Endoscopic endonasal approach for brainstem cavernous malformation

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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Chordoma of the Craniocervical Junction: Endoscopic Endonasal Approach

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1697979 ◽

2019 ◽

Vol 80 (S 04) ◽

pp. S372-S374

Author(s):

Eduard H. Voormolen ◽

Pierre Olivier Champagne ◽

Sebastien Froelich

Keyword(s):

Craniocervical Junction ◽

University Hospital ◽

Neurological Deficits ◽

Preoperative Imaging ◽

Classical Type ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Postoperative Mri ◽

Lower Clivus

Objective This study was aimed to achieve gross-total removal of a chordoma of the craniocervical junction via an endonasal approach (Fig. 1). Design The present study is a case report. Setting The study was conducted at neurosurgical clinic of university hospital. Participant A 40-year-old male, with normal neurologic exam and no prior medical history, presented with a 2-year history of cervicalgia. On preoperative imaging, a midline lesion, with image characteristics of chordoma, was seen in the lower clivus and odontoid. It had limited lateral extension. Main Outcome Measures This study measures postoperative neurological deficits and postoperative tumor volume on magnetic resonance imaging (MRI). Results A binostril approach to the upper nasopharynx was performed using endoscope at 30- and 45-degree angles. Subsequently, a heart-shaped mucosal flap was made and the clivus was drilled to expose the lesion (Fig. 2). After initial debulking, the ring of C1 was slightly drilled to reach the tumor in and around the odontoid. Postoperative MRI showed that a gross-total resection was achieved. The patient had no neurologic deficits postoperatively. Pathologic examination revealed a chordoma of the classical type. Conclusion An endoscopic endonasal approach, utilizing the heart-shaped flap and angled endoscopes and instruments, can be considered for resection of select cases of craniocervical junction chordoma with limited lateral expansion.The link to the video can be found at: https://youtu.be/rwVoZJRBIEo.

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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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Endoscopic Endonasal Transclival Approach to Ventral Pontine Cavernous Malformation: Case Report

Frontiers in Surgery ◽

10.3389/fsurg.2021.654837 ◽

2021 ◽

Vol 8 ◽

Author(s):

Xiao Dong ◽

Xiaoyu Wang ◽

Anwen Shao ◽

Jianmin Zhang ◽

Yuan Hong

Keyword(s):

Case Report ◽

High Risk ◽

Cavernous Malformation ◽

Csf Leak ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Dorsal Approach ◽

Endoscopic Endonasal ◽

Cavernous Malformations ◽

Individualized Approach

Ventral medial pontine cavernous malformations are challenging due to the location in eloquent tissue, surrounding critical anatomy, and potential symptomatic bleeding. Conventional approaches, such as anterolateral, lateral and dorsal approach, are associated with high risk of deleterious consequences due to excessive traction and damage to the surrounding tissues. The authors present an endoscopic endonasal approach for the resection of midline ventral pontine cavernous malformations, which follows principles of optimal access to brainstem cavernous malformations as the “two-point method.” No CSF leak or any other complications are obtained. The successful outcomes indicate that an individualized approach should be chosen before the surgery for brainstem cavernous malformations. With the advance of techniques, endoscopic endonasal approach could provide the most direct route to ventral pontine lesions with safety and efficiency.

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

Journal of Neurosurgery ◽

10.3171/2014.3.jns131521 ◽

2014 ◽

Vol 121 (1) ◽

pp. 100-113 ◽

Cited By ~ 88

Author(s):

Luigi Maria Cavallo ◽

Giorgio Frank ◽

Paolo Cappabianca ◽

Domenico Solari ◽

Diego Mazzatenta ◽

...

Keyword(s):

Removal Rate ◽

Third Ventricle ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Total Removal ◽

Endoscopic Endonasal ◽

Improvement Rate ◽

Large Patient ◽

Csf Leakage ◽

Anterior Pituitary Function

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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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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Concerns of cerebrospinal fluid leak in aggressive expanded endonasal endoscopic approach for craniopharyngiomas

Journal of Neurology & Stroke ◽

10.15406/jnsk.2020.10.00430 ◽

2020 ◽

Vol 10 (4) ◽

pp. 154-156

Author(s):

Marlon Ortiz Machín ◽

Omar López Arbolay

Keyword(s):

Cerebrospinal Fluid ◽

Third Ventricle ◽

Cerebrospinal Fluid Leak ◽

Endoscopic Approach ◽

Csf Leak ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Nasoseptal Flap ◽

Endoscopic Endonasal ◽

Fluid Leak

Cerebrospinal fluid leak represents a frequent complication in Craniopharyngioma´s Endoscopic Endonasal Approach. A descriptive observational investigation was performed in 50 adult patients operated of Craniopharyngiomas by aggressive Expanded Endonasal Endoscopic Approach (EEEA) in “Hermanos Ameijeiras” Hospital since 2010 to 2019 using nasoseptal flap. The 14% of all patients develop CSF leak and 85,7 % of these cases had a great communication into third ventricle creating a cisternoventricular space. Was identified relation with tumor size, hypothalamic invasion and adhesion strength of tumour. Surgical cavity suffered hydrostatic and hydrodynamic pression than lead to CSF leak independent of multilayer reparation.

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Endoscopic Endonasal Approach for Giant Pituitary Adenoma Occupying The Entire Third Ventricle: Surgical Results and A Review of Literature

World Neurosurgery ◽

10.1016/j.wneu.2021.07.022 ◽

2021 ◽

Author(s):

Mohamed A. Jamaluddin ◽

Biren Khimji Patel ◽

Tobin George ◽

Jaypalsinh A. Gohil ◽

Harshavardhan P. Biradar ◽

...

Keyword(s):

Pituitary Adenoma ◽

Third Ventricle ◽

Surgical Results ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Review Of Literature ◽

Endoscopic Endonasal ◽

Giant Pituitary Adenoma

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Extended Endoscopic Endonasal Approach for Suprasellar Craniopharyngioma

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1623529 ◽

2018 ◽

Vol 79 (S 02) ◽

pp. S196-S198 ◽

Cited By ~ 1

Author(s):

D. Locatelli ◽

F. Pozzi ◽

G. Agresta ◽

S. Padovan ◽

A. Karligkiotis ◽

...

Keyword(s):

Skull Base ◽

Third Ventricle ◽

Neurological Status ◽

University Hospital ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Skull Base Reconstruction ◽

Cystic Component ◽

Suprasellar Region

Objectives We illustrate a suprasellar craniopharyngiomas treated with an extended endoscopic endonasal approach (EEEA). Design Case report of a 43-year-old male affected by cerebral lesion located in suprasellar region involving the third ventricle and compressing the neurovascular structures, causing an anterosuperior dislocation of the chiasma. There is a complete disruption of the pituitary stalk that can explain the clinical finding of partial anterior hypopituitarism and hyperprolactinemia. The lesion is characterized by a solid and cystic component. Considering the absence of lateral extension and the suprasellar location of the lesion, an EEEA is preferred. Setting University Hospital “Ospedale di Circolo,” Department of Neurosurgery, Varese, Italy. Participants Neurosurgical and ENT Skull Base Team. Main Outcome Measures A bilateral parasagittal approach is performed using a four-hand technique. The first step of the surgery is the preparation of the Hadad's flap. The approach is extended to the planum sphenoidalis to expose the suprasellar region. The lesion is completely removed employing also an ultrasound aspirator. Skull base reconstruction is performed with three-layer technique: graft of fat tissue, fascia lata, and nasoseptal flap. Results No postoperative complications occurred. In the post-op, the patient presents a panhypopituitarism and an improvement in neurological status. The visual deficit remains stable. Post-op magnetic resonance imaging at 1 year documents the complete absence of pathological contrast enhancement. Conclusions EEEA is a feasible approach in treating craniopharyngioma with suprasellar extension. The advantages include optimal visualization, good resection rate, and absence of brain retraction.The link to the video can be found at: https://youtu.be/IYm-8P1jbBo.

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