Endoscopic Endonasal Approach to Multilobular Giant Pituitary Adenoma with Cavernous Sinus Invasion and Petroclival Extension

Rahimli, Tural; Hidayetov, Tural; Rajabov, Tural

doi:10.1016/j.wneu.2020.11.055

Cited by 5 publications

(4 citation statements)

References 2 publications

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“…Because the CS is a complicated region surrounded and crowded by many neurovascular structures, various surgical approaches have been proposed; using them in combination is often required for large and extensive tumors (10, 18-21). For pituitary adenomas with extensive CS invasion, both transsphenoidal and transcranial surgery can be considered for tumor removal, and radiation and receptor-based pharmacotherapy are also a useful adjunctive treatment option for tumor control (19)(20)(21)(22)(23).…”

Section: Discussionmentioning

confidence: 99%

Endoscopic transorbital approach to the cavernous sinus: Cadaveric anatomy study and clinical application (‡SevEN-009)

et al. 2022

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ObjectiveCavernous sinus (CS) invasion is frequently encountered in the management of skull base tumors. Surgical treatment of tumors in the CS is technically demanding, and selection of an optimal surgical approach is critical for maximal tumor removal and patient safety. We aimed to evaluate the feasibility of an endoscopic transorbital approach (ETOA) to the CS based on a cadaveric study.MethodsFive cadaveric heads were used for dissection under the ETOA in the comparison with the endoscopic endonasal approach (EEA) and the microscopic transcranial approach (TCA). The CS was exposed, accessed, and explored, first using the ETOA, followed by the EEA and TCA. A dedicated endoscopic system aided by neuronavigation guidance was used for the procedures. During the ETOA, neurovascular structures inside the CS were approached through different surgical triangles.ResultsAfter completing the ETOA with interdural dissection, the lateral wall of the CS was fully exposed. The lateral and posterior compartments of the CS, of which accessibility is greatly limited under the EEA, were effectively approached and explored under the ETOA. The anteromedial triangle was the largest window via which most of the lateral compartment was freely approached. The internal carotid artery and abducens nerve were also observed through the anteromedial triangle and just behind V1. During the ETOA, the approaching view through the supratrochlear and infratrochlear triangles was more directed towards the posterior compartment. After validation of the feasibility and safety based on the cadaveric study, ETOA was successfully performed in a patient with a pituitary adenoma with extensive CS invasion.ConclusionsBased on the cadaveric study, we demonstrated that the lateral CS wall was reliably accessed under the ETOA. The lateral and posterior compartments of the CS were effectively explored via surgical triangles under the ETOA. ETOA provides a unique and valuable surgical route to the CS with a promising synergy when used with EEA and TCA. Our experience with a clinical case convinces us of the efficacy of the ETOA during surgical management of skull base tumors with CS-invasion.

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Section: Discussionmentioning

confidence: 99%

Endoscopic transorbital approach to the cavernous sinus: Cadaveric anatomy study and clinical application (‡SevEN-009)

et al. 2022

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“…This can subsequently escalate the risk of postoperative complications, including CSF and meningitis. (5) There is a paucity of research speci cally investigating e cacious methods for skull base reconstruction in EEA surgery of IPAs. Consequently, the exploration of an effective technique is of paramount importance.…”

Section: Introductionmentioning

confidence: 99%

Utilizing In-Situ Bone Flap for Skull Base Reconstruction in Endoscopic Surgery of Invasive Pituitary Adenoma: A Novel Approach

Liu,

Chen,

et al. 2024

Preprint

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Objective: To evaluate the efficacy of in-situ bone flap (ISBF) repositioning technique in skull base reconstruction for invasive pituitary adenoma (IPA) via endoscopic endonasal approach (EEA). Method: In a retrospective study spanning the years 2018 to 2023, we investigated the efficacy of in-situ bone flap (ISBF) repositioning technique in patients with invasive pituitary adenoma (IPA) who underwent endoscopic endonasal surgery (EEA). Among the 115 patients included in the study, 65 were assigned to the group, while the remaining 55 were categorized into the non-ISBF group. Comprehensive data on patients’ basic characteristics, surgical situation, and clinical outcomes were meticulously collected and analyzed. Results: In our study, we observed postoperative cerebrospinal fluid (CSF) leakage in 1 out of 65 patients in the ISBF group, while 8 out of 50 patients in the non-ISBF group experienced this complication, indicating a significant difference (P<0.05). Conclusion: The ISBF repositioning technique emerges as an effective and feasible method for skull base reconstruction in patients who have underwent EEA surgery for IPA. Notably, this technique significantly reduces the incidence of postoperative CSF leakage.

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“…With the continuous improvement of the anatomy of the skull base, the continuous popularization of endoscopic technology and the continuous improvement of endoscopic equipment, neuroendoscopy has developed from simple operation of pituitary tumor to perisaddle and suprasellar lesions[ 1 - 4 ]. Now, neuroendoscopic transnasal approach can carry out a variety of lesions in the sellar region, such as pituitary giant adenoma that breaks through the sellar septum and suprasellar craniopharyngioma[ 5 - 7 ]. However, the complications of cerebrospinal fluid and intracranial infection after the operation are still important and life-threatening complications, which may lead to poor prognosis[ 8 - 9 ].…”

Section: Introductionmentioning

confidence: 99%

“In situ bone flap” combined with vascular pedicled mucous flap to reconstruction of skull base defect

Qian,

Chen,

Zhang

et al. 2023

World J Clin Cases

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Time series analysis is a valuable tool in epidemiology that complements the classical epidemiological models in two different ways: Prediction and forecast. Prediction is related to explaining past and current data based on various internal and external influences that may or may not have a causative role. Forecasting is an exploration of the possible future values based on the predictive ability of the model and hypothesized future values of the external and/or internal influences. The time series analysis approach has the advantage of being easier to use (in the cases of more straightforward and linear models such as Auto-Regressive Integrated Moving Average). Still, it is limited in forecasting time, unlike the classical models such as Susceptible-Exposed-Infectious-Removed. Its applicability in forecasting comes from its better accuracy for short-term prediction. In its basic form, it does not assume much theoretical knowledge of the mechanisms of spreading and mutating pathogens or the reaction of people and regulatory structures (governments, companies, etc. ). Instead, it estimates from the data directly. Its predictive ability allows testing hypotheses for different factors that positively or negatively contribute to the pandemic spread; be it school closures, emerging variants, etc. It can be used in mortality or hospital risk estimation from new cases, seroprevalence studies, assessing properties of emerging variants, and estimating excess mortality and its relationship with a pandemic.

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Endoscopic Endonasal Approach to Multilobular Giant Pituitary Adenoma with Cavernous Sinus Invasion and Petroclival Extension

Cited by 5 publications

References 2 publications

Endoscopic transorbital approach to the cavernous sinus: Cadaveric anatomy study and clinical application (‡SevEN-009)

Endoscopic transorbital approach to the cavernous sinus: Cadaveric anatomy study and clinical application (‡SevEN-009)

Utilizing In-Situ Bone Flap for Skull Base Reconstruction in Endoscopic Surgery of Invasive Pituitary Adenoma: A Novel Approach

“In situ bone flap” combined with vascular pedicled mucous flap to reconstruction of skull base defect

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