Extended endoscopic endonasal approach to the ventral skull base lesions (original) (raw)
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Endonasal surgery of the ventral skull base--endoscopic transcranial surgery
Oral and maxillofacial surgery clinics of North America, 2010
Skull base surgery is evolving from traditional transfacial and transcranial approaches to the endoscopic endonasal approach, a less intrusive corridor for accessing the ventral skull base. This technique eliminates facial scars, expedites recovery, and obviates brain retraction. The goals of surgical excision, whether palliative or curative, are identical: an approach that is less disruptive to normal tissues. By exploiting the sinonasal corridor, the entire ventral skull base may be accessed to successfully treat benign and malignant lesions. The expanding limits of endoscopic skull base surgery have been accompanied by commensurate innovations in reconstructive techniques that are reliable and have been shown to limit postoperative complications. This article describes the basis for this approach and provides the latest outcome data supporting the current state of the art for endoscopic skull base surgery.
Endoscopic Endonasal Approaches for Benign Tumors Involving the Skull Base
Current Otorhinolaryngology Reports, 2013
With continued refinements in endoscopic image quality, instrumentation, surgical navigation, skull base closure techniques, anatomical understanding, and advanced neurosurgical and otolaryngological training, the endonasal endoscopic approach has become a well-accepted and widely utilized technique for the resection of most benign midline ventral skull base tumors. While pituitary adenomas and Rathke's cleft cysts constitute the most common lesions removed via this route, increasing experience has led to its broader utilization for more complex lesions, including craniopharyngiomas, midline meningiomas, and schwannomas. In this article, we review the recent literature published on this topic with an emphasis on the most interesting and important new results and discoveries for each type of benign skull base tumor.
Surgical neurology international, 2015
The past two decades have been the setting for remarkable advancement in endonasal endoscopic neurosurgery. Refinements in camera definition, surgical instrumentation, navigation, and surgical technique, including the dual surgeon team, have facilitated purely endonasal endoscopic approaches to the majority of the midline skull base that were previously difficult to access through the transsphenoidal microscopic approach. This review article looks at many of the articles from 2011 to 2014 citing endonasal endoscopic surgery with regard to approaches and reconstructive techniques, pathologies treated and outcomes, and new technologies under consideration. Refinements in approach and closure techniques have reduced the risk of cerebrospinal fluid leak and infection. This has allowed surgeons to more aggressively treat a variety of pathologies. Four main pathologies with outcomes after treatment were identified for discussion: pituitary adenomas, craniopharyngiomas, anterior skull base...
Transsphenoidal endoscopic skull base surgery: state of the art and future perspective
Innovative Neurosurgery, 2013
Given refinements in endoscopic image quality, instrumentation, surgical navigation, skull base closure techniques and anatomical understanding, the endonasal endoscopic approach is now a well-accepted and widely utilized technique for removal of many if not most midline ventral skull base tumors. Pituitary adenomas and Rathke ' s cleft cysts (RCCs) constitute the majority of lesions removed via this route; however, craniopharyngiomas, clival chordomas, midline meningiomas and other benign and malignant skull base tumors are now increasingly removed by this approach. Herein we describe the evolution of the endonasal endoscopic technique, its current use for sellar and midline skull base tumors and potential for future innovation.
Indications and limitations of endoscopic skull base surgery
A wealth of critical neurovascular structures within a relatively small surface area adds to the already intricate nature of skull base surgery. Surgical approaches to the area are difficult and often associated with significant morbidity and mortality. During the past two decades, endoscopic endonasal approaches (EEAs) have evolved to access the ventral skull base for the resection of tumors (benign and malignant), the decompression of neural structures including the cervicomedullary junction (pannus from rheumatoid arthritis or congenital anomalies, such as platybasia) and the reconstruction of skull base defects (cerebrospinal leaks, meningoencephalocele). These minimal access approaches obviate the need for external incisions, translocation of maxillofacial bones and retraction of the brain. Furthermore, EEAs yield improved visualization, which may reduce complications, and improve quality of life outcomes. Anatomical difficulties (e.g., vascular encasement or extension beyond the plane of a major vessel or cranial nerve), various special conditions (e.g., pediatric patients and vascular tumor) and limitation of institutional resources and technical difficulties may limit the use of EEAs. Thus, one should understand the indications and limitations of EEAs to optimize patient selection, which, in turn, may lead to superior surgical outcomes and reduced morbidity.
Expanded Endoscopic Approach for Anterior Skull Base Tumors
Journal of Craniofacial Surgery, 2019
The aim of this study is to describe the experience of a multidisciplinary skull base team with transnasal endoscopic surgery for anterior cranial base tumors. A retrospective chart review was conducted on patients who underwent an exclusive expanded transnasal approach to the anterior skull base in the period from December 2014 to November 2015. Data on patient demographics, tumor characteristics, surgical information, imaging, and postoperative complications were collected and analyzed. From a total of 120 patients with skull base diseases managed by the skull base team, 36 were admitted to this study. The overall complication rate in this series was 16.7%, gross total resection was achieved in 32 cases (88.9%) and postoperative CSF leakage occurred in 5 cases (13.9%). Our preliminary results confirm that an exclusive endoscopic transnasal approach to the anterior cranial base is a reliable technique with acceptable perioperative morbidity.
Endoscopic endonasal surgery for malignancies of the anterior cranial base
World neurosurgery, 2014
Data from several centers worldwide have demonstrated that transnasal endoscopic surgery performed with or without a transcranial approach is capable of achieving radical resection of selected sinonasal malignancies. We report our experience with endoscopic management of sinonasal cancers, with emphasis on naso-ethmoidal malignancies encroaching on the anterior skull base. Major series reporting results concerning the endoscopic endonasal approach with or without craniectomy for treatment of sinonasal and anterior skull base cancers were reviewed. Preoperative work-up, indications and exclusion criteria, surgical techniques, postoperative management, and adjuvant therapy are reported. In the 2 largest series analyzed, the most common malignancies were adenocarcinoma (28%), olfactory neuroblastoma (14.5%), and squamous cell carcinoma (13.5%). The 5-year disease-specific survival rate ranged from 81.9%-87%, with no major differences in the mean follow-up time (34.1 months vs. 37 month...
Journal of Neurosurgery, 2011
Object The development of endoscopic endonasal approaches, albeit in the early stages, represents part of the continuous evolution of skull base surgery. During this early period, it is important to determine the safety of these approaches by analyzing surgical complications to identify and eliminate their causes. Methods The authors reviewed all perioperative complications associated with endoscopic endonasal skull base surgeries performed between July 1998 and June 2007 at the University of Pittsburgh Medical Center. Results This study includes the data for the authors' first 800 patients, comprising 399 male (49.9%) and 401 female (50.1%) patients with a mean age of 49.21 years (range 3–96 years). Pituitary adenomas (39.1%) and meningiomas (11.8%) were the 2 most common pathologies. A postoperative CSF leak represented the most common complication, occurring in 15.9% of the patients. All patients with a postoperative CSF leak were successfully treated with a lumbar drain and/...