scholarly journals Subnasio-Sella Distance for Transnasal Approach to the Sella Region: Indirect vs. Direct Measurement on Sagittal Section of the Skull in Nigerians

2013 ◽  
Vol 5 (2) ◽  
pp. 120-129
Author(s):  
Ihuoma A Igwilo ◽  
Ademola A Oremosu ◽  
Okezie O Kanu ◽  
Olufunke Dosumu
Keyword(s):  
Skull Base ◽  
Direct Measurement ◽  
Statistical Significance ◽  
Medical Science ◽  
Indirect Measurement ◽  
Anterior Skull Base ◽  
Surgical Instruments ◽  
Adult Males ◽  
Transnasal Approach ◽  
Anterior Nasal Spine

Objectives: The incidence of pituitary pathology requiring surgery is on the increase. The transnasal approach to anterior skull base is a technique which demands a thorough knowledge of the surgical anatomy. There is a dearth of knowledge on reference values for transnasal surgery on subjects of African descent. Thus the aim of this study is to ultimately improve visualisation of the surgical corridor, minimize surgical risks and improved maneuverability of surgical instruments during transnasal microsurgery (ergonomics). Methods & Materials: A total of 11 cadavers of Nigerian descent were employed in this study. Using the 3 piece caliper set (Big Horn Corporation®,India), an indirect measurement of the Subnasio-sella distance was obtained. Subsequently, a direct measurement was obtained from sagittal sections of the same skulls. Result: All randomly selected cadavers employed in the study were adult males of Sub-saharan descent. The mean indirect (distance from the anterior nasal spine i.e. subnasal point to the sella floor in an intact skull), direct A (subnasio-sella distance in a sagitally transected skull) and sella thickness measurements were found to be 8.6cm ± 0.38 cm, 8.7 cm ± 0.37 cm and 0.2 cm±0.05 cm respectively ,at 95% confidence interval. Comparison of the indirect and the direct A measurements showed statistical significance (p<0.5). A semi-logarithmic equation was derived: Direct A= 8.297 ln(Indirect measurement) – 9.079 Conclusion: Since transnasal transsphenoidal approach has been successfully used in the treatment of various anterior skull base pathologies, applying a relationship equation would guide choice of instruments employed and immensely minimize associated operative risks. DOI: http://dx.doi.org/10.3126/ajms.v5i2.8453 Asian Journal of Medical Science, Volume-5(2) 2014: 120-129

Endoscopic Transnasal Approach to the Anterior Skull Base: A Replacement for Maxillotomy Techniques?

2012 ◽  
Vol 73 (S 02) ◽  
Author(s):  
A. Subramanian ◽  
V. Elwell ◽  
D. Roberts ◽  
P. Andrews ◽  
D. Choi
Keyword(s):  
Skull Base ◽  
Anterior Skull Base ◽  
Transnasal Approach ◽  
Endoscopic Transnasal Approach

Extended endoscopic transorbital approach with superior-lateral orbital rim osteotomy: cadaveric feasibility study and clinical implications (SevEN-007)

2021 ◽  
pp. 1-14
Author(s):  
*Jaejoon Lim ◽  
Kyoung Su Sung ◽  
Woohyun Kim ◽  
Jihwan Yoo ◽  
In-Ho Jung ◽  
...  
Keyword(s):  
Skull Base ◽  
Complete Removal ◽  
Vertical Movement ◽  
Anterior Skull Base ◽  
Cadaveric Study ◽  
Surgical Instruments ◽  
Anterior Clinoidectomy ◽  
Endoscopic Transorbital ◽  
Surgical Corridor ◽  
Orbital Rim

OBJECTIVE The endoscopic transorbital approach (ETOA) has been developed, permitting a new surgical corridor. Due to the vertical limitation of the ETOA, some lesions of the anterior cranial fossa are difficult to access. The ETOA with superior-lateral orbital rim (SLOR) osteotomy can achieve surgical freedom of vertical as well as horizontal movement. The purpose of this study was to confirm the feasibility of the ETOA with SLOR osteotomy. METHODS Anatomical dissections were performed in 5 cadaveric heads with a neuroendoscope and neuronavigation system. ETOA with SLOR osteotomy was performed on one side of the head, and ETOA with lateral orbital rim (LOR) osteotomy was performed on the other side. After analysis of the results of the cadaveric study, the ETOA with SLOR osteotomy was applied in 6 clinical cases. RESULTS The horizontal and vertical movement range through ETOA with SLOR osteotomy (43.8° ± 7.49° and 36.1° ± 3.32°, respectively) was improved over ETOA with LOR osteotomy (31.8° ± 5.49° and 23.3° ± 1.34°, respectively) (p < 0.01). Surgical freedom through ETOA with SLOR osteotomy (6025.1 ± 220.1 mm3) was increased relative to ETOA with LOR osteotomy (4191.3 ± 57.2 mm3) (p < 0.01); these values are expressed as the mean ± SD. Access levels of ETOA with SLOR osteotomy were comfortable, including anterior skull base lesion and superior orbital area. The view range of the endoscope for anterior skull base lesions was increased through ETOA with SLOR osteotomy. After SLOR osteotomy, the space for moving surgical instruments and the endoscope was widened. Anterior clinoidectomy could be achieved successfully using ETOA with SLOR osteotomy. The authors performed ETOA with SLOR osteotomy in 6 cases of brain tumor. In all 6 cases, complete removal of the tumor was successfully accomplished. In the 3 cases of anterior clinoidal meningioma, anterior clinoidectomy was performed easily and safely, and manipulation of the extended dural margin and origin dura mater was possible. There was no complication related to this approach. CONCLUSIONS The authors evaluated the clinical feasibility of ETOA with SLOR osteotomy based on a cadaveric study. ETOA with SLOR osteotomy could be applied to more diverse disease groups that do not permit conventional ETOA or to cases in which surgical application is challenging. ETOA with SLOR osteotomy might serve as an opportunity to broaden the indication for the ETOA.

scholarly journals Single surgeon experience with minimally invasive supraorbital craniotomy versus bifrontal craniotomy for anterior skull base meningiomas

2020 ◽  
Vol 11 ◽  
pp. 458
Author(s):  
Scott Christopher Seaman ◽  
Muhammad Salman Ali ◽  
Anthony Marincovich ◽  
Carlos Osorno-Cruz ◽  
Jeremy D. W. Greenlee
Keyword(s):  
Minimally Invasive ◽  
Skull Base ◽  
Statistical Significance ◽  
Extent Of Resection ◽  
Anterior Skull Base ◽  
Presenting Symptoms ◽  
Surgeon Experience ◽  
Transcranial Approach ◽  
Skull Base Meningiomas ◽  
Supraorbital Craniotomy

Background: Anterior skull base meningiomas (ASBMs) account for about 10% of meningiomas. Bifrontal craniotomy (BFC) represents the traditional transcranial approach to accessing meningiomas in these locations. Supraorbital craniotomy (SOC) provides a minimally invasive subfrontal corridor in select patients. Here, we present our series of ASBM accessed by SOC and BFC by a single surgeon to review decision-making and compare outcomes in both techniques. Methods: Thirty-three patients were identified with ASBM. Age, tumor characteristics, presenting symptoms, postoperative complications, and outcomes were analyzed. Results: Bifrontal and SOC were performed in 13 and 20 patients, respectively. Mean follow-up time was 98.4 months. Patients undergoing SOC had smaller tumor size, located farther from the posterior table of frontal sinus, had less peritumoral edema, and decreased length of stay compared to patients undergoing BFC. Extent of resection was slightly better with BFC (99.8%) compared to SOC (91.8%), although this difference did not reach statistical significance. Recurrence-free survival and rate of re-do surgeries were not different between two groups. BFC was associated with higher rates of postoperative encephalomalacia. Conclusion: SOC provides an excellent surgical option for ASBMs providing comparable extent of resection, minimal manipulation of brain, and excellent cosmetic outcomes for patients. The patient selection is key to maximize the benefits from this approach.

S281 – Closure of Anterior Skull Base Cerebrospinal Fluid Fistulas

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P169-P169
Author(s):  
Yadiel A Alameda ◽  
Jose Busquets ◽  
Juan C. Portela
Keyword(s):  
Skull Base ◽  
Revision Surgery ◽  
Statistical Significance ◽  
Anterior Skull Base ◽  
Sinus Surgery ◽  
Fisher Exact Test ◽  
Endoscopic Repair ◽  
Presenting Symptoms ◽  
Surgical Data

Objectives 1) Describe the presenting symptoms, etiology, treatment, and long-term outcomes of patients with anterior skull base CSF fistulas treated endoscopically at our institution. 2) Study the association between closure techniques and complications, and between the use of image guidance surgery (IGS) and complications. Methods A retrospective analysis of patients with anterior CSF fistulas treated endoscopically from November 2004 to December 2007. Demographic and surgical data were collected. Postoperative complications, recurrence, and need for revision surgery were determined. Associations between the use of IGS and complications, and between the closure technique and complications were analyzed using Fisher Exact Test. Results Endoscopic repair of anterior skull base defect was performed in 19 cases. The etiology was spontaneous leak in 10 patients, menigoencephalocele in 7 patients, previous sinus surgery in 1 patient, and trauma in 1 patient. 5 patients had suffered bacterial meningitis before surgery. The most common location of leak was the cribiform plate (9 patients), followed by the ethmoid roof (5 patients). An overlay technique was used for repair in 61% of the procedures. One patient presented with leak recurrence, and underwent successful revision surgery. No statistical significance was found between the use of IGS and complications. The mean follow-up was 17 months. Our overall initial rate of closure was 94%, and 100% after a second procedure. At the last follow-up, none of the patients reported episodes of meningitis postoperatively. Conclusions Endoscopic repair of anterior skull base CSF fistulas has a high success rate and lower morbidity and mortality when compared with open approaches.

scholarly journals The Corkscrew Technique – A Minimally Invasive, Trans-nasal Anterior Skull Base Reconstruction Using a Wedge-shaped Construct for Treatment of Cerebro-Spinal Fluid Leak

2021 ◽  
Author(s):  
Yazid Samih Badarny ◽  
Iddo Paldor ◽  
Samih Badarny ◽  
Ziv Gil ◽  
Gill Sviri
Keyword(s):  
Skull Base ◽  
Lateral Displacement ◽  
Standard Technique ◽  
Fascia Lata ◽  
Anterior Skull Base ◽  
Spinal Fluid ◽  
Csf Leak ◽  
Transnasal Approach ◽  
Skull Base Reconstruction ◽  
Csf Leakage

Abstract Background : Cerebro-spinal fluid rhinorrhea may follow surgical and traumatic events, and may be spontaneous. Various techniques have been employed for reconstruction of the skull base following a CSF leak. Recent years have seen the development of endoscopic, transnasal techniques for reconstruction of the anterior skull base. We describe our experience with a novel corkscrew technique (CST), which entails harvesting a fascia lata graft, and placement of a wedge-shaped construct above the aperture in the skull base dura. This technique serves to prevent dislodgement of the construct extracranially, and lateral displacement of the construct away from the opening. Methods : We operated 28 cases of CSF leak, in 26 patients, with a transnasal endoscopic approach. Twelve were operated using the CST and 16 with standard technique (ST), with a mean follow-up of over 5 years.Results : The success rate in alleviating the leak was 91.7% in the CST group, and 87.5% in the ST group. Altogether, our complication rate was 8.3% in the CST group, and 37.5% in the ST group. None of the differences were statistically significant. Conclusions : We recommend the use of a wedge-shaped, fascia lata based construct for transnasal endoscopic repair of anterior skull base CSF leaks. Keywords: rhinorrhea, pituitary adenoma, CSF leakage, endoscopic transnasal approach, fascia lata.

Quality of Life Evaluation After Trans-Nasal Endoscopic Surgery for Skull Base Tumors

2020 ◽  
pp. 194589242097204
Author(s):  
Gabriele Molteni ◽  
Andrea Sacchetto ◽  
Tommaso Saccardo ◽  
Antonio Gulino ◽  
Daniele Marchioni
Keyword(s):  
Quality Of Life ◽  
Skull Base ◽  
Endoscopic Surgery ◽  
Negative Impact ◽  
Anterior Skull Base ◽  
University Hospital ◽  
Average Score ◽  
Transnasal Approach ◽  
Snot 22

Background The excellent surgical results obtained with transnasal endoscopic approach to the anterior skull base (ASB) are universally recognized; less is known about the quality of life of patients after surgery. Objective The aim of this study is to analyze the quality of life of patients after endoscopic transnasal surgery for the treatment of neoplasms of the ASB. Methods We conducted a retrospective review of patients who underwent transnasal endoscopic surgery for treatment of ASB tumors at the Tertiary Referral Center University Hospital of Verona. All patients were asked to complete the Anterior Skull Base Questionnaire (ASBQ), the Skull Base Inventory (SBI), and the Sino-nasal Outcome Test – 22 Items (SNOT-22) after surgical treatment. The study population was divided into subgroups; a statistical analysis of the overall results and of the different questionnaire domains was performed. Results 51 patients were enrolled in this study. The average score was 3.04 for ASBQ, 4.05 for SBI and 28.88 for SNOT-22. Analysis of the overall results for the ASBQ showed a lower quality of life in patients after recurrent surgery and in female patients. The SBI showed similar results in relation to recurrent surgery and radiotherapy. Similarly, the results for SNOT-22 highlighted the negative impact of recurrent surgery and radiotherapy. Conclusion Our results confirmed that the endoscopic transnasal approach shows excellent results not only in terms of surgical outcome, but also for the possibility of ensuring a good QoL after treatment. Recurrent surgery and radiation treatments were the most important negative prognostic factors.

Dr. Otto “Tiger” Freer: inventor and innovator

2012 ◽  
Vol 33 (2) ◽  
pp. E12 ◽  
Author(s):  
Prashant Chittiboina ◽  
David E. Connor ◽  
Anil Nanda
Keyword(s):  
Skull Base ◽  
Creative Process ◽  
Historical Perspective ◽  
Foramen Magnum ◽  
Anterior Skull Base ◽  
Turn Of The Century ◽  
Surgical Instrument ◽  
Transnasal Approach ◽  
Historical Origin ◽  
Master Surgeon

Every neurosurgeon develops his or her own standard approach to common intracranial pathologies in terms of the order in which different stages are performed and which instruments are used to perform individual tasks. The majority of the basic steps in performing a craniotomy are learned through repetition and practice during residency training. Significant amounts of energy are devoted to mastering technical skills and developing an operative rhythm. What often receives little attention is the historical origin of the instruments that make the work possible. The Freer elevator represents a particularly interesting example. To people unfamiliar with the accomplishments of turn-of-the-century laryngologist Otto “Tiger” Freer, it can be assumed that the name of the instrument in one's hand is simply named for what it can do, that is, to “free” the nasal mucosa from the bony and cartilaginous septum during the transsphenoidal approach. The technique this master surgeon spent his life and career perfecting is now repeated almost daily by skull base neurosurgeons approaching pathologies from the inferior frontal lobe to the foramen magnum. In reviewing his life and work, the authors of this paper discovered an interesting creative process that led to the design of the eponymous instrument. Additionally, they discovered important advances toward the development of the transnasal approach and in our understanding of the anterior skull base. They present a historical perspective on the life and accomplishments of Dr. Freer and the ubiquitous surgical instrument that he invented and popularized.

Combined robotic transorbital and transnasal approach to the nasopharynx and anterior skull base: Feasibility study

2020 ◽  
Vol 45 (4) ◽  
pp. 630-633 ◽  
Author(s):  
Jack Faulkner ◽  
Reshania Naidoo ◽  
Asit Arora ◽  
Jean Pierre Jeannon ◽  
Claire Hopkins ◽  
...  
Keyword(s):  
Skull Base ◽  
Feasibility Study ◽  
Anterior Skull Base ◽  
Transnasal Approach

Transnasal Approach to the Anterior Skull Base

2014 ◽  
Vol 25 (3) ◽  
pp. 1041-1043 ◽  
Author(s):  
Yu Zong ◽  
Xiangcui Li ◽  
Yiming Jiang ◽  
Ji Xu ◽  
Jiping Li
Keyword(s):  
Skull Base ◽  
Anterior Skull Base ◽  
Transnasal Approach
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