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

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.

Endoscopic Endonasal Approaches to the Clivus with No Violation of the Nasopharynx: Surgical Anatomy and Clinical Illustration

2021 ◽  
Author(s):  
Carlos D. Pinheiro-Neto ◽  
Laura Salgado-Lopez ◽  
Luciano C.P.C. Leonel ◽  
Serdar O. Aydin ◽  
Maria Peris-Celda
Keyword(s):  
Posterior Fossa ◽  
Cerebrospinal Fluid Leak ◽  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Surgical Anatomy ◽  
Csf Leak ◽  
Surgical Approaches ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

Abstract Background Despite the use of vascularized intranasal flaps, endoscopic endonasal posterior fossa defects remain surgically challenging with high rates of postoperative cerebrospinal fluid leak. Objective The aim of the study is to describe a novel surgical technique that allows complete drilling of the clivus and exposure of the craniovertebral junction with preservation of the nasopharynx. Methods Two formalin-fixed latex-injected anatomical specimens were used to confirm feasibility of the technique. Two surgical approaches were used: sole endoscopic endonasal approach and transnasion approach. The sole endonasal approach was used in a patient with a petroclival meningioma. Results In both anatomical dissections, the inferior clivectomy with exposure of the foramen magnum was achieved with a sole endoscopic endonasal approach. The addition of the transnasion approach helped to complete drilling of the inferior border of the foramen magnum and exposure of the arch of C1. Conclusion This study shows the anatomical feasibility of total clivectomy and exposure of the craniovertebral junction with preservation of the nasopharynx. A more favorable anatomical posterior fossa defect for the reconstruction is achieved with this technique. Further clinical studies are needed to assess if this change would impact the postoperative CSF leak rate.

Transclival Approach for Resection of a Pontine Cavernous Malformation: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (4) ◽  
pp. E413-E413
Author(s):  
Dennis London ◽  
Seth Lieberman ◽  
Omar Tanweer ◽  
Donato Pacione
Keyword(s):  
Cavernous Malformation ◽  
Case Reports ◽  
Abducens Nerve ◽  
Petrous Bone ◽  
Fat Graft ◽  
Csf Leak ◽  
Endoscopic Endonasal ◽  
Cavernous Malformations ◽  
Lumbar Drain ◽  
Magnetic Resonance Imaging Mri

Abstract Cerebral cavernous malformations are common vascular anomalies consisting of a cluster of capillaries without intervening brain tissue.1 A variety of approaches for resection have been undertaken,2 and a handful of case reports have described the endoscopic, endonasal, transclival approach.3 We present a case of a 51-yr-old woman with lupus and hepatitis B-associated cirrhosis who presented with diplopia, dysphagia, and ataxia. She had a left abducens nerve palsy and magnetic resonance imaging (MRI) showed a left pontine cavernous malformation. After a repeat hemorrhage, she consented to surgical resection. The lesion appeared to come to the medial pontine pial surface. Tractography indicated a rightward displacement of the left corticospinal tract. Therefore, an endoscopic, transnasal, transclival approach was chosen. A lumbar drain was placed preoperatively. The clivus and ventral petrous bone were drilled using the vidian canal to help identify the anterior genu of the petrous carotid artery. The clival dura was opened, revealing the abducens nerve exiting the ventral pons. The cavernoma was visible on the surface lateral to the nerve. It was removed using blunt dissection and the remaining cavity inspected. The skull base was reconstructed using an abdominal dermal-fat graft and Alloderm covered by a nasoseptal flap. Postoperatively she had transient swallowing difficulty. The lumbar drain was kept open for 5 d. Cerebrospinal fluid (CSF) leak was ruled out using an intrathecal fluorescein injection. She was discharged home, but presented 2 wk postoperatively with aseptic meningitis, which was treated supportively. Postoperative imaging did not show residual cavernoma.

Evolving Strategies for Resection of Sellar/Parasellar Synchronous Tumors via Endoscopic Endonasal Approach: A Technical Case Report and Systematic Review of the Literature

2020 ◽  
Vol 133 ◽  
pp. 381-391.e2
Author(s):  
Michel Roethlisberger ◽  
Ronie Romelean Jayapalan ◽  
Isabel Charlotte Hostettler ◽  
Khairul Azmi Bin Abd Kadir ◽  
Kein Seong Mun ◽  
...  
Keyword(s):  
Systematic Review ◽  
Case Report ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Review Of The Literature ◽  
Synchronous Tumors ◽  
Endoscopic Endonasal

Endoscopic Endonasal Approach to Mesencephalic Cavernous Malformations

2016 ◽  
Vol 90 ◽  
pp. 701.e7-701.e10 ◽  
Author(s):  
Shi-Ming He ◽  
Yuan Wang ◽  
Tian-Zhi Zhao ◽  
Tao Zheng ◽  
Wen-Hai Lv ◽  
...  
Keyword(s):  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Cavernous Malformations

scholarly journals Endoscopic Endonasal Approach of Orbital Medial Wall Reconstruction using Septal Cartilage: A Rare Surgical Case Report

2015 ◽  
Vol 8 (1) ◽  
pp. 30-33
Author(s):  
MK Rajasekar ◽  
M Vivek ◽  
V Narendrakumar
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Septal Cartilage ◽  
Medial Wall ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Surgical Case ◽  
Orbital Wall ◽  
Medial Orbital Wall

ABSTRACT Orbital fractures can cause facial disfigurement and disturbs vision. Medial orbital wall fractures are diagnosed with frequent use of computed tomography (CT) scans in the diagnosis of orbital trauma. Orbital reconstruction plays a challenging role for the surgeons as it comes in a multitude of different forms. We report a case of 45-year male with a history of assault presented with diminution of vision, restricted abduction and diplopia of the left eye. Computed tomography scan showed fracture of the left medial orbital wall fracture and the patient was treated by endoscopic endonasal approach of medial orbital wall reconstruction using septal cartilage. How to cite this article Rajasekar MK, Vivek M, Narendrakumar V. Endoscopic Endonasal Approach of Orbital Medial Wall Reconstruction using Septal Cartilage: A Rare Surgical Case Report. Clin Rhinol An Int J 2015;8(1):30-33.

Endoscopic endonasal approach for brainstem cavernous malformation

2019 ◽  
Vol 1 (2) ◽  
pp. V2
Author(s):  
Ezequiel Goldschmidt ◽  
Andrew S. Venteicher ◽  
Maximiliano Nuñez ◽  
Eric Wang ◽  
Carl Snyderman ◽  
...  
Keyword(s):  
Cavernous Malformation ◽  
Motor Evoked Potentials ◽  
Lateral Displacement ◽  
Third Ventricle ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
High Definition ◽  
Endoscopic Endonasal ◽  
Transcallosal Approach ◽  
Postoperative Mri

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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