scholarly journals Role of transcranial sphenoidotomy in skull base surgery: classification of surgical techniques based on the surgical anatomy of the sphenoid sinus

2019 ◽  
Vol 131 (5) ◽  
pp. 1658-1667 ◽  
Author(s):  
Kenichiro Iwami ◽  
Masazumi Fujii ◽  
Yugo Kishida ◽  
Shinya Jinguji ◽  
Masayuki Yamada ◽  
...  
Keyword(s):  
Skull Base ◽  
Sphenoid Sinus ◽  
Skull Base Surgery ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Surgical Anatomy ◽  
University Hospital ◽  
En Bloc ◽  
Cadaveric Dissection ◽  
Medical University

OBJECTIVEAlthough sphenoidotomy is more commonly performed via the transnasal approach than via the transcranial approach, transcranial sphenoidotomy (TCS) remains indispensable for en bloc resection of locally advanced sinonasal malignant tumors (SNMTs) extending to the skull base. TCS also enables transsphenoidal transposition of the temporoparietal galeal flap (TPGF) to compensate for the lack of vascularized reconstructive tissue after endoscopic transnasal skull base surgery. The objective of this study was to review the authors’ surgical experience using TCS with an emphasis on the surgical anatomy of the sphenoid sinus and on the purpose of TCS. Relevant anatomy is further illustrated through cadaveric dissection and photo documentation.METHODSThe authors reviewed the records of 50 patients who underwent TCS at the Nagoya University Hospital, Fukushima Medical University Hospital, or Aichi Medical University Hospital over the course of 7 years (between January 2011 and November 2017). The authors also performed cadaveric dissection in 2 adult cadaveric skull base specimens.RESULTSOf the 50 patients included in this study, 44 underwent craniofacial resection (CFR) for en bloc resection of SNMTs involving the anterior and/or lateral skull base, and 6 underwent transsphenoidal transposition of the TPGF flap. The authors categorized the TCS procedures according to the portion of the sphenoid sinus wall involved (i.e., superior, lateral, and superolateral). Superior sphenoidotomy was used in patients requiring anterior CFR. Lateral sphenoidotomy was further divided into 2 subtypes, with type 1 procedures performed for the transsphenoidal transpositioning of the TPGF, and type 2 procedures used in patients requiring lateral CFR. Superolateral sphenoidotomy was used in anterolateral CFR.CONCLUSIONSTCS still represents a useful tool in the armamentarium of neurosurgeons treating central skull base lesions. The newly proposed surgical classification facilitates a profound understanding of TCS and how to incorporate this technique into clinical practice.

Surgical nuances for the endoscopic endonasal transpterygoid approach to lateral sphenoid sinus encephaloceles

2012 ◽  
Vol 32 (6) ◽  
pp. E5 ◽  
Author(s):  
Richard F. Schmidt ◽  
Osamah J. Choudhry ◽  
Joseph Raviv ◽  
Soly Baredes ◽  
Roy R. Casiano ◽  
...  
Keyword(s):  
Skull Base ◽  
Sphenoid Sinus ◽  
Skull Base Surgery ◽  
Surgical Anatomy ◽  
Endoscopic Endonasal ◽  
Csf Rhinorrhea ◽  
Lateral Recess ◽  
Sternberg Canal ◽  
Deep Location ◽  
Repair Techniques

Lateral sphenoid encephaloceles of the Sternberg canal are rare entities and usually present with spontaneous CSF rhinorrhea. Traditionally, these were treated via transcranial approaches, which can be challenging given the deep location of these lesions. However, with advancements in endoscopic skull base surgery, including improved surgical exposures, angled endoscopes and instruments, and novel repair techniques, these encephaloceles can be resected and successfully repaired with purely endoscopic endonasal approaches. In this report, the authors review the endoscopic endonasal transpterygoid approach to the lateral recess of the sphenoid sinus for repair of temporal lobe encephaloceles, including an overview of the surgical anatomy from an endoscopic perspective, and describe the technical operative nuances and surgical pearls for these cases. The authors also present 4 new cases of lateral sphenoid recess encephaloceles that were successfully treated using this approach.

scholarly journals High proficiency of colonic endoscopic submucosal dissection in Europe thanks to countertraction strategy using a double clip and rubber band

2019 ◽  
Vol 07 (09) ◽  
pp. E1166-E1174 ◽  
Author(s):  
Jérémie Jacques ◽  
Aurélie Charissoux ◽  
Pierre Bordillon ◽  
Romain Legros ◽  
Jérôme Rivory ◽  
...  
Keyword(s):  
Case Series ◽  
Rubber Band ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Point Of View ◽  
University Hospital ◽  
Control Group ◽  
R0 Resection ◽  
Resection Rate ◽  
En Bloc

Abstract Background and study aims ESD in the colon is more challenging technically than in other locations. Here, we report the first comparative case series of colon ESD using a systematic countertraction strategy using two clips and a rubber band. Patients and methods Retrospective comparative study of classic versus countertraction colon ESD performed in colon ESD cases collected prospectively at Lyon Edouard Herriot Hospital and Limoges University Hospital from January 2016 until December 2017. Results The study included 192 cases (control = 76, countertraction = 116). Countertraction using the double clip and rubber band technique versus the control group resulted in a significant decrease in the procedure time (94.7 vs. 117 min; P = 0.004) and significant increases in procedure speed (28.2 vs. 16.7 mm2/min; P < 0.0001), en bloc resection rate (95.7 % vs. 76.3 %, P < 0.0001), and R0 resection rate (78.5 % vs. 64.5 %, P = 0.04).At an individual operator point of view, results varied between operators but the double clip countertraction strategy significantly increased the en bloc resection rate, R0 resection rate, and speed of dissection for each of the 4 operators. Conclusion Systematic countertraction using a double clip and rubber band facilitates colon ESD. This strategy should become the standard for colon ESD.

scholarly journals The utility of a novel colonoscope with retroflexion for colorectal endoscopic submucosal dissection

2019 ◽  
Vol 07 (02) ◽  
pp. E130-E137 ◽  
Author(s):  
Hidenori Tanaka ◽  
Shiro Oka ◽  
Shinji Tanaka ◽  
Katsuaki Inagaki ◽  
Yuki Okamoto ◽  
...  
Keyword(s):  
En Bloc Resection ◽  
Tumor Location ◽  
Bloc Resection ◽  
University Hospital ◽  
Outcome Analysis ◽  
The Novel ◽  
Retrograde Approach ◽  
Resection Rate ◽  
En Bloc ◽  
Colorectal Endoscopic Submucosal Dissection

Abstract Background and study aims The PCF-H290TI/L produced by Olympus is a novel colonoscope equipped with some advantageous features for endoscopic treatment. It is expected to improve the potential for retroflexion and overall endoscope operability, which can reduce the difficulty of performing colorectal ESD. The aim of this study was to evaluate the utility of the novel colonoscope in colorectal ESD. Methods Three hundred and forty-eight consecutive colorectal lesions resected via ESD between June 2014 and January 2017 at Hiroshima University Hospital were included in the retroflexion ability analysis. We compared the retroflexion potential of PCF-H290TI to that of a conventional endoscope. Two hundred and twenty-seven colorectal lesions located in the left-sided colon and resected with ESD between April 2009 and February 2018 were enrolled in the treatment outcome analysis. Treatment outcomes using PCF-H290TI compared to those of the conventional colonoscope, and outcomes of the PCF-H290TI with retroflexion compared to those of the conventional colonoscope without retroflexion were evaluated by propensity score matching. Results The retroflexion rate with the PCF-H290TI was 76 %, which was significantly higher than the 44 % rate with the conventional scope. Endoscope operability was better and dissection speed was faster when using the PCF-H290TI with retroflexion compared to the conventional colonoscope without retroflexion. There were no significant differences between the groups in en bloc resection rate and adverse events. Conclusion Compared to the conventional colonoscope, the PCF-H290TI/L made it easier to perform ESD via a retrograde approach regardless of tumor location, and thus may be useful for performing colorectal ESD.

scholarly journals Complication avoidance in the treatment of malignant tumors of the skull base

2002 ◽  
Vol 12 (5) ◽  
pp. 1-6 ◽  
Author(s):  
James T. Kryzanski ◽  
Donald J. Annino ◽  
Carl B. Heilman
Keyword(s):  
Skull Base ◽  
Malignant Tumors ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Surgical Approaches ◽  
High Complication Rate ◽  
En Bloc ◽  
Complications Of Surgery ◽  
Skull Base Lesions ◽  
Skull Base Defects

The treatment of malignant skull base tumors has improved with the development of skull base surgical approaches that allow en bloc resection of a lesion and increase the efficacy of adjuvant therapies. The anatomical complexity of these lesions and their surroundings has led to a relatively high complication rate. Infection and cerebrospinal fluid fistulas are the most common serious procedure-related complications. They result from the frequent necessity of working in a contaminated space such as the paranasal sinuses as well as from the creation of large dural and skull base defects. The authors have reviewed the literature regarding complications of surgery for malignant skull base lesions and present several techniques and strategies for minimizing their incidence by performing the craniofacial approach to anterior skull base lesions.

Long-term outcome following radical temporal bone resection for lateral skull base malignancies: a neurosurgical perspective

2008 ◽  
Vol 108 (3) ◽  
pp. 501-510 ◽  
Author(s):  
Nobutaka Kawahara ◽  
Tomio Sasaki ◽  
Takahiro Asakage ◽  
Kazunari Nakao ◽  
Masashi Sugasawa ◽  
...  
Keyword(s):  
Skull Base ◽  
Temporal Bone ◽  
Survival Rates ◽  
Surgical Margin ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Bone Resection ◽  
En Bloc ◽  
Temporal Bone Resection

Object Primary temporal bone malignancy is a rare form of tumor for which the therapeutic strategy remains controversial. In this study, the authors reviewed their experience with radical temporal bone resection (TBR) of such lesions and analyzed the long-term results to provide treatment recommendations. Methods Between 1994 and 2006, 17 patients (10 men and 7 women) underwent total or subtotal TBR for primary temporal bone malignancies. Tumors were graded according to the University of Pittsburgh system. The effects of surgical margins and tumor extensions on patient survival were analyzed using the Kaplan–Meier method. Results All tumors, except 1, were graded T4 (most advanced). Subtotal TBR was performed in 14 patients, and total TBR was performed in 3. The surgical margin was tumor negative in 10 patients and tumor positive in 7. For large tumors extending into the infratemporal fossa or encroaching on the jugular foramen, orbitozygomatic (3 patients) and posterior transjugular (4 patients) approaches were combined with the standard approach, and en bloc resection with a negative margin was achieved in all cases but 1. The follow-up time ranged from 0.3–11.6 years (mean 3.3 years). The 5-year recurrence-free and disease-specific survival rates were 67.5 and 60.1%, respectively. When a negative surgical margin was achieved, the survival rates improved to 100 and 89%, respectively. Conclusions The neurosurgical skull base technique could improve the probability of en bloc resection with a tumor-free margin for extensive temporal bone malignancies, which would cure a subset of patients. The active participation of neurosurgeons would improve patient care in this field.

scholarly journals En bloc resection of skull base malignant tumors. Results of resection with dura or brain.

1998 ◽  
Vol 24 (3) ◽  
pp. 316-319
Author(s):  
Kiyoshi SAITO ◽  
Jun YOSHIDA ◽  
Masakatsu TAKAHASHI ◽  
Takashi HASEGAWA ◽  
Keizo FUKUTA
Keyword(s):  
Skull Base ◽  
Malignant Tumors ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc

Subcranial Extended Anterior Approach for Skull Base Tumors

1995 ◽  
Vol 112 (5) ◽  
pp. P168-P168
Author(s):  
Joram Raveh
Keyword(s):  
Optic Nerve ◽  
Skull Base ◽  
Anterior Approach ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Anterior Skull Base ◽  
Skull Base Tumors ◽  
En Bloc ◽  
Nerve Decompression ◽  
Optic Nerve Decompression

Educational objectives: To acquaint participants with the anatomic relations in this area and the application of these methods to the anterior skull base and to explain the en bloc resection of the tumor optic nerve decompression and the functional and aesthetic reconstruction of the skull base and frontonasoethmoidal area.

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