Skull base reconstruction after EEA (endoscopic endonasal approach) – review of 164 cases

Objective: Determine the efficacy of the anterior skull base reconstruction in adult patients with intranasal meningoceles and meningoencephaloceles treated by endoscopic endonasal approach. Study design: Retrospective observational study of adult patients admitted to a tertiary hospital. Materials and methods: Intranasal meningocele was defined as a protrusion of meninges through a defect in the skull base forming a cyst filled with cerebrospinal fluid in the nasal cavity or paranasal sinuses. If the cyst had brain tissue it was called meningoencephalocele. The electronic clinical records of patients admitted with suspected of intranasal MC or MEC between January 2010 and December 2018 were reviewed. All patients treated by endoscopic endonasal approach were included. We excluded those cases with anterior skull base previous surgeries (iatrogenic or following tumoral resections), reconstruction with external surgical approaches and those who were less than 18 years old. Results: Intranasal MC was the most frequent lesion (6/5) and there was one patient with MEC (1/6). 5 cases were idiopathic and one patient had history of transnasal surgery. A total of 83,3% of the cases were primary surgeries and one patient had 3 prior MC surgeries. Only in four of them (66,6%) the lesion location was detected by at least one of the studies (CT, MRI and/or endoscopy). We performed a multilayer closure technique in all patients. During the immediate postoperative period, one patient had acute meningitis. One patient had a CSF leak recurrence 4 months after surgery. The success rate of the reconstructions performed by endonasal approach was 83.33% (5/6). The average follow-up of the patients was 15 months. Conclusion: The effectiveness of the anterior skull base reconstruction in adult patients with meningoceles and meningoencephaloceles performed by endoscopic endonasal approach in our series was 83.33% (5/6). This procedure is currently the gold standard due to its high efficacy and low morbidity. According to current studies, it is recommended to perform the reconstruction with a multilayer technique.

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Extended Endoscopic Endonasal Approach for Suprasellar Craniopharyngioma

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1623529 ◽

2018 ◽

Vol 79 (S 02) ◽

pp. S196-S198 ◽

Cited By ~ 1

Author(s):

D. Locatelli ◽

F. Pozzi ◽

G. Agresta ◽

S. Padovan ◽

A. Karligkiotis ◽

...

Keyword(s):

Skull Base ◽

Third Ventricle ◽

Neurological Status ◽

University Hospital ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Skull Base Reconstruction ◽

Cystic Component ◽

Suprasellar Region

Objectives We illustrate a suprasellar craniopharyngiomas treated with an extended endoscopic endonasal approach (EEEA). Design Case report of a 43-year-old male affected by cerebral lesion located in suprasellar region involving the third ventricle and compressing the neurovascular structures, causing an anterosuperior dislocation of the chiasma. There is a complete disruption of the pituitary stalk that can explain the clinical finding of partial anterior hypopituitarism and hyperprolactinemia. The lesion is characterized by a solid and cystic component. Considering the absence of lateral extension and the suprasellar location of the lesion, an EEEA is preferred. Setting University Hospital “Ospedale di Circolo,” Department of Neurosurgery, Varese, Italy. Participants Neurosurgical and ENT Skull Base Team. Main Outcome Measures A bilateral parasagittal approach is performed using a four-hand technique. The first step of the surgery is the preparation of the Hadad's flap. The approach is extended to the planum sphenoidalis to expose the suprasellar region. The lesion is completely removed employing also an ultrasound aspirator. Skull base reconstruction is performed with three-layer technique: graft of fat tissue, fascia lata, and nasoseptal flap. Results No postoperative complications occurred. In the post-op, the patient presents a panhypopituitarism and an improvement in neurological status. The visual deficit remains stable. Post-op magnetic resonance imaging at 1 year documents the complete absence of pathological contrast enhancement. Conclusions EEEA is a feasible approach in treating craniopharyngioma with suprasellar extension. The advantages include optimal visualization, good resection rate, and absence of brain retraction.The link to the video can be found at: https://youtu.be/IYm-8P1jbBo.

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