Extended Transsphenoidal Endoscopic Endonasal Surgery of Suprasellar Craniopharyngiomas

Fomichev, Dmitry; Kalinin, Pavel; Kutin, Maxim; Sharipov, Oleg

doi:10.1016/j.wneu.2016.06.124

Cited by 43 publications

(32 citation statements)

References 13 publications

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“…In the study by Fomichev et al, 25 the mortality rate was 5.8% (six patients). It occurred in one patient due to bacterial meningitis, in two patients due to myocardial infarction and pneumonia, and in the three other patients due to hemorrhagic complications associated with intraoperative injury of large arterial vessels or delayed bleeding in the postoperative period.…”

Section: Discussionmentioning

confidence: 88%

Surgical Outcomes of Endoscopic Endonasal Surgery in 29 Patients with Craniopharyngioma

Iranmehr

Esmaeilnia

Afshari

et al. 2020

J Neurol Surg B Skull Base

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Background Recently the endoscopic endonasal surgery (EES) has been introduced as a modality for the treatment of patients with craniopharyngiomas. In this study, we describe our initial experience in treatment of 29 patients with craniopharyngiomas using this approach. Methods Twenty-nine consecutive patients with craniopharyngiomas who had undergone EES in a 5-year period were studied retrospectively. Patients underwent preoperative and postoperative endocrinologic and ophthalmologic evaluations. Radiologic characteristics of tumors and extent of resection were determined. The recurrence and complications were evaluated. Results Pituitary and visual dysfunction were observed preoperatively in 89.7 and 86% of patients, respectively. After EES, visual outcome either showed an improvement or else remained unchanged in 92.3% of the cases; however, pituitary function remained unchanged and even got worsened in 34.6% of the cases. Prevalence of diabetes insipidus before and after surgery was 58.6 and 69.2%. The rate of gross total resection was 62%. Moreover, 86.2% of the tumors were almost totally resected (more than 95% of the tumor size resected). After surgery, cerebrospinal fluid (CSF) leak and meningitis occurred in four (13.8%) and two (6.9%) patients, respectively. Perioperative mortality was seen in two of the cases (6.9%). The mean follow-up was 25 months and tumor recurrence was discovered in four patients (15.3%). Conclusion The EES with the goal of maximal and safe tumor resection could be used for the treatment of most craniopharyngiomas. Although the rates of visual improvement and gross tumor resection are high, CSF leak, pituitary dysfunction, and meningitis are serious concerns.

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Section: Discussionmentioning

confidence: 88%

Surgical Outcomes of Endoscopic Endonasal Surgery in 29 Patients with Craniopharyngioma

Iranmehr

Esmaeilnia

Afshari

et al. 2020

J Neurol Surg B Skull Base

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“…identified 49 patients who had undergone endoscopic resection of tuberculum meningiomas, showing a 21% rate of postoperative CSF leaks. Evaluating suprasellar craniopharyngiomas, Fomichev et al . showed an 8.8% reconstructive failure rate in 136 patients.…”

Section: Complicationsmentioning

confidence: 99%

“…Not surprisingly, surgeon experience has been suggested as a significant factor contributing to the success of an endoscopic reconstruction. Most retrospective studies have demonstrated that CSF leaks are more common in the early endoscopic experience compared to later in the surgeon's career . Shikary et al .…”

Section: Complicationsmentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

151

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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“…Transnasal endoscopic approaches in children have mostly been reported as part of larger adult-inclusive series 5,10,12,23 or as case reports, 16,18,32,33,36 but they have increasingly been described in the resection of pediatric skull base lesions. 2,4,6,9,17,30,34,40,41 Our pediatric series presents a tertiary care center's experience of implementing this surgical approach for a diverse group of sellar and suprasellar pathologies (a total of 9 different indications).…”

Section: Discussionmentioning

confidence: 99%

Transnasal endoscopic approach for pediatric skull base lesions: a case series

Quon¹,

Kim²,

Hwang

et al. 2019

Journal of Neurosurgery: Pediatrics

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OBJECTIVETransnasal endoscopic transsphenoidal approaches constitute an essential technique for the resection of skull base tumors in adults. However, in the pediatric population, sellar and suprasellar lesions have historically been treated by craniotomy. Transnasal endoscopic approaches are less invasive and thus may be preferable to craniotomy, especially in children. In this case series, the authors present their institutional experience with transnasal endoscopic transsphenoidal approaches for pediatric skull base tumors.METHODSThe authors retrospectively reviewed pediatric patients (age ≤ 18 years) who had undergone transnasal endoscopic transsphenoidal approaches for either biopsy or resection of sellar or suprasellar lesions between 2007 and 2016. All operations were performed jointly by a team of pediatric neurosurgeons and skull base otolaryngologists, except for 8 cases performed by one neurosurgeon.RESULTSThe series included 42 patients between 4 and 18 years old (average 12.5 years) who underwent 51 operations. Headache (45%), visual symptoms (69%), and symptoms related to hormonal abnormalities (71%) were the predominant presenting symptoms. Improvement in preoperative symptoms was seen in 92% of cases. Most patients had craniopharyngiomas (n = 16), followed by pituitary adenomas (n = 12), Rathke cleft cysts (n = 4), germinomas (n = 4), chordomas (n = 2), and other lesion subtypes (n = 4). Lesions ranged from 0.3 to 6.2 cm (median 2.5 cm) in their greatest dimension. Gross-total resection was primarily performed (63% of cases), with 5 subsequent recurrences. Nasoseptal flaps were used in 47% of cases, fat grafts in 37%, and lumbar drains in 47%. CSF space was entered intraoperatively in 15 cases, and postoperative CSF was observed only in lesions with suprasellar extension. There were 8 cases of new hormonal deficits and 3 cases of new cranial nerve deficits. Length of hospital stay ranged from 1 to 61 days (median 5 days). Patients were clinically followed up for a median of 46 months (range 1–120 months), accompanied by a median radiological follow-up period of 45 months (range 3.8–120 months). Most patients (76%) were offered adjuvant therapy.CONCLUSIONSIn this single-institution report of the transnasal endoscopic transsphenoidal approach, the authors demonstrated that this technique is generally safe and effective for different types of pediatric skull base lesions. Favorable effects of surgery were sustained during a follow-up period of 4 years. Further refinement in technology will allow for more widespread use in the pediatric population.

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Extended Transsphenoidal Endoscopic Endonasal Surgery of Suprasellar Craniopharyngiomas

Cited by 43 publications

References 13 publications

Surgical Outcomes of Endoscopic Endonasal Surgery in 29 Patients with Craniopharyngioma

Surgical Outcomes of Endoscopic Endonasal Surgery in 29 Patients with Craniopharyngioma

ICAR: endoscopic skull‐base surgery

Transnasal endoscopic approach for pediatric skull base lesions: a case series

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