Extended Endoscopic Endonasal Approach to the Skull Base

Arbolay, Omar López; González, Justo González; Gonzalez, Ralph; Galvez, Yusleni Hernandez

doi:10.1055/s-0028-1119414

Cited by 48 publications

(33 citation statements)

References 23 publications

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“…23 Numerous other groups have since illustrated the surgical anatomy and techniques important for successful endoscope-assisted access to the CS. 3,4,8,17,18,24,25 …”

Section: Discussionmentioning

confidence: 99%

Surgical outcomes using a medial-to-lateral endonasal endoscopic approach to pituitary adenomas invading the cavernous sinus

Woodworth

Patel

Shin

et al. 2014

JNS

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OBJECT To detail the extent of resection and complications with endonasal endoscopic surgery for pituitary tumors invading the cavernous sinus (CS) using a moderately aggressive approach to maximize extent of resection through the medial cavernous sinus wall while minimizing the risk of cranial neuropathy and blood loss. Tumor in the medical cavernous sinus was aggressively pursued while tumor in the lateral cavernous sinus was debulked in preparation for radiosurgery. METHODS A prospective surgical database of consecutive endonasal pituitary surgeries with verified CS invasion on intraoperative visual inspection was reviewed. The extent of resection as a whole and within the CS was assessed by an independent neuroradiologist using pre- and post-operative Knosp-Steiner (KS) categorization and volumetrics of the respective magnetic resonance images. The extent of resection and clinical outcomes were compared for medial (KS1-2) and lateral (KS3-4) lesions. RESULTS Thirty-six consecutive patients with pituitary adenomas involving the CS who had surgery via an endonasal endoscopic approach were identified. The extent of resection was 84.6% for KS 1–2 and 66.6% for KS 3–4 (p=.04). Gross-total resection was 53.8% for KS 1–2 and 8.7% for KS 3–4 (p=.0006). Of six patients (16.8%) with pre-operative cranial neuropathies, all showed subjective improvement after surgery. Surgical complications included 2 transient post-operative cranial neuropathies (5.6%), 1 postoperative CSF leak (2.8%), 1 reoperation for mucocele (2.8%) and 1 infection (2.8%). CONCLUSIONS The endoscopic endonasal “medial-to-lateral” approach permits safe debulking of tumors in the medial and lateral CS. Although GTR rates are moderate, particularly in the lateral CS, the risk of permanent cranial neuropathy is extremely low with a high chance of improvement of pre-existing deficits. This approach can also facilitate targeting for post-operative radiosurgery.

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“…23 Numerous other groups have since illustrated the surgical anatomy and techniques important for successful endoscope-assisted access to the CS. 3,4,8,17,18,24,25 …”

Section: Discussionmentioning

confidence: 99%

Surgical outcomes using a medial-to-lateral endonasal endoscopic approach to pituitary adenomas invading the cavernous sinus

Woodworth

Patel

Shin

et al. 2014

JNS

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“…Until now, no new post‐operative cranial nerve or neurological deficits and no surgical mortality are reported following resection. Although reported results are scarce and regardless of which surgical approach is used, total removal is achieved in only 49.2–79% of reported cases 42 ; often, a second operation was needed to remove residual tumour 43–46 …”

Section: Indications For Eeamentioning

confidence: 99%

Extended endoscopic endonasal skull base surgery: from the sella to the anterior and posterior cranial fossa

Oostra

Furth

Georgalas

2012

ANZ Journal of Surgery

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Skull base surgery has gone through significant changes with the development of extended endoscopic endonasal approaches over the last decade. Initially used for the transphenoidal removal of hypophyseal adenomas, the endoscopic transnasal approach gradually evolved into a way of accessing the whole ventral skull base. Improved visualization, avoidance of brain retraction, the ability to access directly tumours with minimal damage to critical neurosurgical structures as well lack of external scars are among its obvious benefits. However, it presents the surgeons with a number of challenges, including the need to deal endoscopically with potential arterial bleeding, complicated reconstruction requirements as well as the need for a true team approach. In this review drawing from our experience as well as published series, we present an overview of current indications, challenges and limitations of the expanded endonasal approaches to the skull base.

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“…The advent of the endoscope promoted recent advancement of endonasal surgery, 6,23 and endoscopic endonasal surgery is gaining acceptance as a routine technique for skull base surgery. 5,6,9 The endoscope provides superb illumination, high magnification, a panoramic view, and the ability to "look around corners." During the past decade, anatomical studies of the medial cavernous sinus via endoscopy precipitated evolution of the endoscopic endonasal approach, 3,4,7,10,18,24 and several clinical studies have reported excellent surgical results for cavernous sinus tumors by this approach.…”

mentioning

confidence: 99%

Endoscopic supraorbital extradural approach to the cavernous sinus: a cadaver study

Komatsu

Inoue

et al. 2011

JNS

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Extended Endoscopic Endonasal Approach to the Skull Base

Cited by 48 publications

References 23 publications

Surgical outcomes using a medial-to-lateral endonasal endoscopic approach to pituitary adenomas invading the cavernous sinus

Surgical outcomes using a medial-to-lateral endonasal endoscopic approach to pituitary adenomas invading the cavernous sinus

Extended endoscopic endonasal skull base surgery: from the sella to the anterior and posterior cranial fossa

Endoscopic supraorbital extradural approach to the cavernous sinus: a cadaver study

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