The endoscopic endonasal approach for the management of craniopharyngiomas: a series of 103 patients

Object Despite their benign histological appearance, craniopharyngiomas can be considered a challenge for the neurosurgeon and a possible source of poor prognosis for the patient. With the widespread use of the endoscope in endonasal surgery, this route has been proposed over the past decade as an alternative technique for the removal of craniopharyngiomas. Methods The authors retrospectively analyzed data from a series of 103 patients who underwent the endoscopic endonasal approach at two institutions (Division of Neurosurgery of the Università degli Studi di Napoli Federico II, Naples, Italy, and Division of Neurosurgery of the Bellaria Hospital, Bologna, Italy), between January 1997 and December 2012, for the removal of infra- and/or supradiaphragmatic craniopharyngiomas. Twenty-nine patients (28.2%) had previously been surgically treated. Results The authors achieved overall gross-total removal in 68.9% of the cases: 78.9% in purely infradiaphragmatic lesions and 66.3% in lesions involving the supradiaphragmatic space. Among lesions previously treated surgically, the gross-total removal rate was 62.1%. The overall improvement rate in visual disturbances was 74.7%, whereas worsening occurred in 2.5%. No new postoperative defect was noted. Worsening of the anterior pituitary function was reported in 46.2% of patients overall, and there were 38 new cases (48.1% of 79) of postoperative diabetes insipidus. The most common complication was postoperative CSF leakage; the overall rate was 14.6%, and it diminished to 4% in the last 25 procedures, thanks to improvement in reconstruction techniques. The mortality rate was 1.9%, with a mean follow-up duration of 48 months (range 3–246 months). Conclusions The endoscopic endonasal approach has become a valid surgical technique for the management of craniopharyngiomas. It provides an excellent corridor to infra- and supradiaphragmatic midline craniopharyngiomas, including the management of lesions extending into the third ventricle chamber. Even though indications for this approach are rigorously lesion based, the data in this study confirm its effectiveness in a large patient series.

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Endoscopic transsphenoidal approach in the diagnosis and treatment of chiasmosellar germinomas

Head and neck tumors (HNT) ◽

10.17650/2222-1468-2020-10-1-29-37 ◽

2020 ◽

Vol 10 (1) ◽

pp. 29-37

Author(s):

M. A. Kutin ◽

D. V. Fomichev ◽

A. N. Shkarubo ◽

I. V. Chernov ◽

O. I. Sharipov ◽

...

Keyword(s):

Professional Associations ◽

Subsequent Treatment ◽

Transsphenoidal Approach ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Total Removal ◽

Endoscopic Endonasal ◽

Study Objective ◽

Female Ratio ◽

Histological Verification

Introduction. According to the recommendations of Russian and international professional associations, treatment of germinomas can be initiated without histological verification of the diagnosis, since it can be based on biochemical tumor markers. However, patients with brain germinomas usually have normal levels of these markers; therefore, histological verification is required. Stereotactic biopsy and transcranial biopsy are sometimes associated with a risk of damage to crucial anatomical structures. Currently, both biopsy and total removal of sellar and parasellar tumors can be performed via endoscopic endonasal approach. The study objective is to demonstrate the possibility of using endoscopic transsphenoidal approach for biopsy and total removal of chiasmosellar germinomas. Materials and methods. Thirteen patients with primary chiasmosellar germinomas underwent endoscopic endonasal interventions in N. N. Burdenko National Medical Research Center for Neurosurgery between 2010 and 2017. The “Germinoma-2008” protocol was used in the subsequent treatment of these patients. The male to female ratio was 2.25 : 1; mean age was 21.1 years (6–38 years).Results. The surgery volume varied between biopsy (n = 4) and partial (n = 5) or complete (n = 4) tumor removal. The diagnosis was histologically verified in all patients. None of the patients developed liquorrhea and / or meningitis in the postoperative period, which suggests that the surgery was effective and safe. Conclusion. The endoscopic endonasal approach for histological verification of the diagnosis and removal of chiasmosellar germinomas is safe and effective.

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Extended Endoscopic Endonasal Resection of a Suprasellar and Third Ventricular Retrochiasmatic Craniopharyngioma with a Narrow Pituitary Gland–Optic Chiasm Interval: Techniques to Optimize Resection

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1625946 ◽

2018 ◽

Vol 79 (S 03) ◽

pp. S252-S253

Author(s):

Tyler Kenning ◽

Carlos Pinheiro-Neto

Keyword(s):

Pituitary Gland ◽

Third Ventricle ◽

Mass Effect ◽

Optic Chiasm ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Posterior Aspect ◽

Endoscopic Endonasal ◽

The Third ◽

Extended Endoscopic Approach

AbstractThe extended endoscopic endonasal approach can be utilized to surgically treat pathology within the suprasellar space. This relies on a sufficient corridor and interval between the superior aspect of the pituitary gland and the optic chiasm. Tumors located in the retrochiasmatic space and within the third ventricle, however, may not have a widened interval through which to work. With mass effect on the superior and posterior aspect of the optic chiasm, the corridor between the chiasm and the pituitary gland might even be further narrowed. This may negate the possibility of utilizing the endoscopic endonasal approach for the management of pathology in this location. We present a case of a retrochiasmatic craniopharyngioma with a narrow resection corridor that was treated with the extended endoscopic approach and we review techniques to potentially overcome this limitation.The link to the video can be found at: https://youtu.be/ogRZj-aBqeQ.

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Extended endoscopic endonasal approach for selected pituitary adenomas: early experience

Journal of Neurosurgery ◽

10.3171/2010.9.jns10262 ◽

2011 ◽

Vol 114 (2) ◽

pp. 345-353 ◽

Cited By ~ 44

Author(s):

Salvatore Di Maio ◽

Luigi M. Cavallo ◽

Felice Esposito ◽

Vita Stagno ◽

Olga Valeria Corriero ◽

...

Keyword(s):

Pituitary Adenomas ◽

Transsphenoidal Surgery ◽

Extent Of Resection ◽

Transsphenoidal Approach ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Csf Leakage ◽

Endoscopic Endonasal Transsphenoidal Surgery ◽

Extended Endoscopic Approach

Object Whereas most pituitary adenomas are removable via the transsphenoidal approach, certain cases, such as dumbbell-shaped or suprasellar adenomas and recurrent and/or fibrous tumors, remain difficult to treat. The authors present their experience with the extended endoscopic endonasal approach to the suprasellar area in managing this subset of tumors, which are classically treated through a transcranial route. Methods From June 1997 to December 2008, 615 patients underwent endoscopic endonasal transsphenoidal surgery for pituitary adenomas in the Department of Neurosurgery of the Università degli Studi di Napoli Federico II. Of this group, 20 patients with pituitary adenomas needed an extended endoscopic endonasal transtuberculum/transplanum approach for tumor removal. Two surgical corridors were used during the transsphenoidal approach: 1) the conventional endosellar extraarachnoidal corridor and 2) a suprasellar transarachnoidal corridor. Results The extent of resection was gross total in 12 (60%) of the 20 patients, near total in 4 (20%), subtotal in 3 (15%), and partial in 1 (5%). Postoperative CSF leakage occurred in 1 patient. One patient experienced worsening of temporal hemianopsia. Conclusions The authors' initial results with the extended endoscopic approach to the suprasellar area for selected pituitary adenomas are promising and may justify a widening of the current classical indications for transsphenoidal surgery.

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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 approach for brainstem cavernous malformation

Neurosurgical Focus: Video ◽

10.3171/2019.10.focusvid.19399 ◽

2019 ◽

Vol 1 (2) ◽

pp. V2

Author(s):

Ezequiel Goldschmidt ◽

Andrew S. Venteicher ◽

Maximiliano Nuñez ◽

Eric Wang ◽

Carl Snyderman ◽

...

Keyword(s):

Cavernous Malformation ◽

Motor Evoked Potentials ◽

Lateral Displacement ◽

Third Ventricle ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

High Definition ◽

Endoscopic Endonasal ◽

Transcallosal Approach ◽

Postoperative Mri

This 25-year-old woman presented after a second hemorrhage from a mesencephalic cavernous malformation. High-definition fiber tracking demonstrated lateral displacement of the corticospinal tracts, making a midline approach ideal. The lesion appeared to present to the third ventricle, but a transcallosal approach was abandoned due to the posterior third ventricular location and after FIESTA imaging revealed a superior and medial rim of normal parenchyma that would have to be transgressed to access the malformation. An endoscopic endonasal approach with interdural pituitary hemitransposition was performed. The interpeduncular cistern was accessed and the thalamoperforating arteries dissected to access the cavernous malformation that was completely removed in a piecemeal fashion. The patient’s preexisting internuclear ocular palsies and hemiparesis were slightly worsened after surgery as predicted by a drop in anterior tibialis motor evoked potentials. Postoperative MRI showed no infarct, and the hemiparesis was back to baseline at 1-month follow-up.The video can be found here: https://youtu.be/e6203R9HHmk.

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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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Total removal of a trigeminal schwannoma via the expanded endoscopic endonasal approach. Technical note

Acta Neurochirurgica ◽

10.1007/s00701-015-2409-5 ◽

2015 ◽

Vol 157 (6) ◽

pp. 935-938 ◽

Cited By ~ 5

Author(s):

Timothée Jacquesson ◽

Moncef Berhouma ◽

Thiébaud Picart ◽

Emmanuel Jouanneau

Keyword(s):

Technical Note ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Total Removal ◽

Endoscopic Endonasal ◽

Trigeminal Schwannoma

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Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions

Journal of Neurosurgery ◽

10.3171/jns.2007.106.3.400 ◽

2007 ◽

Vol 106 (3) ◽

pp. 400-406 ◽

Cited By ~ 236

Author(s):

Ilya Laufer ◽

Vijay K. Anand ◽

Theodore H. Schwartz

Keyword(s):

Sella Turcica ◽

Significant Risk ◽

Csf Leak ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Rathke Cleft Cyst ◽

Extended Transsphenoidal Approach ◽

Csf Leakage ◽

Planum Sphenoidale

Object The extended transsphenoidal approach is a less invasive method for removing purely suprasellar lesions compared with traditional transcranial approaches. Most advocates have used a sublabial incision and a microscope and have reported a significant risk of cerebrospinal fluid (CSF) leakage. The authors report on a series of purely endoscopic endonasal surgeries for resection of suprasellar supradiaphragmatic lesions above a normal-sized sella turcica with a low risk of CSF leakage. Methods A purely endoscopic endonasal approach was used to remove suprasellar lesions in a series of 10 patients. Five lesions were prechiasmal (three tuberculum sellae and two planum sphenoidale meningiomas) and five were post-chiasmal (four craniopharyngiomas and one Rathke cleft cyst). The floor of the planum sphenoidale and the sella turcica was reconstructed using a multilayer closure with autologous and synthetic materials. Spinal drainage was performed in only five cases. Complete resection of the lesions was achieved in all but one patient. The pituitary stalk was preserved in all but one patient, whose stalk was invaded by a craniopharyngioma and who had preoperative diabetes insipidus (DI). Vision improved postoperatively in all patients with preoperative impairment. Six patients had temporary DI; in five, the DI became permanent. Four patients with craniopharyngiomas required cortisone and thyroid replacement. After a mean follow up of 10 months, there was only one transient CSF leak when a lumbar drain was clamped prematurely on postoperative Day 5. Conclusions A purely endoscopic endonasal approach to suprasellar supradiaphragmatic lesions is a feasible minimally invasive alternative to craniotomy. With a multilayer closure, the risk of CSF leakage is low and lumbar drainage can be avoided. A larger series will be required to validate this approach.

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Infrasellar Endoscopic Endonasal Approach for a Pituitary Adenoma Extending into the Third Ventricle, with Anterior Displacement of the Pituitary Gland

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1620261 ◽

2018 ◽

Vol 79 (S 02) ◽

pp. S233-S234

Author(s):

Georgios Zenonos ◽

Eric Wang ◽

Juan Fernandez-Miranda

Keyword(s):

Pituitary Adenoma ◽

Pituitary Gland ◽

Outcome Measures ◽

Third Ventricle ◽

Visual Fields ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Anterior Displacement ◽

The Third

Objectives The current video presents the nuances of the infrasellar endoscopic endonasal approach for a pituitary adenoma extending into the third ventricle, with anterior displacement of the pituitary gland. Design The video analyzes the presentation, preoperative workup and imaging, surgical steps and technical nuances of the surgery, the clinical outcome, and follow-up imaging. Setting The patient was treated by a skull base team consisting of a neurosurgeon and an ENT surgeon at a teaching academic institution. Participants The case refers to 73-year-old female patient who was found to have a sellar mass after failure of vision to improve with cataract surgery. She also reported a several-month history of progressive loss of vision along with daily retro-orbital headaches. The adenoma extended into the clivus as well as in the retrosellar and suprasellar regions, eroding into the floor of the third ventricle. The normal gland was displaced anteriorly. Main Outcome Measures The main outcome measures consisted of reversal of patient symptoms (headaches and visual disturbance), recurrence-free survival based on imaging, as well as absence of any complications. Results The patient's headaches and visual fields improved. There was no evidence of recurrence. Conclusion The infrasellar endoscopic endonasal approach is safe and effective for pituitary adenomas extending into the third ventricle, with anterior displacement of the pituitary gland.The link to the video can be found at: https://youtu.be/zp_06mEyRvY.

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

Operative Neurosurgery ◽

10.1227/01.neu.0000289708.49684.47 ◽

2007 ◽

Vol 61 (suppl_3) ◽

pp. ONS-24-ONS-34 ◽

Cited By ~ 29

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.

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