Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based on the infundibulum

2008 ◽  
Vol 108 (4) ◽  
pp. 715-728 ◽  
Author(s):  
Amin B. Kassam ◽  
Paul A. Gardner ◽  
Carl H. Snyderman ◽  
Ricardo L. Carrau ◽  
Arlan H. Mintz ◽  
...  
Keyword(s):  
Classification Scheme ◽  
Third Ventricle ◽  
Optic Chiasm ◽  
Tumor Classification ◽  
Type I ◽  
Endonasal Approach ◽  
Transnasal Approach ◽  
Endoscopic Endonasal ◽  
The Third ◽  
Expanded Endonasal Approach

Object Craniopharyngiomas are notoriously difficult to treat. Surgeons must weigh the risks of aggressive resection against the long-term challenges of recurrence. Because of their parasellar location, often extending well beyond the sella, these tumors challenge vision and pituitary and hypothalamic function. New techniques are needed to improve outcomes in patients with these tumors while decreasing treatment morbidity. An endoscopic expanded endonasal approach (EEA) is one such technique that warrants understanding and evaluation. The authors explain the techniques and approach used for the endoscopic endonasal resection of suprasellar craniopharyngiomas and introduce a tumor classification scheme. Methods The techniques and approach used for the endoscopic, endonasal resection of suprasellar craniopharyngiomas is explained, including the introduction of a tumor classification scheme. This scheme is helpful for understanding both the appropriate expanded approach as well as relevant involved anatomy. Results The classification scheme divides tumors according to their suprasellar extension: Type I is preinfundibular; Type II is transinfundibular (extending into the stalk); Type III is retroinfundibular, extending behind the gland and stalk, and has 2 subdivisions (IIIa, extending into the third ventricle; and IIIb, extending into the interpeduncular cistern); and Type IV is isolated to the third ventricle and/or optic recess and is not accessible via an endonasal approach. Conclusions The endoscopic EEA requires a thorough understanding of both sinus and skull base anatomy. Moreover, in its application for craniopharyngiomas, an understanding of tumor growth and extension with respect to the optic chiasm and infundibulum is critical to safely approach the lesion via an endonasal route.

scholarly journals Extended Endoscopic Endonasal Resection of a Suprasellar and Third Ventricular Retrochiasmatic Craniopharyngioma with a Narrow Pituitary Gland–Optic Chiasm Interval: Techniques to Optimize Resection

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.

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.

scholarly journals Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa

2005 ◽  
Vol 19 (1) ◽  
pp. 1-10 ◽  
Author(s):  
Amin B. Kassam ◽  
Paul Gardner ◽  
Carl Snyderman ◽  
Arlan Mintz ◽  
Ricardo Carrau
Keyword(s):  
Skull Base ◽  
Cavernous Sinus ◽  
Infratemporal Fossa ◽  
Surgical Anatomy ◽  
Illustrative Case ◽  
Endonasal Approach ◽  
Transnasal Approach ◽  
Endoscopic Endonasal ◽  
Expanded Endonasal Approach ◽  
Neurovascular Structures

Object The middle third of the clivus and the region around the petrous internal carotid artery (ICA) is a difficult area of the skull base in terms of access. This is a deep area rich with critical neurovascular structures, which is often host to typical skull base diseases. Expanded endoscopic endonasal approaches offer a potential option for accessing this difficult region. The objective of this paper was to establish the clinical feasibility of gaining access to the paraclival space in the region of the middle third of the clivus, to provide a practical modular and clinically applicable classification, and to describe the relevant critical surgical anatomy for each module. Methods The anatomical organization of the region around the petrous ICA, cavernous sinus, and middle clivus is presented, with approaches divided into zones. In an accompanying paper in this issue by Cavallo, et al., the anatomy of the pterygopalatine fossa is presented; this was observed through cadaveric dissection for which an expanded endonasal approach was used. In the current paper the authors translate the aforementioned anatomical study to provide a clinically applicable categorization of the endonasal approach to the region around the petrous ICA. A series of zones inferior and superior to the petrous ICA are described, with an illustrative case presented for each region. Conclusions The expanded endonasal approach is a feasible approach to the middle third of the clivus, petrous ICA, cavernous sinus, and medial infratemporal fossa in cases in which the lesion is located centrally, with neurovascular structures displaced laterally.

scholarly journals Infrasellar Endoscopic Endonasal Approach for a Pituitary Adenoma Extending into the Third Ventricle, with Anterior Displacement of the Pituitary Gland

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.

Extended Endoscopic Endonasal Approach to the Third Ventricle: Multimodal Anatomical Study with Surgical Implications

2015 ◽  
Vol 84 (2) ◽  
pp. 267-278 ◽  
Author(s):  
Luigi Maria Cavallo ◽  
Alberto Di Somma ◽  
Matteo de Notaris ◽  
Alberto Prats-Galino ◽  
Salih Aydin ◽  
...  
Keyword(s):  
Third Ventricle ◽  
Anatomical Study ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
The Third

The endoscopic endonasal approach for the management of craniopharyngiomas involving the third ventricle

2012 ◽  
Vol 36 (1) ◽  
pp. 27-38 ◽  
Author(s):  
Luigi Maria Cavallo ◽  
Domenico Solari ◽  
Felice Esposito ◽  
Paolo Cappabianca
Keyword(s):  
Third Ventricle ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
The Third

Endoscopic Endonasal Approach for Resection of Suprasellar Hemangioblastoma: Selective Pituitary Sacrifice and Use of Indocyanine Dye: 2-Dimensional Operative Video

2020 ◽  
Vol 20 (1) ◽  
pp. E46-E47 ◽  
Author(s):  
Kumar Abhinav ◽  
Patricio Gimenez ◽  
Matthew Tyler ◽  
Zara M Patel ◽  
Juan C Fernandez-Miranda
Keyword(s):  
Blood Supply ◽  
Third Ventricle ◽  
Cerebral Arteries ◽  
Optic Chiasm ◽  
Visual Pathways ◽  
Pituitary Function ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Feeding Vessels

Abstract Suprasellar hemangioblastomas are rare lesions occurring sporadically or more commonly with von Hippel Lindau disease (VHLD).1,2 A 27-yr-old female presented with amenorrhea, mildly raised prolactin levels and otherwise normal pituitary function, homonymous hemianopia, and mild cognitive decline. Imaging revealed a large suprasellar lesion arising from the infundibulum, causing compression of optic chiasm with edema in the visual pathways. Lesion appeared hypervascular with prominent feeding vessels from the internal carotid arteries bilaterally. To access these vessels derived from the superior hypophyseal arteries and allow early devascularization, endoscopic endonasal approach was performed.3 Stalk preservation was deemed unlikely. After opening of the suprasellar dura, indocyanine dye allowed early identification of the feeding vessels. They were sequentially sacrificed, allowing early devascularization while preserving the normal blood supply to the optic chiasm from the superior hypophyseal arteries. Pituitary gland and stalk were removed with the latter being completely involved by tumor to provide access to the retroclival region and posterior circulation. After opening of the dura underlying the dorsum sella, inferior pole of the tumor was exposed with blood supply identified from the posterior communicating arteries but not the basilar or posterior cerebral arteries. Devascularized lesion was safely removed from the optic apparatus, hypothalamus, and the third ventricle. Histology was consistent with hemangoblastoma (VHLD negative). Patient's cognitive and visual function normalized with a postoperative magnetic resonance imagingdemonstrating complete resection, no ischemic events on diffusion-weighted imaging, and resolution of the edema in the hypothalamus and visual pathways.1 She was started on desmopressin and replacement therapy for pituitary function. The patient consented to the procedure.  Patient provided consent for publication.

Outcomes of the endoscopic endonasal approach for tumors in the third ventricle or invading the third ventricle

2021 ◽  
Vol 90 ◽  
pp. 302-310
Author(s):  
Youngbeom Seo ◽  
Yong Hwy Kim ◽  
Jung Hee Kim ◽  
Doo-Sik Kong ◽  
Yun-Sik Dho ◽  
...  
Keyword(s):  
Third Ventricle ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
The Third

The Expanded Endonasal Approach: A Fully Endoscopic Transnasal Approach and Resection of the Odontoid Process

Skull Base ◽  
2005 ◽  
Vol 15 (S 2) ◽  
Author(s):  
Carl Snyderman ◽  
Amin Kassam ◽  
Paul Gardner ◽  
Ricardo Carrau ◽  
Richard Spiro
Keyword(s):  
Odontoid Process ◽  
Endonasal Approach ◽  
Transnasal Approach ◽  
Expanded Endonasal Approach ◽  
Endoscopic Transnasal Approach

Clinical features and operative technique of transinfundibular craniopharyngioma

2020 ◽  
Vol 133 (1) ◽  
pp. 119-128 ◽  
Author(s):  
Bin Tang ◽  
ShenHao Xie ◽  
GuanLin Huang ◽  
ZhiGang Wang ◽  
Le Yang ◽  
...  
Keyword(s):  
Clinical Features ◽  
Operative Technique ◽  
Third Ventricle ◽  
Radical Resection ◽  
The Third ◽  
Expanded Endonasal Approach ◽  
Sequencing Studies ◽  
Characteristic Features ◽  
Mri Study ◽  
Adamantinomatous Craniopharyngioma

OBJECTIVETransinfundibular craniopharyngioma (TC) is one of the 4 subtypes of suprasellar craniopharyngioma. In this study, the authors analyzed the clinical features of and operative technique for TC.METHODSA total of 95 consecutive cases of suprasellar craniopharyngioma that had been resected via the endoscopic expanded endonasal approach were retrospectively reviewed. Patients were divided into 2 groups: 34 in the TC group and 61 in the nontransinfundibular craniopharyngioma (NC) group. Clinical and radiographic features, intraoperative findings, histopathological and genetic findings, and surgical outcomes were analyzed and compared between groups.RESULTSCompared with NC, TC was mostly seen in adult patients (97.1%); it was rare in children (2.9%). Clinical presentations tended toward headache, hydrocephalus, and diabetes insipidus. The relatively smaller volume, midline location (consistent with the stalk position), unidentifiable stalk, no shift of the third ventricle, and greater likelihood to involve the third ventricle and cause hydrocephalus were the characteristic features of TC in the preoperative MRI study. According to the degree of vertical extension of the tumor, the 34 TCs could be classified into 3 subtypes: type 1, entity was limited to stalk (n = 2, 5.9%); type 2, tumor extended up to the third ventricle (type 2a) or down to the subdiaphragmatic cavity (type 2b) (n = 23, 67.6%); and type 3, tumor extended in both directions (n = 9, 26.5%). For TC resection, the chiasm–pituitary corridor, lamina terminalis corridor, and pituitary corridor could be used separately or jointly. Most of the TCs originated from the infundibulum–tuber cinereum, grew within and along the long axis of the infundibulum, and the pituitary stalk was not usually preserved in TCs (20.6%), whereas the rate of preservation was higher (80.3%) in NCs. Bilateral hypothalamic injury was found in nearly all TCs if radical resection was performed, whereas the relationship between NCs and hypothalamus was either compression (32.8%) or unilateral invasion (67.2%). Meanwhile, the postoperative endocrine and neuropsychological function outcomes in patients with TC were worse than in patients with NC. The genetic analysis with whole-exome sequencing studies showed no differential mutations of CTNNB1 (β-catenin) and BRAF (V600E) between TC and NC subtypes, but there was a difference between adamantinomatous craniopharyngioma and papillary craniopharyngioma.CONCLUSIONSTC is a special subtype of suprasellar craniopharyngioma, which is remarkably different from NC. Identification of this type of tumor preoperatively is essential for the planning of appropriate surgical approach and degree of excision.

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