  
Daisuke Sato ◽  
Hirotaka Hasegawa ◽  
Masahiro Shin ◽  
Kenji Kondo ◽  
Nobuhito Saito
Keyword(s):  
Posterior Fossa ◽  
Skull Base Surgery ◽  
Abducens Nerve ◽  
Posterior Cranial Fossa ◽  
Neurenteric Cyst ◽  
Endoscopic Endonasal ◽  
Prepontine Cistern ◽  
Suprasellar Region ◽  
Transnasal Surgery ◽  
Cranial Fossa

Background: Intracranial neurenteric cysts (NCs) are extremely rare tumors that more commonly involve the posterior fossa than any other cranial part. While transcranial skull base surgery has been the mainstay of treatment, the utility of endoscopic transnasal surgery (ETS) remains to be established. Case Description: We report a case of a large posterior fossa NC extensively involving the suprasellar region, cerebellopontine angle, and prepontine cistern, which we successfully resected with ETS through a combination of transtubercular and transclival routes. Before surgery, the patient presented with abducens nerve and pseudobulbar palsies, which resolved within 2 weeks postoperatively. The patient remained free from recurrence for 3 years postoperatively. Conclusion: Extended ETS may offer a minimally invasive option for the posterior fossa NC, extensively occupying the ventral space of the brainstem.

Minimally Invasive Approaches to Anterior Skull Base Meningiomas

2020 ◽  
Author(s):  
Scott C. Seaman ◽  
Muhammad S. Ali ◽  
Anthony Marincovich ◽  
Luyuan Li ◽  
Jarrett E. Walsh ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Minimally Invasive ◽  
Skull Base ◽  
Retrospective Chart Review ◽  
Anterior Skull Base ◽  
Direct Access ◽  
Endoscopic Endonasal ◽  
Olfactory Groove ◽  
Skull Base Meningiomas ◽  
Csf Leaks

Abstract Objective Anterior skull base meningiomas include olfactory groove, planum sphenoidale, and tuberculum sellae lesions. Traditionally, standard craniotomy approaches have been used to access meningiomas in these locations. More recently, minimally invasive techniques including supraorbital and endonasal endoscopic approaches have gained favor; however there are limited published series comparing the use of these two techniques for these meningiomas. Using our patent database, we identified patients who underwent these two approaches, and conducted a retrospective chart review to compare outcomes between these two techniques. Methods A total of 32 patients who underwent minimally invasive approaches were identified: 20 supraorbital and 11 endoscopic endonasal. Radiographic images, presenting complaints and outcomes, were analyzed retrospectively. The safety of each approach was evaluated. Results The mean extent of resection through a supraorbital approach was significantly greater than that of the endoscopic endonasal approach, 88.1 vs. 57.9%, respectively (p = 0.016). Overall, preoperative visual acuity and anopsia deficits were more frequent in the endonasal group that persisted postoperatively (visual acuity: p = 0.004; anopsia: p = 0.011). No major complications including cerebrospinal fluid (CSF) leaks or wound-related complications were identified in the supraorbital craniotomy group, while the endonasal group had two CSF leaks requiring lumbar drain placement. Length of stay was shorter in the supraorbital group (3.4 vs. 6.1 days, p < 0.001). Conclusion Anterior skull base meningiomas can be successfully managed by both supraorbital and endoscopic endonasal approaches. Both approaches provide excellent direct access to tumor in carefully selected patients and are safe and efficient, but patient factors and symptoms should dictate the approach selected.

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