Endocrinological and ophthalmological consequences of an initial endonasal endoscopic approach for resection of craniopharyngiomas

Object The expanded endoscopic approach to craniopharyngiomas has recently been described in several small case series. The authors present their experience with this technique and review the available literature. Methods Between September 2006 and September 2009, 14 patients underwent a purely endoscopic, endonasal approach for resection of newly diagnosed craniopharyngiomas. These procedures represent index surgeries; no patient had undergone previous tumor resection. A retrospective review of endocrinological and ophthalmological outcomes, extent of resection, and complication prevalence was completed. Additionally, a review of the English literature was performed to evaluate outcomes of similar endoscopic techniques for resection of craniopharyngiomas. Results Four patients (28.6%) underwent gross-total resection; near total resection or better was achieved in 9 patients (64.3%). All patients presented with some form of visual field or acuity deficit. Postoperatively, 12 patients (85.7%) experienced visual improvement, with 6 patients (42.9%) having complete visual recovery. One patient experienced worsening of her visual deficit. Visual acuity improved in 8 patients ((57.1%), while visual field defects improved in 11 (78.6%). The pituitary stalk was preserved in all cases. Eight (57.1%) of 14 patients experienced some form of anterior pituitary dysfunction postoperatively. Although 9 patients (64.3%) were documented to have either transient or permanent new diabetes insipidus immediately after surgery, at 1-month follow-up only 1 patient met clinical criteria. Five patients (35.7%) developed CSF leaks that were successfully treated by subsequent endoscopic revision. All CSF leaks occurred early in the series. Two patients (14.2%) were treated for presumed meningitis postoperatively. Conclusions The endoscopic endonasal approach is a minimally invasive alternative to open transcranial approaches for select craniopharyngiomas. Similar to previous transcranial series, rates of endocrinopathy and gross-total resection were dependent upon the adherence of the tumor capsule to the hypothalamus, pituitary stalk, and associated vasculature. A review of the literature suggests that the results of the current series are similar to other published series on this topic.

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Expanded Endoscopic Endonasal Approach for Resection of Intradural Chordoma: Surgical and Anatomic Nuances: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opy385 ◽

2018 ◽

Vol 17 (2) ◽

pp. E66-E66

Author(s):

Miguel Marigil ◽

Joao Paulo Almeida ◽

Claire Karekezi ◽

John R de Almeida ◽

Fred Gentili

Keyword(s):

Bone Erosion ◽

Surgical Anatomy ◽

Gross Total Resection ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Total Resection ◽

Endoscopic Endonasal ◽

Endoscopic Techniques ◽

Low Testosterone ◽

Neurovascular Structures

Abstract The expanded endoscopic endonasal approach (EEA) has been growing as a surgical alternative for the treatment of clival chordomas because of their frequent midline location and bone erosion. The endoscopic transclival approach provides with a safer and more direct anatomic route for tumors located predominantly in the midline contributing to minimize postoperative comorbidities. In this video, we demonstrate the step-by-step technique for resection of such challenging clival pathology. This is an operative video of an extended endoscopic resection of a clival chordoma with stepwise description of the surgical technique. We present the case of a 49-yr-old man in whom, incidentally in the context of low testosterone level, a clival lesion with purely midline location with intradural extension into the ventral brainstem and occupation of the left cerebellopontine angle was discovered. The patient was submitted to an expanded endoscopic transclival approach and a macroscopic gross total resection was successfully achieved. The final pathology was compatible with a conventional chordoma. This video details the surgical anatomy of the clival region to facilitate the identification of surgical landmarks and anatomic boundaries with the goal of avoiding injury to the neurovascular structures involved in this approach. Extended endoscopic transclival surgery is a useful and safer option for the management of midline chordomas because it provides with a dissection corridor free of major neurovascular structures. Endoscopic techniques are associated with good outcomes in terms of macroscopic gross total resection and low surgical risks in these selected tumors.

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The efficacy of an endoscopic endonasal approach in the repair of cerebrospinal fluid fistula: a clinical analysis

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20191431 ◽

2019 ◽

Vol 5 (4) ◽

pp. 90

Author(s):

Fulya Ozer ◽

Can Alper Cagici ◽

Cem Ozer ◽

Cuneyt Yilmazer

Keyword(s):

Cerebrospinal Fluid ◽

Endoscopic Approach ◽

Graft Material ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Cerebrospinal Fluid Fistula ◽

Endoscopic Repair ◽

Endoscopic Endonasal ◽

Csf Leakage ◽

Fluid Fistula

Background: Cerebrospinal fluid (CSF) fistula is an abnormal CSF leakage due to bone and/or dural defect of the skull base and usually operated with endonasal endoscopic approach. The aim of this study was to determine the efficacy of an endonasal endoscopic approach in the repair of CSF leakage and to find the reasons of the recurrence of endoscopic procedure.Methods: The medical records of 24 patients that presented with the diagnosis of cerebrospinal fluid fistula and who had undergone endonasal endoscopic repair surgery were reviewed retrospectively. Results: 13 patients (54.2%) were found to have spontaneous CSF fistulas without any history of trauma, while 11 patients (45.8%) had posttraumatic CSF fistulas. The mean body mass index (BMI) of patients was 31. 3 kg/m² (20.1-49.6). Nasal septal cartilage was used as a graft material in 19 patients (79%) while only fascia was used in 5 patients (21%). The evaluation of long-term results revealed recurrence in 4 patients (16.6%). Two of these patients required a second surgical repair.Conclusions: An endoscopic endonasal approach is a safe method with less morbidity and a reliable outcome in the repair of CSF fistulas. The most important causative factors in the recurrence of endoscopic repair of CSF leak might be to have high BMI and not to use multilayered graft material for closure of fistula.

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

Neurosurgical FOCUS ◽

10.3171/2016.9.focus16299 ◽

2016 ◽

Vol 41 (6) ◽

pp. E7 ◽

Cited By ~ 43

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.

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The expanded endoscopic endonasal approach for treatment of tuberculum sellae meningiomas in a series of 40 consecutive cases

Scientific Reports ◽

10.1038/s41598-021-83905-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Peng Yu ◽

Tutu Xu ◽

Xinyu Wu ◽

Zhitong Liu ◽

Yong Wang ◽

...

Keyword(s):

Anterior Cerebral Artery ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Total Resection ◽

Endoscopic Endonasal ◽

Tuberculum Sellae Meningioma ◽

Csf Leakage ◽

Invasive Method ◽

Tuberculum Sellae

AbstractCompared with traditional craniotomy, the expanded endoscopic endonasal approach (EEEA) may have some advantages for tuberculum sellae meningioma (TSM) treatment. We described our experience of the therapeutic effect of endoscopic TSM treatment. From August 2015 to December 2019, 40 patients with a TSM were treated by the EEEA in our institution. EEEA outcome in TSM treatment was analyzed. Among 39 patients with visual impairment, 38 (97.4%) improved their visual function to some extent after the EEEA, and one case had no significant change in visual acuity. Among all patients, 38 (95.0%) achieved gross total resection (GTR) and 2 (5.0%) achieved near-total resection (NTR). Cerebrospinal fluid (CSF) leakage occurred in three patients (7.5%) and meningitis (post-CSF leakage) in two patients (5.0%). Eight patients (20.0%) suffered postoperative hyposmia, three of whom developed long-term hyposmia. One patient (2.5%) suffered from bleeding of the branch of the anterior cerebral artery intraoperatively leading to postoperative acute cerebral infarction. The EEEA is a safe and reliable minimally invasive method for TSM removal. Compared with traditional craniotomy, the EEEA may have better visual outcomes and a higher prevalence of GTR, but carries the risk of CSF leakage.

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Endoscopic endonasal repair of sphenoid cerebrospinal fluid leak, review and institutional experience

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20190753 ◽

2019 ◽

Vol 5 (2) ◽

pp. 241

Author(s):

Isra Al-Jazeeri ◽

Hassan Al-Jazeeri ◽

Ali Al-Momen

Keyword(s):

Demographic Data ◽

Cerebrospinal Fluid Leak ◽

Csf Leak ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Uncommon Presentation ◽

Pubmed Database ◽

Intracranial Complications ◽

Csf Leaks

Background: Rhinogenic CSF leaks are not an uncommon presentation. Considering the possibility of drastic intracranial complications if left untreated, makes the management of such cases of outmost importance. Most of the non-traumatic CSF leaks will need a surgical repair. And since the introduction of the endoscopic nasal surgeries, these repairs are done almost always through the endoscopic endonasal approach.Methods: Retrospective review of cases with endoscopic repair of sphenoid CSF leak, who presented to King Fahad Specialist Hospital in Dammam (KFSH-D), from November 2003 to December 2017. And the U.S. National Library of Medicine (Pubmed) database was searched for “Sphenoid CSF Leak”. Results: We had a total of 12 cases. The demographic data, diagnostic investigations and operative data were retrieved and reviewed.Conclusions: We advise using high resolution CT and intra-operative fluroscein for a reliable localization. And we found no complications with use of correct concentration of fluroscein. Endoscopic endonasal approach for repair of sphenoid CSF leak was found to be both effective and safe.

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A Study of Pituitary Adenoma Surgery: Transphenoidal Microscopic Versus Endoscopic Endonasal Approach

Bangladesh Journal of Neuroscience ◽

10.3329/bjn.v31i1.57372 ◽

2015 ◽

Vol 31 (1) ◽

pp. 21-29

Author(s):

Haradhan Deb Nath ◽

Kanak Kanti Barua ◽

Kazi Hafiz Uddin ◽

Monirul Islam ◽

Omar Faruque ◽

...

Keyword(s):

Pituitary Adenoma ◽

Visual Disturbance ◽

Minimal Invasive ◽

Endoscopic Approach ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Normal Vision ◽

Microscopic Approach ◽

Endoscopic Endonasal ◽

Better Than

Background: Transphenoidal endoscopic approach is minimal invasive surgery in case of pituitary adenoma. Objective : To see the outcome of transphenoidal endoscopic and microscopic approach in case of pituitary tumor. Results : This study showed among the 37 patients, 25 (67.6%) were done by transphenoidal microscopic approach and 12 (32.4%) patients were done by endonasal endoscopic approach. Among the 12 patients 8(66.7%) were male and 4(33.3%) were female. Among the 25, patients 15(60%) were male and 10(40%) were female. It was documented that in 12 patients, 10(83.3%) were macroadenoma and 2(16.7%) were microadenoma. It was evident that among the 25 patient 18(72%) were macroadenoma and 7(28%) were microadenoma. Among 12 patients, 11 (91.7%) had preoperative visual disturbance and 1(8.3%) had normal vision. It was observed that among 25 patients, 23(92%) patients had preoperative visual disturbance and 2 (8%) patients had normal vision. Tumor was totally removed in 9(75%) patients in endoscopic approach and 14(56%) in microscopic approach. Clinically 10(83.3%) patients were improved in endoscopically and 16(64%) patients were improved in microscopic group. Conclusion: It was concluded that endoscopic endonasal approach is better than transphenoidal microscopic approach. Bangladesh Journal of Neuroscience 2015; Vol. 31 (1): 21-29

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Endoscopic endonasal approach to the lateral orbital apex: case report

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.2.peds1575 ◽

2015 ◽

Vol 16 (3) ◽

pp. 305-308 ◽

Cited By ~ 2

Author(s):

Tomasz A. Dziedzic ◽

Vijay K. Anand ◽

Theodore H. Schwartz

Keyword(s):

Optic Nerve ◽

Rectus Muscle ◽

Lateral Compartment ◽

Endoscopic Approach ◽

Minimal Access ◽

Endoscopic Endonasal Approach ◽

Orbital Apex ◽

Total Resection ◽

Endoscopic Endonasal ◽

Lateral Rectus Muscle

Although the medial and inferior orbital apex are considered safely accessible using the endonasal endoscopic approach, the lateral apex has been considered unsafe to access since the optic nerve lies between the surgeon and the pathology. The authors present the case of a 4-year-old girl with recurrent rhabdomyosarcoma attached to the lateral rectus muscle located lateral and inferior to the optic nerve in the orbital apex. The tumor was totally resected through an endoscopic endonasal transmaxillary transpterygoidal approach using a 45° endoscope. A gross-total resection was achieved, and the patient’s vision was unchanged. This procedure is a safe, minimal-access alternative to open procedures in selected cases and provides evidence that increases the applicability of the endonasal endoscopic approach to reach the lateral compartment of the orbital apex.

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

Journal of Neurosurgery ◽

10.3171/2015.1.jns132842 ◽

2015 ◽

Vol 122 (5) ◽

pp. 1166-1172 ◽

Cited By ~ 8

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

Journal of Neurology & Stroke ◽

10.15406/jnsk.2020.10.00430 ◽

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.

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RARE-03. AGGRESSIVE RESECTION FOR PEDIATRIC CRANIOPHARYNGIOMAS VIA ENDOSCOPIC ENDONASAL APPROACH

Neuro-Oncology ◽

10.1093/neuonc/noaa222.715 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii442-iii442

Author(s):

Hiroki Morisako ◽

Takeo Goto ◽

Hiroki Ohata ◽

Hiroaki Sakamoto ◽

Kenji Ohata

Keyword(s):

Extent Of Resection ◽

Cognitive Outcomes ◽

Csf Leak ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Total Resection ◽

Endoscopic Endonasal ◽

Transcranial Approach ◽

Surgical Modality

Abstract OBJECTIVE In recent years, the endoscopic endonasal approach (EEA) has been increasingly used for pediatric craniopharyngiomas. We here present our experience and the outcomes of the EEA resection of pediatric craniopharyngiomas. MATERIALS AND METHODS Between April 2014 and December 2019, 16 cases of pediatric craniopharyngiomas were operated at the Osaka city university (OCU) hospital. Eight patients were diagnosed with primary craniopharyngiomas while 8 had a recurrent tumor. There were 5 males and 11 females, with a mean age of 10.7 years (3–17 years). EEA was selected in all patients and a case of large muti-lobulated tumor was resected by combination of microscopic transcranial approach. RESULTS Gross total resection was achieved in 14 patients and near total resection in other 2. Post-op CSF leak occurred in 3 patients, which was treated with re-exploration. Pituitary stalk was preserved intraoperatively in 4 cases, and 15 patients developed diabetes insipidus and anterior hormonal replacement therapy was required in 15 patients at last follow-up. Visual improvement was noted in 4 patients while vision remained unchanged in the rest. Neuropsychological function status was preserved in all patients, and there was no new-onset obesity postoperatively. The mean follow-up duration was 35.1 months (2 – 69 months) and 4 of 8 recurrent cases had re-recurrence during this period, however there was no recurrent in 8 primary cases. CONCLUSIONS EEA should be the surgical modality of choice for treating pediatric craniopharyngiomas. It results in better visual and cognitive outcomes with a significantly increased extent of resection.

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