scholarly journals Anatomical assessment of the endoscopic endonasal approach for the treatment of paraclinoid aneurysms

2019 ◽  
Vol 131 (6) ◽  
pp. 1734-1742 ◽  
Author(s):  
Ali Tayebi Meybodi ◽  
Leandro Borba Moreira ◽  
Andrew S. Little ◽  
Michael T. Lawton ◽  
Mark C. Preul
Keyword(s):  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Oculomotor Nerve ◽  
Endoscopic Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Risks And Benefits ◽  
Paraclinoid Aneurysms ◽  
Distal Internal Carotid Artery ◽  
Dural Opening ◽  
Neurovascular Structures

OBJECTIVEEndoscopic endonasal approaches (EEAs) are increasingly being incorporated into the neurosurgeon’s armamentarium for treatment of various pathologies, including paraclinoid aneurysms. However, few anatomical assessments have been performed on the use of EEA for this purpose. The aim of the present study was to provide a comprehensive anatomical assessment of the EEA for the treatment of paraclinoid aneurysms.METHODSFive cadaveric heads underwent an endonasal transplanum-transtuberculum approach to expose the paraclinoid area. The feasibility of obtaining proximal and distal internal carotid artery (ICA) control as well as the topographic location of the origin of the ophthalmic artery (OphA) relative to dural landmarks were assessed. Limitations of the EEA in exposing the supraclinoid ICA were also recorded to identify favorable paraclinoid ICA aneurysm projections for EEA.RESULTSThe extracavernous paraclival and clinoidal ICAs were favorable segments for establishing proximal control. Clipping the extracavernous ICA risked injury to the trigeminal and abducens nerves, whereas clipping the clinoidal segment put the oculomotor nerve at risk. The OphA origin was found within 4 mm of the medial opticocarotid point on a line connecting the midtubercular recess point to the medial vertex of the lateral opticocarotid recess. An average 7.2-mm length of the supraclinoid ICA could be safely clipped for distal control. Assessments showed that small superiorly or medially projecting aneurysms were favorable candidates for clipping via EEA.CONCLUSIONSWhen used for paraclinoid aneurysms, the EEA carries certain risks to adjacent neurovascular structures during proximal control, dural opening, and distal control. While some authors have promoted this approach as feasible, this work demonstrates that it has significant limitations and may only be appropriate in highly selected cases that are not amenable to coiling or clipping. Further clinical experience with this approach helps to delineate its risks and benefits.

Endoscopic Endonasal Approach to the Optic Canal: Anatomic Considerations and Surgical Relevance

2015 ◽  
Vol 11 (3) ◽  
pp. 431-446 ◽  
Author(s):  
Kumar Abhinav ◽  
Yancy Acosta ◽  
Wei-Hsin Wang ◽  
Luis R Bonilla ◽  
Maria Koutourousiou ◽  
...  
Keyword(s):  
Ophthalmic Artery ◽  
Human Head ◽  
Optic Canal ◽  
Falciform Ligament ◽  
Endoscopic Endonasal Approach ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Dural Opening ◽  
Anatomic Relationship

Abstract BACKGROUND Increasing use of endoscopic endonasal surgery for suprasellar lesions with extension into the optic canal (OC) has necessitated a better endonasal description of the OC. OBJECTIVE To identify the osseous OC transcranially and then investigate its anatomic relationship to the key endonasal intrasphenoidal landmarks. We also aimed to determine and describe the technical nuances for safely opening the falciform ligament and intracanalicular dura (surrounding the optic nerve [ON]) endonasally. METHODS Ten fresh human head silicon-injected specimens underwent an endoscopic transtuberculum/transplanum approach followed by 2-piece orbitozygomatic craniotomy to allow identification of 20 OCs. After completing up to 270° of endonasal bony decompression of the OC, a dural incision started at the sella and continued superiorly across the superior intercavernous sinus. Subsequently the dural opening was extended anterolaterally across the dura of the prechiasmatic sulcus, limbus sphenoidale, and planum. RESULTS Endonasally, the length of the osseous OC was approximately 6 mm and equivalent to the length of the lateral opticocarotid recess, as measured anteroposteriorly. The ophthalmic artery arose from the supraclinoidal carotid artery at approximately 2.5 mm from the medial osseous OC entrance. Transcranial correlation of the endonasal dural incision confirmed medial detachment of the falciform ligament and exposure of the preforaminal ON. CONCLUSION The lateral opticocarotid recess allows distinction of the preforaminal ON, roofed by the falciform ligament from the intracanalicular segment in the osseous OC. This facilitates the preoperative surgical strategy regarding the extent of OC decompression and dural opening. Extensive endonasal decompression of the OC and division of the falciform ligament is feasible.

scholarly journals How I do it: endoscopic endonasal resection of tuberculum sellae meningioma

2021 ◽  
Author(s):  
Markus Wiedmann ◽  
Aslan Lashkarivand ◽  
Jon Berg-Johnsen ◽  
Daniel Dahlberg
Keyword(s):  
Team Approach ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Ongoing Debate ◽  
Endoscopic Endonasal ◽  
Microsurgical Technique ◽  
Tuberculum Sellae Meningioma ◽  
Tuberculum Sellae ◽  
Dedicated Team ◽  
Neurovascular Structures

Abstract Background Tuberculum sellae meningiomas (TSMs) adherent to neurovascular structures are particularly challenging lesions requiring delicate and precise microneurosurgery. There is an ongoing debate about the optimal surgical approach. Method We describe technical nuances and challenges in TSM resection using the endoscopic endonasal approach (EEA) in two cases of fibrous tumors with adherence to neurovascular structures. The cases are illustrated with a video (case 1) and figures (cases 1 and 2). Conclusion A dedicated team approach and precise microsurgical technique facilitate safe resection of complex TSMs through the EEA.

scholarly journals Endoscopic endonasal transoculomotor triangle approach for adenomas invading the parapeduncular space: surgical anatomy, technical nuances, and case series

2019 ◽  
Vol 130 (4) ◽  
pp. 1304-1314 ◽  
Author(s):  
Cristian Ferrareze Nunes ◽  
Stefan Lieber ◽  
Huy Q. Truong ◽  
Georgios Zenonos ◽  
Eric W. Wang ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Case Series ◽  
Surgical Anatomy ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
Tumor Extension ◽  
Endoscopic Endonasal ◽  
Transcranial Approach ◽  
Surgical Corridor ◽  
Dural Opening

OBJECTIVEPituitary adenomas may extend into the parapeduncular space by invading through the roof of the cavernous sinus. Currently, a transcranial approach is the preferred choice, with or without the combination of an endonasal approach. In this paper the authors present a novel surgical approach that takes advantage of the natural corridor provided by the tumor to further open the oculomotor triangle and resect tumor extension into the parapeduncular space.METHODSSix injected specimens were used to demonstrate in detail the surgical anatomy related to the approach. Four cases in which the proposed approach was used were retrospectively reviewed.RESULTSFrom a technical perspective, the first step involves accessing the superior compartment of the cavernous sinus. The interclinoid ligament should be identified and the dura forming the oculomotor triangle exposed. The oculomotor dural opening may be then extended posteriorly toward the posterior petroclinoidal ligament and inferolaterally toward the anterior petroclinoidal ligament. The oculomotor nerve should then be identified; in this series it was displaced superomedially in all 4 cases. The posterior communicating artery should also be identified to avoid its injury. In all 4 cases, the tumor invading the parapeduncular space was completely removed. There were no vascular injuries and only 1 patient had a partial oculomotor nerve palsy that completely resolved in 2 weeks.CONCLUSIONSThe endoscopic endonasal transoculomotor approach is an original alternative for removal of tumor extension into the parapeduncular space in a single procedure. The surgical corridor is increased by opening the dura of the oculomotor triangle and by working below and lateral to the cisternal segment of the oculomotor nerve.

Anatomic Nuances of the Ophthalmic Artery Origin from a Ventral Viewpoint: Considerations and Implications for Endoscopic Endonasal Surgery

2018 ◽  
Vol 16 (4) ◽  
pp. 478-485
Author(s):  
Cristian A Naudy ◽  
Juan C Yanez-Siller ◽  
Paulo M Mesquita Filho ◽  
Matias Gomez G. ◽  
Bradley A Otto ◽  
...  
Keyword(s):  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Point Of View ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Nerve Segment ◽  
Surgical Field ◽  
The Right ◽  
Ophthalmic Arteries

Abstract BACKGROUND The origin of the ophthalmic artery is within the surgical field of endoscopic endonasal approaches (EEAs) to the suprasellar and parasellar regions. However, its anatomy from the endoscopic point-of-view has not been adequately elucidated. OBJECTIVE To highlight the anatomy of the ophthalmic artery origin from an endoscopic endonasal perspective. METHODS The origin of the ophthalmic artery was studied bilaterally under endoscopic visualization, after performing transplanum/transtubercular EEAs in 17 cadaveric specimens (34 arteries). Anatomic relationships relevant to surgery were evaluated. To complement the cadaveric findings, the ophthalmic artery origin was reviewed in 200 “normal” angiographic studies. RESULTS On the right side, 70.6% of ophthalmic arteries emerged from the superior aspect, while 17.6% and 11.8% emerged from the superomedial and superolateral aspects of the intradural internal carotid artery, respectively. On the left, 76.5%, 17.6%, and 5.9% of ophthalmic arteries emerged from the superior, superomedial, and superolateral aspects of the internal carotid, respectively. Similar findings were observed on angiography. All ophthalmic arteries emerged at the level of the medial opticocarotid recess. Overall, 47%, 26.5%, and 26.5% of ophthalmic arteries (right and left) were inferolateral, inferior, and inferomedial to the intracranial optic nerve segment, respectively. On both sides, the intracranial length of the ophthalmic artery ranged from 1.5 to 4.5 mm (mean: 2.90 ± standard deviation of 0.74 mm). CONCLUSION Awareness of the endoscopic nuances of the ophthalmic artery origin is paramount to minimize the risk of sight-threatening neurovascular injury during EEAs to the suprasellar and parasellar regions.

scholarly journals Expanded Endoscopic Endonasal Resection of Retrochiasmatic Craniopharyngioma

2018 ◽  
Vol 79 (S 02) ◽  
pp. S194-S195
Author(s):  
Justin Davanzo ◽  
Neerav Goyal ◽  
Brad Zacharia
Keyword(s):  
Optic Chiasm ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Nasoseptal Flap ◽  
Endoscopic Endonasal ◽  
Expanded Endonasal Approach ◽  
Close Proximity ◽  
Dural Opening ◽  
Neurologically Intact ◽  
Video Abstract

AbstractThis video abstract demonstrates the use of the expanded endoscopic endonasal approach for the resection of a retrochiasmatic craniopharyngioma. These tumors are notoriously difficult to treat, and many approaches have been tried to facilitate safe and effective resection. The endoscopic endonasal approach has been increasingly utilized for selected sellar/suprasellar pathology. We present the case of a 39-year-old man who was found to have a cystic, partially calcified suprasellar mass consistent with a craniopharyngioma. To facilitate robust skull base repair, a vascularized nasoseptal flap was harvested. A wide sphenoidotomy was performed and the sella and tuberculum were exposed. After the dural opening and arachnoid dissection, the stalk was identified, merging seamlessly with the tumor capsule. The lesion was then internally debulked with the use of an ultrasonic aspirator. The capsule was then dissected off of the optic chiasm, thalamus, and hypothalamus. The cavity was inspected with an angled endoscope to ensure complete resection. A multilayered reconstruction was performed using autologous fascia lata, the previously harvested nasoseptal flap, and dural sealant. Postoperatively, the patient did have expected panhypopituitarism but remained neurologically intact and had improvement in his vision. In conclusion, this video demonstrates how an expanded endonasal approach can be used to safely resect a craniopharyngioma, even when in close proximity to delicate structures such as the optic chiasm.The link to the video can be found at: https://youtu.be/tahjHmrXhc4.

A Surgical Technique for the Removal of Clinoidal Meningiomas

2006 ◽  
Vol 59 (suppl_1) ◽  
pp. ONS-108-ONS-114 ◽  
Author(s):  
Joung H. Lee ◽  
Burak Sade ◽  
Bong J. Park
Keyword(s):  
Optic Nerve ◽  
Surgical Technique ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Oculomotor Nerve ◽  
Tumor Removal ◽  
The Past ◽  
Aggressive Tumor ◽  
Neurovascular Structures

Abstract CLINOIDAL MENINGIOMAS, ALSO referred to as medial or inner sphenoid wing meningiomas, are often difficult and challenging to remove completely and safely, especially when they become large enough to encircle, compress, or displace the adjacent critical neurovascular structures such as the optic nerve, the internal carotid artery and its branches, and the oculomotor nerve. In this article, the authors describe the detailed surgical technique used in their practice in addition to subtle nuances learned from their experience of operating on more than 40 patients with clinoidal meningiomas over the past several years. The primary goals of surgery are to achieve aggressive tumor removal with avoidance of intraoperative morbidity and, in addition, for those with preoperative compromised vision, to provide improvement in their visual function after surgery.

Relationship between the ophthalmic artery and the dural ring of the internal carotid artery

2009 ◽  
Vol 111 (1) ◽  
pp. 119-123 ◽  
Author(s):  
Tetsuyoshi Horiuchi ◽  
Yuichiro Tanaka ◽  
Yoshikazu Kusano ◽  
Takehiro Yako ◽  
Tetsuo Sasaki ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ophthalmic Artery ◽  
Internal Carotid ◽  
Medial Side ◽  
Paraclinoid Aneurysm ◽  
Paraclinoid Aneurysms ◽  
Ophthalmic Arteries

Object The ophthalmic artery (OphA) usually arises from the intradural internal carotid artery (ICA), and the extradural origin has also been known. However, the interdural origin is extremely rare. The purpose of this paper was to clarify the origin of the OphA in patients with a paraclinoid aneurysm in the ICA based on intraoperative findings. Methods The authors retrospectively examined 156 patients who underwent direct surgical treatment for 166 paraclinoid aneurysms during a 17-year period. Based on intraoperative findings, 119 ophthalmic arteries were analyzed with respect to their origins. Results The OphA originated from the intradural ICA on 102 sides (85.7%), extradural on 9 (7.6%), and interdural on 8 (6.7%). Although the extradural origin might be recognized preoperatively, it was difficult to distinguish the interdural origin of the OphA from the intradural one. Conclusions The incidence of the interdural origin was 6.7% and was not as rare as the authors expected. Neurosurgeons should know the possible existence of the interdural origin of the OphA to section the medial side of the dural ring.

Assessment of Internal Carotid Artery Invasion With the Endoscopic Endonasal Approach

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Huankang Zhang ◽  
Xicai Sun ◽  
Huapeng Yu ◽  
Weidong Zhao ◽  
Keqing Zhao ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal
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