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Dannhoff G, Gallinaro P, Todeschi J, Ganau M, Spatola G, Ollivier I, Cebula H, Mallereau CH, Baloglu S, Pop R, Proust F, Chibbaro S. Approaching Intradural Lesions of the Anterior Foramen Magnum and Craniocervical Junction: Anatomical Comparison of the Open Posterolateral and Anterior Extended Endonasal Endoscopic Approaches. World Neurosurg 2023; 178:e410-e420. [PMID: 37482086 DOI: 10.1016/j.wneu.2023.07.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/16/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Lesions of the foramen magnum (FM) and craniocervical junction area are traditionally managed surgically through anterior, anterolateral, and posterolateral skull-base approaches. This anatomical study aimed to compare the usefulness of a modified extended endoscopic approach, the so-called far-medial endonasal approach (FMEA), versus the traditional posterolateral far-lateral approach (FLA). METHODS Ten fixed silicon-injected heads specimens were used in the Skull Base ENT-Neurosurgery Laboratory of the University Hospital of Strasbourg, France. A total of 20 FLAs and 10 FMEAs were realized. A high-resolution computed tomography scan was performed for quantitative analysis of the different approaches. The analysis aimed to estimate the extent of surgical exposure and freedom of movement (maneuverability) through the operating channel using a polygonal surface model to obtain a morphometric estimation of the area of interest (surface and volume) on postdissection computed tomography scans using Slicer 3D software. RESULTS FMEA allows for a more direct route to the anterior FM, with wider brainstem exposure compared with the FLA and an excellent visualization of all anterior midline structures. The limitations of the FMEA include the deep and narrow surgical corridor and difficulty in reaching lesions located laterally over the jugular foramen and hypoglossal canal. CONCLUSIONS The FMEA and FLA are both effective surgical routes to reach FM and craniocervical junction lesions. Modern skull base surgeons should have a good command of both because they appear complementary. This anatomical study provides the tools for comprehensive preoperative evaluations and selection of the most appropriate surgical approach.
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Affiliation(s)
- Guillaume Dannhoff
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France; Neuroradiology Unit, Strasbourg University Hospital, Strasbourg, France; Skull Base ENT-Neurosurgery Laboratory, University Hospital of Strasbourg, Strasbourg, France.
| | - Paolo Gallinaro
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Julien Todeschi
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Mario Ganau
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Giorgio Spatola
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Irène Ollivier
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Hélène Cebula
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | | | - Seyyid Baloglu
- Neuroradiology Unit, Strasbourg University Hospital, Strasbourg, France
| | - Raoul Pop
- Neuroradiology Unit, Strasbourg University Hospital, Strasbourg, France
| | - Francois Proust
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France
| | - Salvatore Chibbaro
- Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France; Neuroradiology Unit, Strasbourg University Hospital, Strasbourg, France; Skull Base ENT-Neurosurgery Laboratory, University Hospital of Strasbourg, Strasbourg, France
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Shinya Y, Shin M, Hasegawa H, Koizumi S, Kin T, Kondo K, Saito N. Endoscopic endonasal transpetroclival approach for recurrent bilateral petroclival meningioma. Neurosurgical Focus: Video 2022; 6:V7. [PMID: 36284997 PMCID: PMC9558911 DOI: 10.3171/2022.1.focvid21229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/24/2022] [Indexed: 11/25/2022]
Abstract
The authors performed an endoscopic endonasal transpetroclival approach for recurrent bilateral petroclival meningioma, with the aim of sufficient tumor resection with cranial nerve functional preservation. The tumor was sufficiently removed with excellent postoperative course. Petroclival meningioma, especially located in the medial region with dural attachment of the clivus, is considered a good indication for this approach. Recurrent tumors after radiotherapy often have strong adhesion to the brainstem and basilar artery; therefore, careful assessment of whether or not tumor detachment is possible is essential. The endoscopic endonasal transpetroclival approach is an acceptable, less-invasive treatment for petroclival tumors. The video can be found here: https://stream.cadmore.media/r10.3171/2022.1.FOCVID21229
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Affiliation(s)
- Yuki Shinya
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiro Shin
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
- Department of Neurosurgery, Teikyo University Hospital, Tokyo, Japan; and
| | - Hirotaka Hasegawa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Satoshi Koizumi
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Taichi Kin
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Kenji Kondo
- Department of Otorhinolaryngology, The University of Tokyo Hospital, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
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Loymak T, Belykh E, Abramov I, Tungsanga S, Sarris CE, Little AS, Preul MC. Comparative Analysis of Surgical Exposure among Endoscopic Endonasal Approaches to Petrosectomy: An Experimental Study in Cadavers. J Neurol Surg B Skull Base 2022; 83:526-535. [PMID: 36097500 PMCID: PMC9462962 DOI: 10.1055/s-0041-1741067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 11/12/2021] [Indexed: 01/16/2023] Open
Abstract
Objectives Endoscopic endonasal approaches (EEAs) for petrosectomies are evolving to reduce perioperative brain injuries and complications. Surgical terminology, techniques, landmarks, advantages, and limitations of these approaches remain ill defined. We quantitatively analyzed the anatomical relationships and differences between EEA exposures for medial, inferior, and inferomedial petrosectomies. Design This study presents anatomical dissection and quantitative analysis. Setting Cadaveric heads were used for dissection. EEAs were performed using the medial petrosectomy (MP), the inferior petrosectomy (IP), and the inferomedial petrosectomy (IMP) techniques. Participants Six cadaver heads (12 sides, total) were dissected; each technique was performed on four sides. Main Outcomes and Measures Outcomes included the area of exposure, visible distances, angles of attack, and bone resection volume. Results The IMP technique provided a greater area of exposure ( p < 0.01) and bone resection volume ( p < 0.01) when compared with the MP and IP techniques. The IMP technique had a longer working length of the abducens nerve (cranial nerve [CN] VI) than the MP technique ( p < 0.01). The IMP technique demonstrated higher angles of attack to specific neurovascular structures when compared with the MP (midpons [ p = 0.04], anterior inferior cerebellar artery [ p < 0.01], proximal part of the cisternal CN VI segment [ p = 0.02]) and IP (flocculus [ p = 0.02] and the proximal [ p = 0.02] and distal parts [ p = 0.02] of the CN VII/VIII complex) techniques. Conclusion Each of these approaches offers varying degrees of access to the petroclival region, and the surgical approach should be appropriately tailored to the pathology. Overall, the IMP technique provides greater EEA surgical exposure to vital neurovascular structures than the MP and the IP techniques.
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Affiliation(s)
- Thanapong Loymak
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Evgenii Belykh
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Irakliy Abramov
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Somkanya Tungsanga
- Division of Nephrology, Department of Internal Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Christina E. Sarris
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Andrew S. Little
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Mark C. Preul
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona,Address for correspondence Mark C. Preul, MD c/o Neuroscience Publications, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center350 West Thomas Road, Phoenix, Arizona 85013
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Ha CM, Hong SD, Choi JW, Seol HJ, Nam DH, Lee JI, Kong DS. Graded Reconstruction Strategy Using a Multilayer Technique Without Lumbar Drainage After Endoscopic Endonasal Surgery. World Neurosurg 2021; 158:e451-e458. [PMID: 34767991 DOI: 10.1016/j.wneu.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/31/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Sellar reconstruction following endoscopic endonasal surgery (EES) requires modification based on the degree of cerebrospinal fluid (CSF) leak. For high-flow (grade II or III according to Esposito et al. 2007) intraoperative CSF leak, lumbar drainage (LD), in addition to the multilayer closing technique, is generally recommended. However, LD occasionally has complications including postpuncture headache, overdrainage symptoms, and increased length of stay. We retrospectively evaluated the outcome of our graded reconstruction strategy using a multilayer technique with a novel material, without LD, after EES. METHODS Ninety-seven patients who underwent EES with grade II or III intraoperative CSF leak between June 2020 and March 2021 were retrospectively reviewed. For grade II CSF leak, fibrin sealant and a nasoseptal flap were placed; for grade III CSF leak, a multilayer technique was used in combination with collagen matrix, an acellular dermal graft, injectable hydroxyapatite (HXA), and a nasoseptal flap. Postoperatively, routine LD was not performed. RESULTS This study included 48 (49.5%) grade II and 49 (50.5%) grade III CSF leaks. At follow-up (mean, 8.7 months), no patient showed postoperative CSF leak in either group. No HXA-associated complications occurred. CONCLUSIONS A graded surgical repair strategy after EES could avoid postoperative CSF leak. Combined use of injectable HXA and acellular dermal grafts for high-flow CSF leak can limit LD requirement without significant risks.
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Affiliation(s)
- Chang-Min Ha
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Won Choi
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ho Jun Seol
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Do-Hyun Nam
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung-Il Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Hasegawa H, Shin M, Makita N, Shinya Y, Kondo K, Saito N. Delayed Postoperative Hyponatremia Following Endoscopic Transsphenoidal Surgery for Non-Adenomatous Parasellar Tumors. Cancers (Basel) 2020; 12:cancers12123849. [PMID: 33419307 PMCID: PMC7766216 DOI: 10.3390/cancers12123849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/08/2020] [Accepted: 12/17/2020] [Indexed: 11/16/2022] Open
Abstract
Little is known about delayed postoperative hyponatremia (DPH) accompanied with transsphenoidal surgery for non-adenomatous skull base tumors (NASBTs). Consecutive data on 30 patients with parasellar NASBT was retrospectively reviewed with detailed analyses on perioperative serial sodium levels. Serological DPH (sodium ≤ 135 mmol/L) was observed in eight (27%), with four (13%) of them being symptomatic. DPH developed on postoperative day 7-12 where the mean sodium levels were 134 mmol/L (a mean of 7 mmol/L drop from the baseline) in asymptomatic and 125 mmol/L (a mean of 17.5 mmol/L drop from the baseline) in symptomatic DPH. Serological DPH was accompanied with "weight loss and hemoconcentration (cerebral salt wasting type)" in four (50%), "weight gain and hemodilution (syndrome of inappropriate antidiuretic hormone secretion type)" in three (38%), and no significant weight change in one. Intraoperative extradural retraction of the pituitary gland was the only significant factor for serological DPH (p = 0.035; odds ratio, 12.25 (95% confidence interval, 1.27-118.36)). DPH should be recognized as one of the significant postsurgical complications associated with TSS for NASBTs. Although the underlying mechanism is still controversial, intraoperative extradural compression of the pituitary gland and subsequent dysregulation of the hypothalamo-hypophyseal axis may be responsible.
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Affiliation(s)
- Hirotaka Hasegawa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan; (H.H.); (Y.S.); (N.S.)
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Masahiro Shin
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan; (H.H.); (Y.S.); (N.S.)
- Correspondence: ; Tel.: +81-3-5800-8853
| | - Noriko Makita
- Department of Endocrinology and Nephrology, The University of Tokyo Hospital, Tokyo 113-8655, Japan;
| | - Yuki Shinya
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan; (H.H.); (Y.S.); (N.S.)
| | - Kenji Kondo
- Department of Otolaryngology, The University of Tokyo Hospital, Tokyo 113-8655, Japan;
| | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo 113-8655, Japan; (H.H.); (Y.S.); (N.S.)
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Weiss A, Perrini P, De Notaris M, Soria G, Carlos A, Castagna M, Lutzemberger L, Santonocito OS, Catapano G, Kassam A, Prats-Galino A. Endoscopic Endonasal Transclival Approach to the Ventral Brainstem: Anatomic Study of the Safe Entry Zones Combining Fiber Dissection Technique with 7 Tesla Magnetic Resonance Guided Neuronavigation. Oper Neurosurg (Hagerstown) 2020; 16:239-249. [PMID: 29750275 DOI: 10.1093/ons/opy080] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 03/19/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Treatment of intrinsic lesions of the ventral brainstem is a surgical challenge that requires complex skull base antero- and posterolateral approaches. More recently, endoscopic endonasal transclival approach (EETA) has been reported in the treatment of selected ventral brainstem lesions. OBJECTIVE In this study we explored the endoscopic ventral brainstem anatomy with the aim to describe the degree of exposure of the ventral safe entry zones. In addition, we used a newly developed method combining traditional white matter dissection with high-resolution 7T magnetic resonance imaging (MRI) of the same specimen coregistered using a neuronavigation system. METHODS Eight fresh-frozen latex-injected cadaver heads underwent EETA. Additional 8 formalin-fixed brainstems were dissected using Klingler technique guided by ultra-high resolution MRI. RESULTS The EETA allows a wide exposure of different safe entry zones located on the ventral brainstem: the exposure of perioculomotor zone requires pituitary transposition and can be hindered by superior cerebellar artery. The peritrigeminal zone was barely visible and its exposure required an extradural anterior petrosectomy. The anterolateral sulcus of the medulla was visible in most of specimens, although its close relationship with the corticospinal tract makes it suboptimal as an entry point for intrinsic lesions. In all cases, the use of 7T-MRI allowed the identification of tiny fiber bundles, improving the quality of the dissection. CONCLUSION Exposure of the ventral brainstem with EETA requires mastering surgical maneuvers, including pituitary transposition and extradural petrosectomy. The correlation of fiber dissection with 7T-MRI neuronavigation significantly improves the understanding of the brainstem anatomy.
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Affiliation(s)
- Alessandro Weiss
- Department of Neurosurgery, Hospital of Livorno, Livorno, Italy.,Laboratory of Surgical NeuroAnatomy (LSNA), University of Barcelona, Barcelona, Spain.,Microneurosurgical Laboratory, University of Pisa, Pisa, Italy
| | - Paolo Perrini
- Microneurosurgical Laboratory, University of Pisa, Pisa, Italy.,Department of Neurosurgery, University of Pisa, Pisa, Italy
| | - Matteo De Notaris
- Laboratory of Surgical NeuroAnatomy (LSNA), University of Barcelona, Barcelona, Spain.,Division of Neurosurgery, "G. Rummo" Hospital, Benevento, Italy
| | - Guadalupe Soria
- Laboratory of Surgical NeuroAnatomy (LSNA), University of Barcelona, Barcelona, Spain
| | - Alarcon Carlos
- Laboratory of Surgical NeuroAnatomy (LSNA), University of Barcelona, Barcelona, Spain
| | - Maura Castagna
- Microneurosurgical Laboratory, University of Pisa, Pisa, Italy.,Department of Human Pathology, University of Pisa, Pisa, Italy
| | - Lodovico Lutzemberger
- Microneurosurgical Laboratory, University of Pisa, Pisa, Italy.,Department of Neurosurgery, University of Pisa, Pisa, Italy
| | | | | | - Amin Kassam
- St. Luke's Medical Center, Aurora Neuroscience Innovation Institute, Milwaukee, Wisconsin
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Tayebi Meybodi A, Hendricks BK, Witten AJ, Hartman J, Tomlinson SB, Cohen-Gadol AA. Virtual Exploration of Safe Entry Zones in the Brainstem: Comprehensive Definition and Analysis of the Operative Approach. World Neurosurg 2020; 140:499-508. [PMID: 32474103 DOI: 10.1016/j.wneu.2020.05.207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 04/28/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND A detailed and accurate understanding of the intrinsic brainstem anatomy and the interrelationship between its internal tracts and nuclei and external landmarks is of paramount importance for safe and effective brainstem surgery. Using anatomical models can be an important step in increasing such understanding. In the present study, we have shown the applicability of our developed virtual 3-dimensional (3D) model in depicting the safe entry zones (SEZs) to the brainstem. METHODS Accurate 3D virtual models of brainstem elements were created using high-resolution magnetic resonance imaging and computed tomography to depict the brainstem SEZs. RESULTS All the described SEZs to different parts of the brainstem were successfully depicted using our 3D virtual models. CONCLUSIONS The virtual models provide an immersive experience of brainstem anatomy, allowing users to understand the intricacies of the microdissection that is necessary to appropriately work through the brainstem nuclei and tracts toward a particular target. The models provide an unparalleled learning environment to understand the SEZs into the brainstem that can be used for training and research.
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Affiliation(s)
- Ali Tayebi Meybodi
- The Neurosurgical Atlas, Indianapolis, Indiana, USA; Department of Neurosurgery, Rutgers University Medical School, Newark, New Jersey, USA
| | | | - Andrew J Witten
- Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | | | - Aaron A Cohen-Gadol
- The Neurosurgical Atlas, Indianapolis, Indiana, USA; Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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Hasanbelliu A, Andaluz N, Di Somma A, Keller JT, Zimmer LA, Samy RN, Pensak ML, Zuccarello M. Extended Anterior Petrosectomy Through the Transcranial Middle Fossa Approach and Extended Endoscopic Transsphenoidal-Transclival Approach: Qualitative and Quantitative Anatomic Analysis. World Neurosurg 2020; 138:e405-e412. [PMID: 32145421 DOI: 10.1016/j.wneu.2020.02.127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Petroclival tumors and ventrolateral lesions of the pons present unique surgical challenges. This cadaveric study provides qualitative and quantitative anatomic comparison for an anterior petrous apicectomy through the transcranial middle fossa (TMF) and expanded endoscopic transsphenoidal-transclival approaches. METHODS In 10 silicone-injected heads, the petrous apex and clivus were drilled extradurally using middle fossa and endonasal approaches. With in situ and frameless stereotactic navigation, we defined consistent points to compare working areas, bone removal volumes, approach angles, and surgical freedom. RESULTS Mean exposed TMF area (21.03 ± 3.46 cm2) achieved a 44.71 ± 4.13° working angle to the brainstem between cranial nerves V and VI. Kawase's rhomboid area measured 1.76 ± 0.34 cm2, and bone removal averaged 1.20 ± 0.12 cm3 at the petrous apex. Surgical freedom on the lateral brainstem was higher halfway between cranial nerves V and VI at the center of the rhomboid compared with midline at the basilar sulcus (P < 0.01). After clivectomy and petrous apicectomy, mean exposed expanded endoscopic transsphenoidal-transclival area was 5.29 ± 0.66 cm2. Approach from either nostril showed no statistically significant differences in surgical freedom at the foramen lacerum and midpoint basilar sulcus. At the petrous apex, bone volume removed and area exposed were significantly larger for the TMF approach (P < 0.001). CONCLUSIONS Expanded transclival anterior petrosectomy through the TMF approach provides an adequate corridor to lesions in the upper ventrolateral pons. The expanded endoscopic transsphenoidal-transclival approach better fits midline lesions not extending laterally beyond cranial nerve VI and C3 carotid when evaluating normal anatomic parameters.
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Affiliation(s)
- Aurel Hasanbelliu
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Norberto Andaluz
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Brain Tumor Center at University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio, USA; Mayfield Clinic, Cincinnati, Ohio, USA.
| | - Alberto Di Somma
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università; degli Studi di Napoli Federico II, Naples, Italy
| | - Jeffrey T Keller
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Brain Tumor Center at University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio, USA
| | - Lee A Zimmer
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Brain Tumor Center at University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio, USA; Mayfield Clinic, Cincinnati, Ohio, USA
| | - Ravi N Samy
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Brain Tumor Center at University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio, USA
| | - Myles L Pensak
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Brain Tumor Center at University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio, USA
| | - Mario Zuccarello
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA; Brain Tumor Center at University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio, USA
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de Divitiis O, d’Avella E, de Notaris M, Di Somma A, De Rosa A, Solari D, Cappabianca P. The (R)evolution of Anatomy. World Neurosurg 2019; 127:710-735. [DOI: 10.1016/j.wneu.2019.03.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/05/2019] [Indexed: 11/28/2022]
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10
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Tomasello F, Angileri FF, Conti A, Scibilia A, Cardali S, La Torre D, Germanò A. Petrosal Meningiomas: Factors Affecting Outcome and the Role of Intraoperative Multimodal Assistance to Microsurgery. Neurosurgery 2018; 84:1313-1324. [DOI: 10.1093/neuros/nyy188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/19/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Alfredo Conti
- Department of Neurosurgery, University of Messina, Messina, Italy
- Depart-ment of Neurosurgery, Charité Univer-sitätsmedizin, Berlin, Germany
| | | | | | | | - Antonino Germanò
- Department of Neurosurgery, University of Messina, Messina, Italy
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Hasegawa H, Shin M, Kondo K, Saito N. Reconstruction of Dural Defects in Endoscopic Transnasal Approaches for Intradural Lesions Using Multilayered Fascia with a Pressure-Control Spinal Drainage System. World Neurosurg 2018; 114:e1316-24. [PMID: 29631081 DOI: 10.1016/j.wneu.2018.03.209] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Nasoseptal flap reconstruction is a widely accepted method for reducing cerebrospinal fluid (CSF) leakage after endoscopic transnasal surgeries (ETSs). However, this method is associated with nasal complications and is difficult to apply repeatedly in recurrent cases. Therefore, alternative methods are needed. METHODS Layers of autologous fascia lata were placed on the inside and outside of the dural defect to sufficiently cover it, and the grafts were compressed with an inflated balloon. A lumbar drainage system with a pressure-control valve was used for 72 hours postoperatively. We retrospectively analyzed data on patients with skull base lesions showing intracranial extensions that required wide opening of the ventral dura in ETS. Fifty cases (47 skull base tumors and 3 others) were included, 28 of which were recurrent cases. RESULTS In 21 cases (42%), the nasal septum was not intact because of the previous ETS. Seventeen patients (34%) had a history of radiotherapy and 9 (18%) had undergone multisession radiotherapies. None of the 50 patients required additional surgery for postoperative CSF rhinorrhea, and 2 had intermittent CSF leakage that resolved with prolonged lumbar drainage placement for a week. Previous multisession radiotherapy was the only significant risk factor for the need of prolonged drainage (P = 0.029). CONCLUSIONS The multilayer closure method with a pressure-control spinal drainage system is a simple, safe, and effective method for preventing postoperative CSF leakage, which can be readily applied to dural defects in any parts of the skull base regions and in patients with various conditions.
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12
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Hasegawa H, Shin M, Kondo K, Hanakita S, Mukasa A, Kin T, Saito N. Role of endoscopic transnasal surgery for skull base chondrosarcoma: a retrospective analysis of 19 cases at a single institution. J Neurosurg 2017; 128:1438-1447. [PMID: 28686110 DOI: 10.3171/2017.1.jns162000] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Skull base chondrosarcoma is one of the most intractable tumors because of its aggressive biological behavior and involvement of the internal carotid artery and cranial nerves (CNs). One of the most accepted treatment strategies for skull base chondrosarcoma has been surgical removal of the tumor in conjunction with proactive extensive radiation therapy (RT) to the original tumor bed. However, the optimal strategy has not been determined. The goal of this study was to evaluate the early results of endoscopic transnasal surgery (ETS). METHODS The authors retrospectively analyzed 19 consecutive patients who underwent ETS at their institution since 2010. Adjuvant stereotactic radiosurgery (SRS) was performed only for the small residual tumors that were not resected to avoid critical neurological complications. Histological confirmation and evaluation of the MIB-1 index was performed in all cases. The Kaplan-Meier method was used to determine the actuarial rate of tumor-free survival. RESULTS The median tumor volume and maximal diameter were 14.5 cm3 (range 1.4-88.4 cm3) and 3.8 cm (range 1.5-6.7 cm), respectively. Nine patients (47%) had intradural extension of the tumor. Gross-total resection was achieved in 15 (78.9%) of the 19 patients, without any disabling complications. In 4 patients, the surgery resulted in subtotal (n = 2, 11%) or partial (n = 2, 11%) resection because the tumors involved critical structures, including the basilar artery or the lower CNs. These 4 patients were additionally treated with SRS. The median follow-up duration was 47, 28, and 27 months after the diagnosis, ETS, and SRS, respectively. In 1 patient with an anterior skull base chondrosarcoma, the tumor relapsed in the optic canal 1 year later and was treated with a second ETS. Favorable tumor control was achieved in all other patients. The actuarial tumor control rate was 93% at 5 years. At the final follow-up, all patients were alive and able to perform independent activities of daily living without continuous neurological sequelae. CONCLUSIONS These preliminary results suggest that ETS can achieve sufficient radical tumor removal, resulting in comparative resection rates with fewer neurological complications to those in previous reports. Although the follow-up periods of these cases were relatively short, elective SRS to the small tumor remnant may be rational, achieving successful tumor control in some cases, instead of using proactive extensive RT. Thus, the addition of RT should be discussed with each patient, after due consideration of histological grading and biological behavior. To determine the efficacy of this strategy, a larger case series with a longer follow-up period is essential. However, this strategy may be able to establish evidence in the management of skull base chondrosarcoma, providing less-invasive and effective options as an initial step of treatment.
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Affiliation(s)
| | | | - Kenji Kondo
- 2Otorhinolaryngology, University of Tokyo Hospital, Tokyo, Japan
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Mason E, Rompaey JV, Solares CA, Figueroa R, Prevedello D. Subtemporal Retrolabyrinthine (Posterior Petrosal) versus Endoscopic Endonasal Approach to the Petroclival Region: An Anatomical and Computed Tomography Study. J Neurol Surg B Skull Base 2016; 77:231-7. [PMID: 27175318 DOI: 10.1055/s-0035-1566123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 09/03/2015] [Indexed: 10/22/2022] Open
Abstract
Background The petroclival region seats many neoplasms. Traditional surgical corridors to the region can result in unacceptable patient morbidity. The combined subtemporal retrolabyrinthine transpetrosal (posterior petrosal) approach provides adequate exposure with hearing preservation; however, the facial nerve and labyrinth are put at risk. Approaching the petroclival region with an endoscopic endonasal approach (EEA) could minimize morbidity. Objective To provide an anatomical and computed tomography (CT) comparison between the posterior petrosal approach and EEA to the petroclival region. Methods The petroclival region was approached transclivally with EEA. Different aspects of dissection were compared with the posterior petrosal approach. The two approaches were also studied using CT analysis. Results A successful corridor medial to the internal auditory canal (IAC) was achieved with EEA. Wide exposure was achieved with no external skin incisions, although significant sinonasal resection was required. The posterior petrosal was comparable in terms of exposure medially; however, the dissection involved more bone removal, greater skill, and a constricting effect upon deeper dissection. Importantly, access lateral to the IAC was obtained, whereas EEA could not reach this area. Conclusion An EEA to the petroclival region is feasible. This approach can be considered in lesions medial to the IAC.
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Affiliation(s)
- Eric Mason
- Department of Otolaryngology, Georgia Regents University, Augusta, Georgia, United States; Center for Cranial Base Surgery, Georgia Regents University, Augusta, Georgia, United States
| | - Jason Van Rompaey
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, United States
| | - C Arturo Solares
- Department of Otolaryngology, Georgia Regents University, Augusta, Georgia, United States; Center for Cranial Base Surgery, Georgia Regents University, Augusta, Georgia, United States
| | - Ramon Figueroa
- Department of Radiology, Georgia Regents University, Augusta, Georgia, United States
| | - Daniel Prevedello
- Department of Neurosurgery, Ohio State University, Columbus, Ohio, United States
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