Endoscopic Resection of Clival Malignancies

Folbe, Adam J.; Svider, Peter F.; Liu, James K.; Eloy, Jean Anderson

doi:10.1016/j.otc.2016.12.008

Cited by 19 publications

(17 citation statements)

References 48 publications

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“…Lesions of the clivus encompass a broad differential diagnosis, with chondrosarcomas and chordomas representing the majority of these lesions, with the latter being the most common. Comprised of physaliferous cells theoretically derived from the notochord (with a “soap bubble” appearance on histology), chordomas represent a low‐grade malignancy with significant potential for functional deficits because of the crucial structures adjacent to the clivus . Patients often present with discrete symptoms from CN deficits, commonly CN VI palsy, nonspecific complaints including headaches, or can have lesions detected incidentally on imaging studies.…”

Section: Clival Tumorsmentioning

confidence: 99%

“…After elevation of an NSF (usually unilateral) and placement away from the surgical site, the sphenoid rostrum is removed. Sellar bone is drilled away, exposing the dura, and the clivus bone is drilled medial to the vidian nerves bilaterally just below the second genu of the carotid arteries . The ICAs are avoided using several strategies, including knowledge of the location of the vidian nerve, neuronavigation, Doppler, and carefully removing bone with a diamond burr rather than a cutting bur .…”

Section: Clival Tumorsmentioning

confidence: 99%

“…Sellar bone is drilled away, exposing the dura, and the clivus bone is drilled medial to the vidian nerves bilaterally just below the second genu of the carotid arteries . The ICAs are avoided using several strategies, including knowledge of the location of the vidian nerve, neuronavigation, Doppler, and carefully removing bone with a diamond burr rather than a cutting bur . Clival drilling continues at the clivus until the dura is exposed, and if dural opening is necessary, it is done so in the midline to avoid CN VI injury.…”

Section: Clival Tumorsmentioning

confidence: 99%

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ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

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152

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: Clival Tumorsmentioning

confidence: 99%

Section: Clival Tumorsmentioning

confidence: 99%

Section: Clival Tumorsmentioning

confidence: 99%

See 1 more Smart Citation

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

Self Cite

152

279

View full text Add to dashboard Cite

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“…This is especially true in academic centers . Additional studies have shown the safety and efficacy of endoscopic approaches for the removal of sinonasal tumors . Thus, endoscopic approaches to these sinonasal tumors are recommended when feasible.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and management of sinonasal paragangliomas: a systematic review

Nguyen

Patel

Arianpour

et al. 2018

Int Forum Allergy Rhinol

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Background: Paragangliomas of the nasal cavity and paranasal sinuses, although exceedingly rare, can exhibit frequent and aggressive recurrences. Our objective was to evaluate tumor characteristics, clinical course, management, and associated complications of sinonasal paragangliomas Methods: A systematic review of the literature was performed utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, searching for sinonasal paraganglioma. Studies meeting inclusion criteria were assessed for level of evidence. Patient demographics, tumor characteristics, primary intervention, and other clinical characteristics were evaluated.Results: Forty-five relevant studies encompassing 54 patients with sinonasal paraganglioma were identified. The most common tumor locations were the nasal cavity (66.7%), ethmoid sinuses (22.2%), maxillary sinuses (7.4%), and sphenoid sinuses (3.7%). Common presenting symptoms included recurrent epistaxis (68.5%), nasal obstruction (53.7%), and headache (13.0%). Tumors were malignant in 28.6% of patients. Only 4 cases (7.4%) involved functional tumors. Initial management was always surgical, via either an open (63.0%) or endoscopic (33.3%) approach. Radiotherapy was used as adjunctive treatment in 10 cases (18.5%). Recurrence rate was 21.7% and occurred between 12 to 156 months a er initial resection. The overall survival was 87.0% with a metastatic rate of 8.7%. Conclusion:Sinonasal paragangliomas are vascular neoplasms manifesting clinically with recurrent epistaxis and nasal obstruction. Management goals are total resection with clear margins and long-term follow-up due to tendency for local recurrence. Radiotherapy has been utilized as adjuvant therapy with variable results. Further randomized controlled studies may be invaluable in elucidating these findings. C 2018 ARS-AAOA, LLC.

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“…3 Complex interventions such as the management of traumatic, spontaneous, and iatrogenic cerebrospinal fluid (CSF) leaks are routinely performed via the transnasal endoscopic approach, while indications for safety and efficiency are reported comprehensively. [4][5][6] In the present day, head and neck surgeons, as well as neurosurgeons, are exceeding the anatomic boundaries of the skull base and treating neoplasms of the anterior skull base, 7 clival region, 8 odontoid, 9 and perhaps most commonly, the pituitary gland, 10 either using solely endoscopic methods or in combination with an open approach. For all these applications, difficulties of instrumentation and visualization increase with the skill level of the specific intervention, which is mainly attributable to limited space and applicability of instruments.…”

Section: Introductionmentioning

confidence: 99%

An Innovate Robotic Endoscope Guidance System for Transnasal Sinus and Skull Base Surgery: Proof of Concept

Friedrich¹,

Sommer²,

Scheithauer³

et al. 2017

J Neurol Surg B

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Advanced transnasal sinus and skull base surgery remains a challenging discipline for head and neck surgeons. Restricted access and space for instrumentation can impede advanced interventions. Thus, we present the combination of an innovative robotic endoscope guidance system and a specific endoscope with adjustable viewing angle to facilitate transnasal surgery in a human cadaver model. The applicability of the robotic endoscope guidance system with custom foot pedal controller was tested for advanced transnasal surgery on a fresh frozen human cadaver head. Visualization was enabled using a commercially available endoscope with adjustable viewing angle (15-90 degrees). Visualization and instrumentation of all paranasal sinuses, including the anterior and middle skull base, were feasible with the presented setup. Controlling the robotic endoscope guidance system was effectively precise, and the adjustable endoscope lens extended the view in the surgical field without the common change of fixed viewing angle endoscopes. The combination of a robotic endoscope guidance system and an advanced endoscope with adjustable viewing angle enables bimanual surgery in transnasal interventions of the paranasal sinuses and the anterior skull base in a human cadaver model. The adjustable lens allows for the abandonment of fixed-angle endoscopes, saving time and resources, without reducing the quality of imaging.

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Endoscopic Resection of Clival Malignancies

Cited by 19 publications

References 48 publications

ICAR: endoscopic skull‐base surgery

ICAR: endoscopic skull‐base surgery

Characteristics and management of sinonasal paragangliomas: a systematic review

An Innovate Robotic Endoscope Guidance System for Transnasal Sinus and Skull Base Surgery: Proof of Concept

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