scholarly journals Surgical treatment of non-functioning pituitary macroadenomas by the endoscopic endonasal approach in the elderly

2015 ◽  
Vol 73 (9) ◽  
pp. 764-769 ◽  
Author(s):  
Horacio Armando Marenco ◽  
Samuel Tau Zymberg ◽  
Rodrigo de Paula Santos ◽  
Cláuder Oliveira Ramalho
Keyword(s):  
Surgical Treatment ◽  
Elderly Patients ◽  
The Elderly ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
The Past ◽  
Pituitary Dysfunction ◽  
Visual Improvement ◽  
Transcranial Approach

Over the past three decades, surgical series of elderly patients treated for pituitary adenomas have been published, all of which used the microscopic transsphenoidal or transcranial approach. The objective of this study was to retrospectively analyze the surgical results of our first 25 elderly patients with non-functioning pituitary macroadenoma (NFPM) operated by the endoscopic endonasal approach (EEA). Preoperative visual loss was found in 92.8% of the cases, and 70.8% experienced visual improvement following surgery. Preoperative pituitary dysfunction was found in 69.2% of the cases and postoperative pituitary recovery occurred in 22.2% of them. Mean hospital stay was 6.7 days. The results of this study suggest that surgery remains the first line of treatment for NFPM in the elderly. Because age alone is not a barrier for surgery, patients should be selected for surgical treatment based on their symptoms and clinical condition, as defined by comorbidities.

scholarly journals Endoscopic endonasal versus open transcranial resection of craniopharyngiomas: a case-matched single-institution analysis

2016 ◽  
Vol 41 (6) ◽  
pp. E7 ◽  
Author(s):  
Nelson Moussazadeh ◽  
Vishaal Prabhu ◽  
Evan D. Bander ◽  
Ryan C. Cusic ◽  
Apostolos John Tsiouris ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Outcome Data ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Single Institution ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Visual Improvement ◽  
Select Group ◽  
Transcranial Approach

OBJECTIVE The authors compared clinical and radiological outcomes after resection of midline craniopharyngiomas via an endoscopic endonasal approach (EEA) versus an open transcranial approach (TCA) at a single institution in a series in which the tumors were selected to be equally amenable to gross-total resection (GTR) with either approach. METHODS A single-institution retrospective review of previously untreated adult midline craniopharyngiomas was performed. Lesions were evaluated by 4 neurosurgeons blinded to the actual approach used to identify cases that were equally amenable to GTR using either an EEA or TCA. Radiological and clinical outcome data were assessed. RESULTS Twenty-six cases amenable to either approach were identified, 21 EEA and 5 TCA. Cases involving tumors that were resected via a TCA had a trend toward larger diameter (p = 0.10) but were otherwise equivalent in preoperative clinical and radiological characteristics. GTR was achieved in a greater proportion of cases removed with an EEA than a TCA (90% vs 40%, respectively; p = 0.009). Endoscopic resection was associated with superior visual restoration (63% vs 0%; p < 0.05), a decreased incidence of recurrence (p < 0.001), lower increase in FLAIR signal postoperatively (−0.16 ± 4.6 cm3 vs 14.4 ± 14.0 cm3; p < 0.001), and fewer complications (20% vs 80% of patients; p < 0.001). Significantly more TCA patients suffered postoperative cognitive loss (80% vs 0; p < 0.0001). CONCLUSIONS An EEA is a safe and effective approach to suprasellar craniopharyngiomas amenable to GTR. For this select group of cases, the EEA may provide higher rates of GTR and visual improvement with fewer complications compared with a TCA.

The endoscopic endonasal approach for cerebrospinal fluid leak repair in the elderly

2015 ◽  
Vol 132 ◽  
pp. 21-25 ◽  
Author(s):  
Enzo Emanuelli ◽  
Laura Milanese ◽  
Marta Rossetto ◽  
Diego Cazzador ◽  
Elena d’Avella ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebrospinal Fluid Leak ◽  
The Elderly ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Fluid Leak

scholarly journals Endoscopic Endonasal Approach for Clival Chordomas

2018 ◽  
Vol 23 (1) ◽  
pp. 61-64
Author(s):  
Flávio Ramalho Romero ◽  
Sérgio Listik
Keyword(s):  
Surgical Treatment ◽  
Radical Resection ◽  
Transsphenoidal Approach ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Clival Chordoma

Chordomas of the clivus are aggressive lesions which arise from the remnants of the primitive notochord and pose unique diagnostic and management challenges. Radical resection of chordomas has been recommended for better outcomes and their surgical treatment has been challenging to neurosurgeons for many years. Transbasal, orbitozygomatic, subtemporal,transcondylar, transmaxillary, and extended transsphenoidal techniques have been proposed. We report a case of clival chordoma treated by endonasal endoscopic transsphenoidal approach. 

Endoscopic Endonasal versus Transcranial Optic Canal Decompression: A Morphometric, Cadaveric Study

2021 ◽  
Author(s):  
Jun Kim ◽  
Aaron R Plitt ◽  
Awais Vance ◽  
Scott Connors ◽  
James Caruso ◽  
...  
Keyword(s):  
Anatomical Study ◽  
Contralateral Side ◽  
Lateral Approach ◽  
Ct Scans ◽  
Optic Canal ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Transcranial Approach ◽  
The Mean

Abstract Introduction Decompression of the optic nerve within the optic canal is indicated for compressive visual decline. The two most common approaches utilized for optic canal decompression are a medial approach with an endoscopic endonasal approach and a lateral approach with a craniotomy. Our study is a cadaveric anatomical study comparing the length and circumference of the orbit decompressed via an endoscopic endonasal approach versus a frontotemporal craniotomy. Methods Five cadaveric specimens were utilized. Predissection computed tomography (CT) scans were performed on each specimen. On each specimen, a standard frontotemporal craniotomy with anterior clinoidectomy and superolateral orbital decompression was performed on one side and an endoscopic endonasal approach with medial wall decompression was performed on the contralateral side. Post-dissection CT scans were performed. An independent radiologist provided measurements of the length (mm) and circumference (degrees) of optic canal decompression bilaterally. Results The mean length of optic canal decompression for open and endoscopic approach was 13 mm (range 12–15 mm) and 12.4 mm (range 10–16 mm), respectively. The mean circumference of decompression for open and endoscopic approaches was 252.8 degrees (range 205–280 degrees) and 124.6 degrees (range 100–163 degrees), respectively. Conclusion The endoscopic endonasal and the transcranial approaches provide a similar length of optic canal decompression, but the transcranial approach leads to greater circumferential decompression. The endoscopic endonasal approach has the benefit of being minimally invasive, though. Ultimately, the surgical approach decision should be based on the location of the pathology and the surgeon's comfort.

Extended Endoscopic Endonasal Transsphenoidal Approach to the Suprasellar Area: Anatomic Considerations—Part 1

2007 ◽  
Vol 61 (suppl_3) ◽  
pp. ONS-24-ONS-34 ◽  
Author(s):  
Luigi M. Cavallo ◽  
Oreste de Divitiis ◽  
Salih Aydin ◽  
Andrea Messina ◽  
Felice Esposito ◽  
...  
Keyword(s):  
Third Ventricle ◽  
Transsphenoidal Approach ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Microsurgical Approach ◽  
Transcranial Approach ◽  
Median Approach ◽  
Key Steps ◽  
Brain Retraction

Abstract Introduction: Interest in using the extended endonasal transsphenoidal approach for management of suprasellar lesions, with either a microscopic or endoscopic technique, has increased in recent years. The most relevant benefit is that this median approach permits the exposure and removal of suprasellar lesions without the need for brain retraction. Materials and Methods: Fifteen human cadaver heads were dissected to evaluate the surgical key steps and the advantages and limitations of the extended endoscopic endonasal transplanum sphenoidale approach. We compared this with the transcranial microsurgical view of the suprasellar area as explored using the bilateral subfrontal microsurgical approach, and with the anatomy of the same region as obtained through the endoscopic endonasal route. Results: Some anatomic conditions can prevent or hinder use of the extended endonasal approach. These include a low level of sphenoid sinus pneumatization, a small sella size with small distance between the internal carotid arteries, a wide intercavernous sinus, and a thick tuberculum sellae. Compared with the subfrontal transcranial approach, the endoscopic endonasal approach offers advantages to visualizing the subchiasmatic, retrosellar, and third ventricle areas. Conclusion: The endoscopic endonasal transplanum sphenoidale technique is a straight, median approach to the midline areas around the sella that provides a multiangled, close-up view of all relevant neurovascular structures. Although a lack of adequate instrumentation makes it impossible to manage all structures that are visible with the endoscope, in selected cases, the extended endoscopic endonasal approach can be considered part of the armamentarium for surgical treatment of the suprasellar area.

scholarly journals Suprachiasmatic translamina terminalis corridor used in endoscopic endonasal approach for resecting third ventricular craniopharyngioma

2015 ◽  
Vol 122 (5) ◽  
pp. 1166-1172 ◽  
Author(s):  
Ye Gu ◽  
Xiaobiao Zhang ◽  
Fan Hu ◽  
Yong Yu ◽  
Tao Xie ◽  
...  
Keyword(s):  
Hormone Replacement ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Single Center ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Visual Improvement ◽  
Single Center Study ◽  
Anterior Extension ◽  
Center Study

OBJECT The translamina terminalis corridor was used in the transcranial anterior route to treat third ventricular craniopharyngioma (TVC), which presents a challenge to neurosurgeons. The endoscopic endonasal approach (EEA) has recently been used to treat craniopharyngiomas. However, there are few reports of the EEA being used to treat TVC. The authors' novel surgical approach of treating selected TVC by the endoscopic endonasal route via the suprachiasmatic translamina terminalis (STLT) corridor is described. METHODS In this single-center study, the EEA via the STLT corridor was used to resect TVC with great upper and anterior extension causing bulged lamina terminalis, and TVC with a residual upper compartment, after routine infrachiasmatic transmetastalk corridor resection. RESULTS The STLT corridor was used in 3 patients. Gross-total resection was achieved in all cases. One patient achieved visual improvement, and the other 2 patients showed partial visual improvement. Leakage of CSF occurred in 1 patient. Postoperative hormone replacement therapy was required in all patients. CONCLUSIONS The STLT corridor is a complementary minimally invasive corridor used in the EEA for treating selected TVC. The STLT alone or combined with infrachiasmatic transmetastalk corridors should be selected depending on the size of suprachiasmatic and infrachiasmatic space.

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