Expanded transnasal approaches to the skull base in the Middle East: Where do we stand?

Alsaleh, Saad; Albakr, Abdulrahman; Alromaih, Saud; Alatar, Abdullah; Alroqi, Ahmad; Ajlan, Abdulrazag

doi:10.5144/0256-4947.2020.94

Cited by 8 publications

(9 citation statements)

References 38 publications

(42 reference statements)

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“…In cases of extensive intra, extra-intra cranial tumors growth or those cases with tumors expansion on the outer cranial surface, we used extended EET approaches but even in these cases, we rely on some criteria. These criteria include vascularity, the relationship of the crucial nerves and vessels, tumor invasiveness, and surgical approach accessibility [2,6,9,10]. The subtotal resection was achieved in 11 (28.2 %) cases (in 4 out of them in pituitary adenomas, in 3 out of them in petroclival tumors, in the rest 4 cases different tumors located to the sphenoid sinus and pterygopalatine fossa).…”

Section: Discussionmentioning

confidence: 99%

“…Tumors of the infratemporal fossa, pterygopalatine fossa are difficult to approach with standard EET rout [10,11,16]. To achieve lateral exposure, EET extended transpterygoid approach was used [16].…”

Section: Discussionmentioning

confidence: 99%

“…With EET transpterygoid approach, we achieved gross total resection in 12 (30.7 %) cases. When amenable to radical excision as a cancer is involving the maxillary sinus, typically treatment starts with surgery followed by adjuvant radiotherapy with chemotherapy [2,10,11,15,16]. All our patients received radio-and chemotherapy according to the standard protocols.…”

Section: Discussionmentioning

confidence: 99%

“…Pioneers in endoscopic pituitary surgery, Jho and Carrau, reported their technique and results using endoscopic approach for tumor resection in 1997 and 1998, respectively [4]. Nowadays endoscopic endonasal transsphenoidal approach allows achieving direct approach to the sella region and widely expose parasellar region [6][7][8], Meckel's cave [8], pterygopalatine and infratemporal fossae [9][10][11]. Complete tumor resection is challenging to achieve by standard endoscopic endonasal technique [2,7,10,11].…”

Section: Introductionmentioning

confidence: 99%

“…Nowadays endoscopic endonasal transsphenoidal approach allows achieving direct approach to the sella region and widely expose parasellar region [6][7][8], Meckel's cave [8], pterygopalatine and infratemporal fossae [9][10][11]. Complete tumor resection is challenging to achieve by standard endoscopic endonasal technique [2,7,10,11]. Extended endoscopic endonasal transsphenoidal (EET) approach might simplify procedure and is discussed here as a method to treat intra-, extracranial skull base tumors.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic endonasal approaches to the skull base tumors: minimally-invasive approach with achievement of radicality. Our experience

Palamar¹,

Huk²,

Aksyonov³

et al. 2020

Ukr Neurosurg J

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Objective: to optimize surgical tactic of endoscopic endonasal transsphenoidal (EET) approaches in cases of tumors with intra-and extracranial extension.Material and methods. For the period of 2013-2019, we retrospectively reviewed 39 patients with tumors of intra-extra skull base location or just extracranial extension. Tumor location and pathology: tumors in pterygopalatine fossa (paraganglioma, carcinoma, neurilemmoma, neurofibroma, chondrosarcoma) -10 (25.6 %), pituitary adenomas with sphenoid sinus and/or parasellar extension -14 (35.9 %), sphenoid sinus tumors (carcinoma, neurilemmoma, fibrous dysplasia, angiofibroma, esthesioneuroblastoma) -8 (20.5 %), petroclival tumors -6 (15.4 %): hemangiopericytoma -1, clival tumors -5 (chordoma), sella turcica lesion with posterior clinoid recess extension (osteoma) -1 (2.5 %). The extended EET approaches used were as follows: EET + transpterygoid approach -22 (56.4 %) (in 4 (18.1 %) cases transmaxillary approach was additionally used), extended EET + transclival approach -4 (10.2 %), EET + transcavernous approach -2 (5.1 %), EET + transethmoidal approach -11 (28.2 %). In all cases, we used Karl Storz rigid 4mm 18cm with 0 and 30-degree angled optics. The extent of resection was determined based on routine postoperative CT scans performed within 24 hours after surgery. The volume of resection was evaluated using gadolinium. Gross total resection was defined as the resection of 100 % of the target lesion, subtotal resection as less than 100 % volumetric reduction of the lesion on postoperative CT scans. Further follow-up was done in three, six months and 1 year after surgery, then annually by MRI scanning with gadolinium.Results. Gross total resection was achieved in 7 (77.8 %) cases of tumor in pterygopalatine fossa. In cases of pituitary adenomas with Knosp 3, Knosp 4 cavernous sinus extension, gross total resection was achieved in 7 (53.8 %) individuals. Sphenoid sinus tumors were totally removed in 5 (62.5 %) cases. Subtotal resection was achieved in 11 (28.2 %) cases. Partial resection was achieved in 8 (20.5 %) cases. Postoperative complications were observed in 5 (12.1 %) cases. ConclusionsTransethmoidal extended endoscopic endonasal approach is sufficient and good to access the anterior wall of the cavernous sinus improving visualization and better removing of cavernous sinus pathology extension. Transpterygoid extended endoscopic endonasal approach provides sufficient visualization of pterygopalatine fossa, petroclival region. Transmaxillary extension allows reaching the subtemporal region.

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Section: Discussionmentioning

confidence: 99%