Comparing nasal physiology after superior ethmoidal and traditional endoscopic anterior cranial base approaches

Patel, Varun; Viswanathan, Rohan; Ruffner, Randall; Peris-Celda, María; Pinheiro‐Neto, Carlos D.

doi:10.4193/rhin20.325

Cited by 4 publications

(6 citation statements)

References 8 publications

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“…A follow-up study was published in 2020 comparing the nasal physiology of the SEA technique with traditional endoscopic cranial base resections utilizing computational flow dynamics (CFD). 57 CFD results in SEA patients mirrored that of non-operated control patients, with the majority of airflow directed along the nasal floor and inferior turbinates and equivalent air temperature to control patients (33.7-32.72°C, p ¼ 0.468). On the other hand, patients who underwent traditional endoscopic cranial base resections had increased airflow directed at the maxillary sinus, sphenoid sinus, and nasal cavity roof.…”

Section: Septal Transposition For Olfactory Groove Meningiomasmentioning

confidence: 71%

Optimizing Quality of Life and Minimizing Morbidity through Nasal Preservation in Endoscopic Skull Base Surgery: A Contemporary Review

Pinheiro‐Neto

Rowan

Celda

et al. 2022

J Neurol Surg B Skull Base

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Introduction Endoscopic endonasal approaches (EEAs) are increasingly utilized for intracranial pathology. As opposed to sinonasal tumors, the nasal cavity is being used as a corridor to access these intracranial tumors but is not the site of primary surgical intent. Accordingly, there has been recent interest in preserving intranasal structures not directly involved by tumor and improving postoperative sinonasal quality of life (QOL). Objectives The aim of the study is to highlight recent advances in EEA techniques focused on improving sinonasal QOL including turbinate preservation, reducing the morbidity of reconstructive techniques, and the development of alternative minimally invasive EEA corridors. Methods The method of the study involves contemporary literature review and summary of implications for clinical practice. Results Nasoseptal flap (NSF) harvest is associated with significant morbidity including septal perforation, prolonged nasal crusting, and external nasal deformities. Various grafting and local rotational flaps have demonstrated the ability to significantly limit donor site morbidity. Free mucosal grafts have re-emerged as a reliable reconstructive option for sellar defects with an excellent sinonasal morbidity profile. Middle turbinate preservation is achievable in most EEA cases and has not been shown to cause postoperative obstructive sinusitis. Recently developed minimally invasive EEA techniques such as the superior ethmoidal approach have been described to better preserve intranasal structures while allowing intracranial access to resect skull base tumors and have shown promising sinonasal QOL results. Conclusion This contemporary review discusses balancing effective skull base reconstructive techniques with associated morbidity, the role of turbinate preservation in EEA, and the development of unique EEA techniques that allow for increased nasal structure preservation.

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Section: Septal Transposition For Olfactory Groove Meningiomasmentioning

confidence: 71%

Optimizing Quality of Life and Minimizing Morbidity through Nasal Preservation in Endoscopic Skull Base Surgery: A Contemporary Review

Pinheiro‐Neto

Rowan

Celda

et al. 2022

J Neurol Surg B Skull Base

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“…This technique maintains physiologic airflow, as it preserves structures of the middle ostiomeatal complex and the middle turbinate and its attachments. 18,19 Extracranial Anatomy of the ACF Once exposure of the ACF has been afforded, either through a traditional total ethmoidectomy or a superior ethmoidal approach, its boundaries are the lamina papyracea of the orbits bilaterally, the posterior table of the frontal sinus anteriorly, and the limbus sphenoidale posteriorly. The main arterial structures on the extracranial surface of the ACF are the posterior and anterior ethmoidal arteries, bilaterally.…”

Section: Anatomy Of the Sphenoid Sinus Ethmoid Labyrinth And Frontal ...mentioning

confidence: 99%

Surgical Anatomy of Endoscopic Endonasal Approaches to the Anterior Cranial Fossa

Alexander,

Agosti,

Leonel

et al. 2024

Contemporary Neurosurgery

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Lesions of the anterior cranial fossa (ACF) are challenging to treat. Historically, to obviate retraction on the frontal lobes and access the entire lesion, extensive craniofacial and skull base approaches were employed, often leading to significant cosmetic defects and morbidity. With the advent of expanded endonasal approaches, select lesions involving the ACF are treated with endoscopic endonasal approaches (EEAs). Consequently, for the contemporary skull base neurosurgeon, understanding the anatomy of EEAs to ACF lesions is vital. Thus, in this article we detail the surgical anatomy of EEAs to the ACF.

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“…1 To mitigate the removal of normal nasal anatomy, recent publications have suggested the superior ethmoidal approach, which preserves the attachments of the middle turbinate and structures of the middle meatus, thus preserving physiological nasal airflow. 2,3 While descriptions of this approach exist in the literature, no video details its operative steps while highlighting the anatomy involved in its successful execution. In this video, we present the case of a 67-year-old woman with an incidentally found olfactory groove meningioma.…”

mentioning

confidence: 99%

Superior Ethmoidal Approach to an Olfactory Groove Meningioma: Maximizing Preservation of Nasal Anatomy: 2-Dimensional Operative Video

Alexander,

Agosti,

Pinheiro-Neto

et al. 2024

Operative Neurosurgery

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Olfactory groove meningiomas can be approached through a transcranial or expanded endoscopic endonasal approach. Benefits of the expanded endoscopic endonasal approach to olfactory groove meningiomas include early devascularization of the tumor, direct access to the dura from which the tumor arises, obviation of frontal lobe retraction, and, if bony extension of the tumor is present, immediate access to the involved bone. Disadvantages of the expanded endoscopic endonasal approach include loss of smell, which is a direct sequela of the approach as the olfactory apparatus is removed, and removal of the ostiomeatal nasal complex, which may predispose the patient to colder, nonphysiological nasal airflow and consequent nasal crusting. 1 To mitigate the removal of normal nasal anatomy, recent publications have suggested the superior ethmoidal approach, which preserves the attachments of the middle turbinate and structures of the middle meatus, thus preserving physiological nasal airflow. 2,3 While descriptions of this approach exist in the literature, no video details its operative steps while highlighting the anatomy involved in its successful execution. In this video, we present the case of a 67-year-old woman with an incidentally found olfactory groove meningioma. Despite having residual olfaction, she did not want a transcranial approach and elected to undergo resection through an endoscopic endonasal, superior ethmoidal approach. Gross total resection of the lesion was achieved. This manuscript was conducted in accordance with the ethical standards of our institution's Institutional Review Board. The patient gave informed consent for surgery and video recording.

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Comparing nasal physiology after superior ethmoidal and traditional endoscopic anterior cranial base approaches

Cited by 4 publications

References 8 publications

Optimizing Quality of Life and Minimizing Morbidity through Nasal Preservation in Endoscopic Skull Base Surgery: A Contemporary Review

Optimizing Quality of Life and Minimizing Morbidity through Nasal Preservation in Endoscopic Skull Base Surgery: A Contemporary Review

Surgical Anatomy of Endoscopic Endonasal Approaches to the Anterior Cranial Fossa

Superior Ethmoidal Approach to an Olfactory Groove Meningioma: Maximizing Preservation of Nasal Anatomy: 2-Dimensional Operative Video

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