The extended direct endonasal transsphenoidal approach for nonadenomatous suprasellar tumors

2005 ◽  
Vol 102 (5) ◽  
pp. 832-841 ◽  
Author(s):  
Joshua R. Dusick ◽  
Felice Esposito ◽  
Daniel F. Kelly ◽  
Pejman Cohan ◽  
Antonio DeSalles ◽  
...  
Keyword(s):  
Residual Tumor ◽  
Transsphenoidal Approach ◽  
Total Removal ◽  
Content Type ◽  
Patients Âgés ◽  
Extended Transsphenoidal Approach ◽  
Planum Sphenoidale ◽  
Dural Defects ◽  
Fine Print ◽  
Csf Leaks

Object. The extended transsphenoidal approach, which requires a bone and dural opening through the tuberculum sellae and posterior planum sphenoidale, is increasingly used for the treatment of nonadenomatous suprasellar tumors. The authors present their experiences in using the direct endonasal approach in patients with nonadenomatous suprasellar tumors. Methods. Surgery was performed with the aid of an operating microscope and angled endoscopes were used to assess the completeness of resection. Bone and dural defects were repaired using abdominal fat, collagen sponge, titanium mesh, and, in most cases, lumbar drainage of cerebrospinal fluid (CSF). Twenty-six procedures for tumor removal were performed in 24 patients (ages 9–79 years), including two repeated operations for residual tumor. Gross-total removal could be accomplished in only 46% of patients, with near-gross-total removal or better in 74% of 23 patients (five of eight with craniopharyngiomas, six of seven with meningiomas, five of six with Rathke cleft cysts, and one of two with a dermoid or epidermoid cyst); a patient with a lymphoma only underwent biopsy. Of 13 patients with tumor-related visual loss, 85% improved postoperatively. The complications that occurred included five patients (21%) with postoperative CSF leaks, one patient (4%) with bacterial meningitis; five patients (21%) with new endocrinopathy; and two patients (8%) who needed to undergo repeated operations to downsize suprasellar fat grafts. The only permanent neurological deficit was anosmia in one patient; there were no intracranial vascular injuries. Conclusions. The direct endonasal skull-base approach provides an effective minimally invasive means for resecting or debulking nonadenomatous suprasellar tumors that have traditionally been approached through a sublabial or transcranial route. Procedures in the supraglandular space can be performed effectively with excellent visualization of the optic apparatus while preserving pituitary function in most cases. The major challenge remains developing consistently effective techniques to prevent postoperative CSF leaks.

Surgical treatment of clival chordomas: the transsphenoidal approach revisited

1996 ◽  
Vol 85 (5) ◽  
pp. 784-792 ◽  
Author(s):  
Giulio Maira ◽  
Roberto Pallini ◽  
Carmelo Anile ◽  
Eduardo Fernandez ◽  
Fabrizio Salvinelli ◽  
...  
Keyword(s):  
Spinal Metastasis ◽  
Postoperative Radiotherapy ◽  
Primary Treatment ◽  
Transsphenoidal Approach ◽  
Total Removal ◽  
Partial Removal ◽  
Content Type ◽  
Mortality And Morbidity ◽  
Lower Clivus ◽  
Fine Print

✓ This is a report of 12 cases of clival chordomas that were surgically treated at the Catholic University Medical School, Rome, Italy, over a 7-year period. The study emphasizes the role of the transsphenoidal approach. The study group included seven men and five women whose ages ranged from 26 to 80 years (mean 49.8 years). Diplopia was the most common presenting symptom (eight cases). The tumor involved the upper and middle clivus in five cases, the middle clivus in five, and the lower clivus in two cases. One patient developed spinal metastasis. On histological examination, eight cases proved to be typical chordomas, three cases had a chondroid component, and one case of chordoma had atypical features. Immunohistological staining for vimentin and epithelial membrane antigen was positive in all cases. Follow-up periods ranged from 14 to 86 months (mean 40.2 months). The primary treatment consisted of surgery. Ten patients with chordomas of the upper and middle clivus underwent a total of 13 transsphenoidal procedures. Total tumor removal was achieved in seven cases, subtotal removal in two, and partial removal in one case. In the two cases of lower clival chordomas, total removal was accomplished in one and partial removal in the other. After total removal, no recurrence was noted at 14 to 86 months (mean 37.5 months). In the cases undergoing operation via a transsphenoidal approach, there was zero morbidity and one cerebrospinal fluid fistula that resolved without surgery. The tumor recurred in two patients after subtotal and partial removal, respectively. The authors opted to reoperate in cases of recurrence. Postoperative radiotherapy was administered in only two cases in which further surgery was not indicated because of medical reasons or because such a procedure was contrary to the patient's wishes. When mortality and morbidity rates of this group are compared to those of chordoma patients who were treated with extensive skull-base surgery, the results prompt a reappraisal of the transsphenoidal approach in the treatment of clival chordomas.

Meningeal melanocytoma of the planum sphenoidale

2001 ◽  
Vol 94 (5) ◽  
pp. 841-845 ◽  
Author(s):  
Michael Chow ◽  
David B. Clarke ◽  
William J. Maloney ◽  
Virgilio Sangalang
Keyword(s):  
Personality Change ◽  
Resonance Imaging ◽  
Imaging Studies ◽  
Total Removal ◽  
Neurological Sequelae ◽  
Content Type ◽  
Meningeal Melanocytoma ◽  
Presenting Symptoms ◽  
Planum Sphenoidale ◽  
Fine Print

✓ Meningeal melanocytoma is a rare benign primary melanotic tumor of the meninges, most commonly found in the spinal canal and the posterior fossa. The authors report the 19th published case of a supratentorial meningeal melanocytoma and the first reported case in which the tumor arose from the planum sphenoidale. The patient's presenting symptoms were characteristic of a large bifrontal lesion and included headaches, personality change, lethargy, and urinary and fecal incontinence. Computerized tomography and magnetic resonance imaging studies revealed an extraaxial lesion arising from the planum sphenoidale. The patient underwent successful gross total removal of the tumor without neurological sequelae. Based on the findings shown in this case report, meningeal melanocytoma should be included in the differential diagnosis of extraaxial lesions arising from the area of the planum sphenoidale.

Benign osteoblastoma of a thoracic vertebra

1980 ◽  
Vol 53 (5) ◽  
pp. 710-713 ◽  
Author(s):  
Nancy Epstein ◽  
Vallo Benjamin ◽  
Richard Pinto ◽  
Gleb Budzilovich
Keyword(s):  
Spinal Cord ◽  
Computerized Tomography ◽  
Residual Tumor ◽  
Cord Compression ◽  
Transthoracic Approach ◽  
Content Type ◽  
Benign Osteoblastoma ◽  
Posterior Laminectomy ◽  
Subtotal Removal ◽  
Fine Print

✓ A patient with osteoblastoma of the T-11 vertebral body presented with symptoms of spinal cord compression. Six weeks after an emergency laminectomy and subtotal removal, spinal computerized tomography disclosed residual tumor, which was totally removed via a combined anterior transthoracic approach and posterior laminectomy.

Meningeal melanocytoma

1998 ◽  
Vol 88 (1) ◽  
pp. 116-121 ◽  
Author(s):  
David B. Clarke ◽  
Richard Leblanc ◽  
Gilles Bertrand ◽  
Gilbert R. C. Quartey ◽  
G. Jackson Snipes
Keyword(s):  
Histological Examination ◽  
Posterior Fossa ◽  
Clinical Presentation ◽  
Residual Tumor ◽  
Posterior Fossa Decompression ◽  
Content Type ◽  
Meningeal Melanocytoma ◽  
Radiological Appearance ◽  
Histological Features ◽  
Fine Print

✓ Meningeal melanocytomas are rare tumors of the central nervous system that are found almost exclusively in the posterior fossa and spinal cord and whose natural history is poorly defined. In this report, the authors review the clinical presentation, radiological appearance, operative findings, and histological features in two cases of meningeal melanocytoma: one cranial and one spinal. Two women, aged 21 and 30 years, were admitted to the hospital 60 years apart: the first because of progressive paraplegia and the second because of slowly progressive hearing loss. The first patient had an extradural tumor that was treated by laminectomy, subtotal resection, and postoperative radiotherapy in 1936. Her symptoms recurred 16 years later and she underwent reoperation of the residual tumor, which was found to have an intradural component. The authors' patient, who presented 60 years later, underwent plain and enhanced computerized tomography and magnetic resonance imaging that demonstrated a large posterior fossa lesion indicative of either an acoustic neuroma or a meningioma. She underwent posterior fossa decompression but only partial excision of the tumor could be accomplished because vigorous bleeding limited the extent of the resection. Surgery was followed by radiotherapy. The residual tumor enlarged despite these measures and required repeated resection 6 months later. At the second operation the tumor was much less vascular, perhaps reflecting the effects of radiotherapy, and was removed almost entirely. The patient died 6 months later from an anticoagulant-related cerebellar hemorrhage. In both cases the lesions were jet black, and histological examination revealed melanin-containing hypercellular tumors with rare mitotic figures. Meningeal melanocytomas are being diagnosed with increased frequency in parallel with improvements in neuroimaging and clarification of histological features. Clinical presentation of patients with these tumors typically occurs in their fifth decade and women are affected twice as often as men. The posterior fossa lesions can mimic acoustic neuromas and meningiomas in location and radiological appearance; however, the internal auditory canal is normal. In the spine, meningeal melanocytomas present with the clinical features of myeloradiculopathy. Diagnosis is made intraoperatively from the gross, jet-black appearance of the tumor and from histological examination. Vascularity, size, and location may render complete resection unfeasible. Because of the tumor's propensity to recur, radiotherapy has been recommended but its role remains to be elucidated.

Total removal of large global meningiomas at the medial aspect of the sphenoid ridge

1971 ◽  
Vol 34 (1) ◽  
pp. 107-113 ◽  
Author(s):  
Albert W. Cook
Keyword(s):  
Optic Nerve ◽  
Middle Cerebral Artery ◽  
Operative Technique ◽  
Middle Meningeal Artery ◽  
Medial Aspect ◽  
Total Removal ◽  
Content Type ◽  
Meningeal Artery ◽  
Sphenoid Ridge ◽  
Fine Print

✓ An operative technique for total removal of large global meningiomas at the medial aspect of the sphenoid ridge is described, and experience with 11 patients reported. The technique involves extradural liberation of the dural and tumor attachments to the underlying bone, and extradural occlusion of the blood supply through bone and middle meningeal artery. Subsequent procedures are carried out sequentially in the parasellar area to free the optic nerve and carotid, in the subtemporal tentorial region to release tumor from neighboring structures, and in the Sylvian fissure to isolate the middle cerebral artery.

Preservation of olfaction in anterior craniofacial approaches

1993 ◽  
Vol 79 (1) ◽  
pp. 48-52 ◽  
Author(s):  
Robert F. Spetzler ◽  
James M. Herman ◽  
Stephen Beals ◽  
Edward Joganic ◽  
John Milligan
Keyword(s):  
Cribriform Plate ◽  
Csf Leak ◽  
En Bloc ◽  
Reconstructive Procedures ◽  
Content Type ◽  
The Mean ◽  
Ethmoid Sinuses ◽  
Fine Print ◽  
Csf Leaks

✓ Through the combined efforts of neurosurgeons, head and neck surgeons, and craniofacial surgeons, the standard transbasal approach to the frontal fossa has been modified to include removal of the orbital roofs, nasion, and ethmoid sinuses. This approach has been combined further with facial disassembly procedures to provide extensive midline exposure to the midface and clival region. Extended frontal approaches, however, necessitate removal of the crista galli and sectioning of the olfactory rootlets with the associated risk of anosmia, cerebrospinal fluid (CSF) leak, and the need for complex reconstruction of the frontal floor. To avoid these problems, the authors have modified the technique of handling the cribriform plate to preserve the olfactory unit. Circumferential osteotomy cuts are made around the cribriform plate to allow an en bloc removal with its attachment to both the dura and underlying mucosa. Opening of the dura is avoided and the cribriform bone is used to reconstruct the floor. Four patients underwent this approach, for treatment of an angiofibroma in three and a fibrosarcoma in one. The mean follow-up period was 7 months. No patients developed a CSF leak, and within 8 weeks olfaction had returned in all patients. There was no other associated morbidity. These data suggest that this modification of the transbasilar approach can alleviate extensive reconstructive procedures and CSF leaks while preserving olfaction.

Interhemispheric approach for the surgical removal of thalamocaudate arteriovenous malformations

1987 ◽  
Vol 66 (3) ◽  
pp. 345-351 ◽  
Author(s):  
Robert A. Solomon ◽  
Bennett M. Stein
Keyword(s):  
Corpus Callosum ◽  
Arteriovenous Malformations ◽  
Surgical Removal ◽  
Cerebral Arteriovenous Malformations ◽  
Total Removal ◽  
Recurrent Hemorrhage ◽  
Content Type ◽  
Interhemispheric Approach ◽  
Parinaud’S Syndrome ◽  
Fine Print

✓ A series of 250 surgically treated cerebral arteriovenous malformations (AVM's) is presented, in which 22 lesions were located primarily in the thalamus and caudate nucleus. A standardized interhemispheric approach through the posterior corpus callosum and into the atrium of the lateral ventricle was utilized for the surgical removal of these AVM's. Total removal was confirmed by angiography in 18 patients; removal was subtotal in four cases. There were no deaths in this group of patients. Disturbances of recent memory pre- and postoperatively were seen in half of the patients, but most of these deficits were temporary. Other complications included: postoperative homonymous hemianopsia (six cases), transient hemiparesis (three cases), hemisensory loss (two cases), Parinaud's syndrome (one case), and recurrent hemorrhage 2 years after surgery (one case). All 22 patients returned to their previous occupations and are leading independent lives. The results of this experience indicate that thalamocaudate AVM's can be effectively treated by resection.

Acoustic neuroma with malignant transformation

2001 ◽  
Vol 95 (3) ◽  
pp. 518-521 ◽  
Author(s):  
Kenichiro Hanabusa ◽  
Atsunori Morikawa ◽  
Tetsuya Murata ◽  
Waro Taki
Keyword(s):  
Malignant Transformation ◽  
Initial Treatment ◽  
Cerebellopontine Angle ◽  
Residual Tumor ◽  
Initial Operation ◽  
Content Type ◽  
Histological Studies ◽  
Mitotic Figures ◽  
Causal Sequence ◽  
Fine Print

✓ The authors describe the case of a 57-year-old woman who had a right-sided hearing disturbance that had remained untreated for 1 year. The diagnosis was of a right cerebellopontine angle tumor, and the patient underwent its removal via retrosigmoid approach. Pathologically, the tumor was a typical benign neuroma. Growth of residual tumor was detected 4 years after the initial operation, and it was treated with gamma knife surgery (GKS). Six months later, the tumor had grown, and the patient underwent surgery via a combined retrosigmoid—translabyrinthine approach. Abnormal mitotic figures were observed on histological studies, indicating that the tumor had become malignant. Thereafter, the tumor grew rapidly, and the patient died 6.5 years after the initial treatment. It cannot be ruled out that GKS affected the outcome, but the causal sequence was unclear. Because such a patient is rare, documentation of the case was considered clinically important.

Intrinsic brainstem choroid plexus papilloma

2004 ◽  
Vol 100 (6) ◽  
pp. 1076-1078 ◽  
Author(s):  
Ashok Pillai ◽  
Kariyattil Rajeev ◽  
Sushil Chandi ◽  
Muthukuttiparambil Unnikrishnan
Keyword(s):  
Central Nervous System ◽  
Choroid Plexus ◽  
Choroid Plexus Papilloma ◽  
Residual Tumor ◽  
Brainstem Lesion ◽  
Content Type ◽  
The Central Nervous System ◽  
Choroid Plexus Papillomas ◽  
Fine Print ◽  
Plexus Papilloma

✓ The authors report an intrinsic brainstem lesion that was diagnosed initially as a pontine cavernoma, which finally proved to be a choroid plexus papilloma. Choroid plexus papillomas are rare tumors of the central nervous system and are usually intraventricular in location. The occurrence of this tumor in an intraparenchymal location is extremely rare, and its occurrence within the brainstem is previously unreported. The authors also report a trial of chemotherapy with lomustine in the management of the residual tumor.

Pterional surgery of suprasellar meningiomas of the tuberculum sellae and planum sphenoidale: surgical results with special consideration of ophthalmological and endocrinological results

2002 ◽  
Vol 96 (2) ◽  
pp. 235-243 ◽  
Author(s):  
Rudolf Fahlbusch ◽  
Werner Schott
Keyword(s):  
Recurrence Rate ◽  
Tumor Resection ◽  
Morbidity Rate ◽  
Duration Of Symptoms ◽  
Content Type ◽  
Pituitary Dysfunction ◽  
Endocrine Disturbances ◽  
Planum Sphenoidale ◽  
Secondary Hypogonadism ◽  
Fine Print

Object. The authors reviewed 47 cases of suprasellar meningiomas with special attention to ophthalmological and endocrinological outcomes. Methods. All patients underwent surgery performed via a unilateral pterional approach between January 1983 and January 1998. Ophthalmological and endocrinological examinations were performed before the operation as well as 1 week and 3 months postoperatively. A special scoring system was adopted to quantify the extent of ophthalmological disturbances. Complete tumor resection was possible in all but one patient. There were no fatalities and the rate of visual improvement was 80%. The best prognoses were found in patients younger than 50 years and in patients in whom the duration of symptoms was less than 1 year. Before surgery, tumor-related endocrine disturbances were present in only three women who suffered from secondary hypogonadism; two of these patients recovered after surgery. Postoperatively, no patient needed replacement therapy for pituitary dysfunction. The overall tumor recurrence rate was 2.1% (one of 47 cases). For patients in whom long-term (> 5 years) follow-up data were available, the recurrence rate was 4.2% (one of 24 cases). Conclusions. In this series, complete resection of suprasellar meningiomas was possible through a unilateral pterional craniotomy and was associated with a low morbidity rate and no deaths.

Sign in / Sign up

Export Citation Format

Share Document