Critical Appraisal of Extent of Resection of Clival Lesions Using the Expanded Endoscopic Endonasal Approach

Cutler, Aaron; Wang, Marilene; Suh, Jeffrey D.; Bergsneider, Marvin

doi:10.1055/s-0032-1312171

Cited by 3 publications

(8 citation statements)

References 11 publications

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“…A handful of retrospective reviews have also highlighted rates of CSF leak for transclival surgeries, particularly dealing with the resection of chordomas. These studies report rates of reconstructive failure of 32.7% (17/52), 15.7% (8/51), 19% (2/19), 6.7% (1/15), and 21% (3/14), respectively. Aggregating this data reveals a 19.1% rate of reconstructive failure for a total of 299 patients with clival defects.…”

Section: Complicationsmentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

150

279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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Section: Complicationsmentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

150

279

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“…Independently, meningoencephaloceles or encephaloceles were associated with primary leaks in 17 studies 12,17,24,30,34,38,40,44,49,53,75,82,98,101,102,104,108 or 192 primary leaks. The distribution of the primary etiology for secondary leaks (the source of the primary leak that recurred) was available for 51 studies 4,6,9,11,12,14,17,21,23,27,29,31–40,43,45–49,52–54,56,57,59,62,65,66,68,71,72,76,80,81,86,89–91,94,…”

Section: Csf Leak Characteristicsmentioning

confidence: 99%

“…The distribution of the primary etiology for secondary leaks (the source of the primary leak that recurred) was available for 51 studies 4,6,9,11,12,14,17,21,23,27,29,31–40,43,45–49,52–54,56,57,59,62,65,66,68,71,72,76,80,81,86,89–91,94,95,101,102,104–106,108,109. Iatrogenic leaks were the most likely to recur in 22 studies 20,24,27,43,44,47,49,54,56,65–…”

Section: Csf Leak Characteristicsmentioning

confidence: 99%

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A Systematic Review of Secondary Cerebrospinal Fluid Leaks

Konuthula

Khan

Signore

et al. 2017

Am J Rhinol�Allergy

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“…Up to now, many variants have been published, either by using the traditional microscopic or newer endoscopic techniques, or a combination of both. According to some enthusiastic protagonists, midline skull base lesions from the frontobasal region to the dens axis can be sufficiently reached (26,27). As with any surgical method, the chance and risk analysis should be compared with alternative methods.…”

mentioning

confidence: 99%

Surgery for pediatric craniopharyngiomas: is less more?

Flitsch

Aberle

Burkhardt

2015

Journal of Pediatric Endocrinology and Metabolism

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Surgery for craniopharyngiomas, especially in childhood and adolescence, has evolved from an era of aggressive strategies - with the primary goal of gross total removal and accepting an impaired functional outcome - to a more individually tailored therapy that avoids immediate treatment-related and long-term morbidity. Modern imaging techniques and a wider understanding of hypothalamic risk factors have led to surgical strategies adapted to the localization of these inhomogenously grown pathologies. Whereas purely infradiaphragmatic as well as supradiaphragmatic/infrachiasmatic tumors have a favorably surgical outcome with higher gross total resection rates in experienced hands, lesions within the third ventricle extending beyond the mammillary bodies remain a problem. The same is valid for lesions beyond 3 cm in diameter, more or less independent of their localization. Aside from the traditional microscopic approach via the subfrontal or pterional craniotomy, transsphenoidal approaches and other minimal invasive surgical methods, e.g., catheter implantation into cystic formations of the tumor have become popular. Radiotherapy, with its risks and limitations, can effectively be added to avoid recurrences. Nowadays, surgery as part of an interdisciplinary treatment strategy is still the typical first choice. However, taking the patient's long-term prognosis into considertaion, the surgical complication rates have to be minimized.

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Critical Appraisal of Extent of Resection of Clival Lesions Using the Expanded Endoscopic Endonasal Approach

Cited by 3 publications

References 11 publications

ICAR: endoscopic skull‐base surgery

ICAR: endoscopic skull‐base surgery

A Systematic Review of Secondary Cerebrospinal Fluid Leaks

Surgery for pediatric craniopharyngiomas: is less more?

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