Endoscopic endonasal approach to cholesterol granulomas of the petrous apex: a series of 17 patients

2012 ◽  
Vol 116 (4) ◽  
pp. 792-798 ◽  
Author(s):  
Alessandro Paluzzi ◽  
Paul Gardner ◽  
Juan C. Fernandez-Miranda ◽  
Carlos D. Pinheiro-Neto ◽  
Tiago Fernando Scopel ◽  
...  
Keyword(s):  
Strong Correlation ◽  
Petrous Apex ◽  
Consecutive Series ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Carotid Artery Injuries ◽  
Skull Base Lesions ◽  
Serous Otitis Media

Object The aim of this study was to report the results in a consecutive series of patients who had undergone an endoscopic endonasal approach (EEA) for drainage of a petrous apex cholesterol granuloma (CG). Methods Seventeen cases with a confirmed diagnosis of petrous apex CG were identified from a database of more than 1600 patients who had undergone an EEA to skull base lesions at the authors' institution in the period from 1998 to 2011. Clinical outcomes were reviewed and compared with those in previous studies of open approaches. Results Nine patients underwent a transclival approach and 8 patients underwent a combined transclival and infrapetrous approach. A Silastic stent was used in 11 patients (65%), a miniflap in 4 (24%), and a simple marsupialization of the cyst in 3 (18%). All symptomatic patients had partial or complete improvement of their symptoms postoperatively and at the follow-up (mean follow-up 20 months, range 3–67 months). Complications developed in 3 patients (18%) including epistaxis, chronic serous otitis media, eye dryness, and a transient sixth cranial nerve palsy. Two patients (12%) had a symptomatic recurrence of the cyst requiring repeat endoscopic endonasal drainage. There were no instances of internal carotid artery injuries, CSF leaks, or new hearing loss. The mean postoperative hospital stay was 2 days (range 0.7–4.6 days). These results were comparable with those in previous studies of open approaches to petrous apex CGs. There was a strong correlation between the size of the cyst and the type of approach chosen (Rpb [point biserial correlation coefficient] = +0.67, p = 0.003359) and a very strong correlation between the degree of medial extension (defined by the V-angle) and the choice of approach (Rpb = +0.81, p < 0.0001). Based on these observations, the authors developed an algorithm for guiding the choice of the most appropriate route of drainage. Conclusions The EEA is a safe and effective alternative to traditional open approaches to petrous apex CGs.

scholarly journals P.053 Expanded endoscopic endonasal approach for petrous apex lesions: our clinical experience and surgical techniques

2018 ◽  
Vol 45 (s2) ◽  
pp. S29-S29
Author(s):  
F Alkherayf ◽  
S Kilty
Keyword(s):  
Cranial Nerve ◽  
Surgical Techniques ◽  
Csf Leak ◽  
Petrous Apex ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Invasive Approach ◽  
Brain Retraction

Background: Traditionally petrous apex lesions surgical approach is associated with multiple complications including brain injury secondary to brain retraction. Expanded endoscopic endonasal trans-clival (EEET) can be used in selected patients with minimal complications. Methods: We are presenting our experience over the last three years in patients who underwent EEET resection of petrous apex lesions: 8 patients underwent such procedure. All patients underwent extensive workup including MRI and CTA to identify the relation of the carotid to the lesion. All surgeries were done with neuro-physiological monitoring. Intraoperative neuronavigation and endoscopic Doppler were used to identify the petrous segment of the internal carotid artery. Our follow up ranged from 6 months to 2.5 years. Results: All patients presented with severe neurologic symptoms related to either fifth cranial nerve, sixth cranial nerve or brain stem compression. Pathologies included chondrosarcoma, cholesterol granulomas and lymphangioma. All patients demonstrated improvement in their symptoms. None of our patients had intra-operative vascular injury. There was no post-operative CSF leak or infection. Postoperative imaging demonstrated excellent resection with no clear residual. Three patient required adjuvant stereotactic radiosurgery because of their underlying pathology. Conclusions: The expanded endoscopic endonasal approach for petrous apex lesion should be considered as a minimally invasive approach in selected cases.

Endoscopic Endonasal Approach to Cholesterol Granulomas of the Petrous Apex: A Series of 17 Patients

2012 ◽  
Vol 73 (S 02) ◽  
Author(s):  
A. Paluzzi ◽  
M. Koutourousiou ◽  
J. Fernandez-Miranda ◽  
P. Gardner ◽  
C. Snyderman
Keyword(s):  
Petrous Apex ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

Endoscopic Endonasal Approach to the Petrous Apex: A Retrospective Study and Outcomes

2015 ◽  
Vol 76 (S 01) ◽  
Author(s):  
Robert Miller ◽  
Maria Koutourousiou ◽  
Eric Wang ◽  
Juan Fernandez-Miranda ◽  
Carl Snyderman ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Petrous Apex ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

scholarly journals Excision of Greater Superficial Petrosal Nerve Schwannoma Via a Pure Endoscopic Endonasal Approach

2021 ◽  
pp. 014556132110263
Author(s):  
Zhenlin Wang ◽  
Siyuan Zhang ◽  
Yan Qi ◽  
Lianjie Cao ◽  
Pu Li ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Clinical Features ◽  
Middle Cranial Fossa ◽  
Nerve Sheath Tumor ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Greater Superficial Petrosal Nerve ◽  
Clinical Records

Greater superficial petrosal nerve (GSPN) schwannomas are an exceedingly rare nerve sheath tumor. The current literature search was conducted using Medline and Embase database by key search terms. Only 31 cases have been reported in the literature so far. Facial palsy, hearing loss, and xerophthalmia accounted for 48.4% (15), 41.9% (13), and 29% (9) of all cases, respectively. The middle cranial fossa approach was used in all previous reports. A retrospective review of 2 GSPN schwannomas patients treated by endoscopic endonasal approach (EEA) in our center was collected. Clinical records, including clinical features, pre- and postoperative images, surgery, and follow-up information, were reviewed. In all cases, clinical features including facial numbness and headache were found, with tinnitus in case 1, hearing loss, xerophthalmia in case 2. Imaging studies showed a solid mass that originated in the anterior of the petrous bone. Two patients were treated by EEA. Furthermore, no recurrence was found during the follow-up period (15-29 months) in both of the 2 cases after the operation. Complete resection of GSPN schwannomas can be achieved via the pure EEA. Endoscopic endonasal approach for radical removal of tumors is safe and feasible.

scholarly journals Machine learning–based prediction of outcomes of the endoscopic endonasal approach in Cushing disease: is the future coming?

2020 ◽  
Vol 48 (6) ◽  
pp. E5
Author(s):  
Matteo Zoli ◽  
Victor E. Staartjes ◽  
Federica Guaraldi ◽  
Filippo Friso ◽  
Arianna Rustici ◽  
...  
Keyword(s):  
Machine Learning ◽  
Area Under The Curve ◽  
Complex Data ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Cushing Disease ◽  
Endoscopic Endonasal ◽  
Internal Validation

OBJECTIVEMachine learning (ML) is an innovative method to analyze large and complex data sets. The aim of this study was to evaluate the use of ML to identify predictors of early postsurgical and long-term outcomes in patients treated for Cushing disease (CD).METHODSAll consecutive patients in our center who underwent surgery for CD through the endoscopic endonasal approach were retrospectively reviewed. Study endpoints were gross-tumor removal (GTR), postsurgical remission, and long-term control of disease. Several demographic, radiological, and histological factors were assessed as potential predictors. For ML-based modeling, data were randomly divided into 2 sets with an 80% to 20% ratio for bootstrapped training and testing, respectively. Several algorithms were tested and tuned for the area under the curve (AUC).RESULTSThe study included 151 patients. GTR was achieved in 137 patients (91%), and postsurgical hypersecretion remission was achieved in 133 patients (88%). At last follow-up, 116 patients (77%) were still in remission after surgery and in 21 patients (14%), CD was controlled with complementary treatment (overall, of 131 cases, 87% were under control at follow-up). At internal validation, the endpoints were predicted with AUCs of 0.81–1.00, accuracy of 81%–100%, and Brier scores of 0.035–0.151. Tumor size and invasiveness and histological confirmation of adrenocorticotropic hormone (ACTH)–secreting cells were the main predictors for the 3 endpoints of interest.CONCLUSIONSML algorithms were used to train and internally validate robust models for all the endpoints, giving accurate outcome predictions in CD cases. This analytical method seems promising for potentially improving future patient care and counseling; however, careful clinical interpretation of the results remains necessary before any clinical adoption of ML. Moreover, further studies and increased sample sizes are definitely required before the widespread adoption of ML to the study of CD.

Endoscopic Endonasal Approach for Petrous Apex Cholesterol Granuloma: Cases Report and Review

2014 ◽  
Vol 75 (S 02) ◽  
Author(s):  
Mohammad Samadian ◽  
Nader Dilmaghani ◽  
Habibollah Moghaddasi ◽  
Mohsen Vazirnezami ◽  
Reza Jabbari ◽  
...  
Keyword(s):  
Petrous Apex ◽  
Cholesterol Granuloma ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

Endoscopic Surgery of a Sinonasal Inverted Papilloma: Surgical Strategy, Follow-up, and Recurrence Rate

2017 ◽  
Vol 31 (1) ◽  
pp. 51-55 ◽  
Author(s):  
Xiao-Dan Jiang ◽  
Qing-Zhe Dong ◽  
Shen-Ling Li ◽  
Tian-Qiao Huang ◽  
Nian-Kai Zhang
Keyword(s):  
Recurrence Rate ◽  
Endoscopic Surgery ◽  
Inverted Papilloma ◽  
Surgical Strategy ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Sinonasal Inverted Papilloma ◽  
Significant Difference

Background Sinonasal inverted papilloma (SNIP) is noted for its high rate of recurrence and malignant transformation. Although many clinical studies have demonstrated the effectiveness of the endoscopic approach for SNIP, the surgical strategy has been the subject of much debate. Objective To evaluate the effectiveness of the endoscopic endonasal approach in SNIP. Methods A systematic review of patients with a diagnosis of SNIP and who had surgery at our institution from June 2005 to March 2013 was performed. All the patients who had postoperative follow-up for >2 years were enrolled. Each case was categorized into one of four stages as reported by Krouse. Demographic and tumor date, operative approach, complications, and recurrence rates were collected. Results A total of 125 patients were included in this study. There were 17 patients in stage 1, 40 in stage 2, 57 in stage 3, and 11 in stage 4. The overall recurrence rate was 8.0%. There was no significant difference in recurrence among the stages (all p > 0.05). Recurrence after endoscopic endonasal approach (8.4%) and a combined endoscopic and open exposure procedure (5.6%) were not significantly different (p > 0.05). The recurrence rate was significantly (p < 0.05) higher in patients with revision (15.6%) than in patients in the primary cases (3.8%). A common site of tumor origin was recorded to be from the maxillary sinus (40.2%). Twenty percent of recurrences were observed up to 5 years after surgery. Conclusion Endoscopic surgery may be preferred for treating SNIP. The elevated recurrence rate after revision emphasized the significance of the first surgery. We encourage a follow-up period of at least 5 years.

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