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

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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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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Application of endoscopic endonasal approach in skull base surgeries: summary of 1886 cases in a single center for 10 consecutive years

Chinese Neurosurgical Journal ◽

10.1186/s41016-020-00199-w ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Chuzhong Li ◽

Haibo Zhu ◽

Xuyi Zong ◽

Xinsheng Wang ◽

Songbai Gui ◽

...

Keyword(s):

Skull Base ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Single Center ◽

Endoscopic Endonasal

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

Neurosurgical FOCUS ◽

10.3171/2010.1.focus09292 ◽

2010 ◽

Vol 28 (4) ◽

pp. E8 ◽

Cited By ~ 58

Author(s):

Peter G. Campbell ◽

Brian McGettigan ◽

Adam Luginbuhl ◽

Sanjay Yadla ◽

Marc Rosen ◽

...

Keyword(s):

Visual Field ◽

English Literature ◽

Endoscopic Approach ◽

Pituitary Stalk ◽

Gross Total Resection ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Total Resection ◽

Endoscopic Endonasal ◽

Csf Leaks

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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Three-Dimensional Endoscopic Endonasal Approach and Outcomes in Sellar Lesions: A Single-Center Experience of 104 Cases

World Neurosurgery ◽

10.1016/j.wneu.2016.01.049 ◽

2016 ◽

Vol 89 ◽

pp. 121-125 ◽

Cited By ~ 23

Author(s):

Valentina Pennacchietti ◽

Massimiliano Garzaro ◽

Silvia Grottoli ◽

Paolo Pacca ◽

Diego Garbossa ◽

...

Keyword(s):

Three Dimensional ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Single Center ◽

Endoscopic Endonasal ◽

Single Center Experience ◽

Sellar Lesions

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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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An endoscopic endonasal approach to craniopharyngioma via the infrachiasmatic corridor: a single center experience of 84 patients

Acta Neurochirurgica ◽

10.1007/s00701-021-04832-0 ◽

2021 ◽

Author(s):

Savas Ceylan ◽

Melih Caklili ◽

Atakan Emengen ◽

Eren Yilmaz ◽

Yonca Anik ◽

...

Keyword(s):

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Single Center ◽

Endoscopic Endonasal ◽

Single Center Experience

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Extended endoscopic endonasal approach for pituitary adenoma: a single-center experience of 171 patients

Chinese Neurosurgical Journal ◽

10.1186/s41016-017-0080-9 ◽

2017 ◽

Vol 3 (1) ◽

Cited By ~ 1

Author(s):

Xiaobing Jiang ◽

Zhen Liu ◽

Xing Huang ◽

Haijun Wang ◽

Hongyang Zhao

Keyword(s):

Pituitary Adenoma ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Single Center ◽

Endoscopic Endonasal ◽

Single Center Experience

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Surgical treatment of non-functioning pituitary macroadenomas by the endoscopic endonasal approach in the elderly

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20150112 ◽

2015 ◽

Vol 73 (9) ◽

pp. 764-769 ◽

Cited By ~ 11

Author(s):

Horacio Armando Marenco ◽

Samuel Tau Zymberg ◽

Rodrigo de Paula Santos ◽

Cláuder Oliveira Ramalho

Keyword(s):

Surgical Treatment ◽

Elderly Patients ◽

The Elderly ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

The Past ◽

Pituitary Dysfunction ◽

Visual Improvement ◽

Transcranial Approach

Over the past three decades, surgical series of elderly patients treated for pituitary adenomas have been published, all of which used the microscopic transsphenoidal or transcranial approach. The objective of this study was to retrospectively analyze the surgical results of our first 25 elderly patients with non-functioning pituitary macroadenoma (NFPM) operated by the endoscopic endonasal approach (EEA). Preoperative visual loss was found in 92.8% of the cases, and 70.8% experienced visual improvement following surgery. Preoperative pituitary dysfunction was found in 69.2% of the cases and postoperative pituitary recovery occurred in 22.2% of them. Mean hospital stay was 6.7 days. The results of this study suggest that surgery remains the first line of treatment for NFPM in the elderly. Because age alone is not a barrier for surgery, patients should be selected for surgical treatment based on their symptoms and clinical condition, as defined by comorbidities.

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