Extended endoscopic endonasal approach to the midline skull base: the evolving role of transsphenoidal surgery

Cappabianca, Paolo; Cavallo, Luigi Maria; Esposito, Felice; Divitiis, Oreste de; Messina, A.; Divitiis, Enrico de

doi:10.1007/978-3-211-72283-1_4

Cited by 337 publications

(211 citation statements)

References 138 publications

(116 reference statements)

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“…3,5,11,23,24,29,36,43,[46][47][48][49][50]55 More recently, there has been interest in endonasal extended transsphenoidal approaches (microscopic, microscopic with endoscopic assistance, and purely endoscopic) to remove tuberculum sellae meningiomas. 7,8,12,13,15,16,21,25,31,32,35,37,58,59 The purely endoscopic endonasal extended transsphenoidal route via a transplanum transtuberculum corridor offers direct and immediate exposure to the tumor without having to apply brain retraction and manipulation of neurovascular structures. Because the dural origin is adjacent to the paranasal sinuses, early devascularization of the tumor and subsequent radical resection of the involved hyperostotic bone, dural attachment, and optic canal involvement can be achieved.…”

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confidence: 99%

Surgical nuances for removal of tuberculum sellae meningiomas with optic canal involvement using the endoscopic endonasal extended transsphenoidal transplanum transtuberculum approach

Liu¹,

Christiano²,

Patel³

et al. 2011

FOC

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Tuberculum sellae meningiomas frequently extend into the optic canals. Radical tumor resection including the involved dural attachment, underlying hyperostotic bone, and intracanalicular tumor in the optic canal offers the best chance of a Simpson Grade I resection to minimize recurrence. Decompression of the optic canal with removal of the intracanalicular tumor also improves visual outcome since this portion of the tumor is usually the cause of asymmetrical visual loss. The purely endoscopic endonasal extended transsphenoidal approach offers a direct midline trajectory and immediate access to tuberculum sellae meningiomas without brain retraction and manipulation of neurovascular structures. Although the endoscopic approach has been previously criticized for its inability to remove tumor within the optic canals, complete Simpson Grade I tumor removal including intracanalicular tumor, dural attachment, and involved hyperostotic bone can be achieved in properly selected patients. Excellent visualization of the suprasellar region and the inferomedial aspects of both optic canals allows for extracapsular, extraarachnoid dissection of the tumor from the critical structures using bimanual microsurgical dissection. In this report, the authors describe the operative nuances for removal of tuberculum sellae meningiomas with optic canal involvement using a purely endoscopic endonasal extended transsphenoidal (transplanum transtuberculum) approach. They specifically highlight the technique for endonasal bilateral optic nerve decompression and removal of intracanalicular tumor to improve postoperative visual function, as demonstrated in 2 illustrative cases. Special attention is also given to cranial base reconstruction to prevent CSF leakage using the vascularized pedicled nasoseptal flap.

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mentioning

confidence: 99%

Surgical nuances for removal of tuberculum sellae meningiomas with optic canal involvement using the endoscopic endonasal extended transsphenoidal transplanum transtuberculum approach

Liu¹,

Christiano²,

Patel³

et al. 2011

FOC

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“…Many authors prefer the pterional route, as it provides lateral access between the optic nerves (ipsilateral to the optic nerve), with preservation of the olfactory tracts, and represents a short distance to the tuberculum sellae after removal of the greater wing of the sphenoid [3][4][5] . Recently, several authors have proposed the resection of these lesions using minimally invasive ways or with the aid of a surgical microscope or endoscopically guided vision [12][13][14][15][16] . Although these authors reported successful results, the risk of complications was increased.…”

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confidence: 99%

Tuberculum sellae meningiomas: surgical considerations

Landeiro

Gonçalves

Guimarães

et al. 2010

Arq. Neuro-Psiquiatr.

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We report our experience on the treatment of tuberculum sellae meningiomas (TSMs) regarding the involvement of the optic canal and clinical outcomes. We reviewed 23 patients who were operated on between January 1997 and December 2008. The surgical approach was unilateral subfrontal supraorbital osteotomy in one piece. Attempts were made to improve visual function via extra/intradural unroofing of the optic canal, which released the optic nerve. Visual symptoms were present preoperatively in 21 patients, and two patients were asymptomatic. Visual acuity remained intact in 6 patients, improved in 10, was unchanged in 5 patients, and worsened in 2 patients. The postoperative visual field was normal or improved in 17 patients, unchanged in four patients, and worsened in two patients. The optic canal and clinoid were drilled extradurally in eight patients and intradurally in nine patients. Total resection of TSMs was achieved in 19 patients. Incomplete resection occurred in two patients. Decompression of the optic canal seemed to increase the visual outcome. Key words: tuberculum sellae meningioma, optic canal, visual symptoms. Meningiomas do tuberculo selar: aspectos cirúrgicos resuMoApresentamos nossa experiência em 23 pacientes operados com meningiomas do tubérculo da sela, com enfoque na descompressão do nervo óptico e nos sintomas visuais do pós-operatório. Vinte e três pacientes com meningiomas do tubérculo da sela foram operados entre janeiro de 1997 e dezembro de 2008, através do acesso subfrontal via ostetomia supraorbital. Remoção do teto do canal óptico por via extra ou intradural foi realizada em 17 pacientes. Sintomas visuais no pré-operatório ocorreram em 21 pacientes, 2 eram assintomáticos. Melhora visual ocorreu em 10, permaneceu inalterada em 5 e piorou em 2 pacientes. No pós-operatório o campo visual normalizou-se em 17 pacientes, permaneceu inalterado em 4 e diminuiu em 2. Descompressão dos nervos ópticos foi realizada em 17 pacientes. Ressecção total dos meningiomas do tubérculo da sela foi possível em 19 pacientes. Abertura do canal óptico permitiu a manipulação do nervo óptico sem novos déficites. Palavras-chave: meningioma, tubérculo selar, nervo óptico, sintomas visuais.

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“…В случае же использования метода «подкладки» постановка люмбального дренажа нецелесообразна, так как внутричерепное давление, напротив, прижимает пластический материал к краям дефекта, способ-ствуя его более надежной фиксации [58].…”

Section: роль временного наружного дренирования люмбального ликвораunclassified

Tactics of reconstructive closure of basal defects after resection of midline tumors of the anterior skull base (a literature review)

Gol'bin

Mindlin

2017

Vopr. neirokhir.

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Тактика пластического закрытия базальных дефектов после удаления срединных новообразований передних отделов основания черепа (обзор литературы)К.м.н. Д.А. ГОЛЬБИН 1 , С.Н. МИНДЛИН 2 1 ФГАУ ННПЦН им. акад. Н.Н. Бурденко» Минздрава России; 2 ФГБОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России, Москва, Россия Цель данного обзора -анализ используемых методик реконструкции срединных дефектов передних отделов основания черепа после транскраниального и эндоскопического эндоназального удаления опухолей основания черепа. Представ-лены краткие сведения о технике забора различных лоскутов, показаниях и противопоказаниях, преимуществах и недо-статках. Проанализированы мировой опыт использования васкуляризированных и неваскуляризированных лоскутов, а также существующие алгоритмы пластики сложных дефектов срединных отделов основания черепа. Данные литературы демонстрируют отсутствие общепринятой тактики пластического закрытия обсуждаемых дефектов. Для решения этого вопроса требуется проведение метаанализа в комбинации с оригинальным проспективным исследованием. Наибольший риск формирования сквозных де-фектов возникает при новообразованиях передних отделов основания черепа срединной локализации и пирамиды височной кости. Настоящая работа по-священа обсуждению пластики базальных дефектов после удаления срединных новообразований перед-них отделов основания черепа. Здесь находятся об-ширные зоны непосредственного контакта полости мозгового черепа с воздухоносными пространства-ми головы, причем именно в центральных отделах передней черепной ямки (ПЧЯ) расположены наи-более тонкие костные структуры, образующие обо-нятельную ямку. Кроме того, близость глазниц, за-ключающих орган зрения и его вспомогательный аппарат, хиазмы зрительных нервов и передних от-делов виллизиева круга могут обусловливать осо-бенную сложность этих дефектов, из-за прилежания к их краям этих «критических» сосудисто-нервных структур.Возможность эффективной пластики дефекта основания черепа, наряду с другими факторами (распространенность опухоли, вовлечение сосуди-сто-нервных структур, инфильтрация мозга и др.), определяет возможность радикального удаления опухоли. Анатомическая сложность центральных отделов ПЧЯ делает сложной и многослойной ре-конструкцию основания черепа, когда в зависимо-сти от локализации, размеров и формы дефектов ис-

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Extended endoscopic endonasal approach to the midline skull base: the evolving role of transsphenoidal surgery

Cited by 337 publications

References 138 publications

Surgical nuances for removal of tuberculum sellae meningiomas with optic canal involvement using the endoscopic endonasal extended transsphenoidal transplanum transtuberculum approach

Surgical nuances for removal of tuberculum sellae meningiomas with optic canal involvement using the endoscopic endonasal extended transsphenoidal transplanum transtuberculum approach

Tuberculum sellae meningiomas: surgical considerations

Tactics of reconstructive closure of basal defects after resection of midline tumors of the anterior skull base (a literature review)

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