Fully endoscopic expanded endonasal approach treating skull base lesions in pediatric patients

Kassam, Amin; Thomas, Ajith J.; Snyderman, Carl H.; Carrau, Ricardo L.; Gardner, Paul A.; Mintz, Arlan; Kanaan, Hilal; Horowitz, Michael; Pollack, Ian F.

doi:10.3171/ped.2007.106.2.75

Cited by 142 publications

(176 citation statements)

References 23 publications

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“…The advent of endoscopic-assisted transnasal surgery offers an appealing alternative to intracranial surgery for tumors situated in the parasellar region. 5,16,34 Using the nasal aperture as a primary surgical corridor, the transsphenoidal route or extended cranial-base routes can be used to resect intradural tumors. Currently there is no dedicated study of transnasal endoscopically assisted surgery for parasellar CNS GCT, but the anatomical considerations do not differ greatly from other tumors that have been successfully managed using this approach.…”

Section: Advances In Neurosurgical Managementmentioning

confidence: 99%

Surgical management of primary central nervous system germ cell tumors

Souweidane

Krieger

Weiner

et al. 2010

PED

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The successful treatment of children with a primary CNS germ cell tumor can be greatly influenced by the neurosurgeon involved in the diagnostic and therapeutic care of these children. Variability in surgical philosophies no doubt exists due to the relatively infrequent incidence of these tumors, a lack of consensus regarding diagnostic and therapeutic approaches, and the advent of recent surgical innovations. Many of these issues were discussed at the Second International Symposium on Central Nervous System Germ Cell Tumors through presented abstracts and invited presentations. The neurosurgical aspects of these proceedings are summarized here in an effort to present the agreed-upon and debated issues that may confront the pediatric neurosurgeon.

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Section: Advances In Neurosurgical Managementmentioning

confidence: 99%

Surgical management of primary central nervous system germ cell tumors

Souweidane

Krieger

Weiner

et al. 2010

PED

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“…5,7 Tumor was encountered within the ethmoid sinuses on the left (as suggested by preoperative imaging) and found to be intimately associated with the olfactory filaments. The anterior and posterior ethmoid arteries were identified bilaterally and cauterized at the junction of the orbit and skull base.…”

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confidence: 99%

“…This was accomplished using an expanded endonasal transplanum and transcribriform approach as previously described by our group. 5,7 Because of the unusual nature of the lesion and its uncertain histological characteristics, a 2-stage approach was planned. The first of these stages was designed to achieve exposure, biopsy, and debulking, with the thought that if this lesion proved to be a type for which aggressive resection was not warranted (for example, metastatic neuroblastoma and inflammatory process), we would have spared the patient the potential morbidity of dissecting the mass from the edematous frontal lobe and anterior cerebral blood supply.…”

mentioning

confidence: 99%

Expanded endoscopic endonasal resection of an olfactory schwannoma

Kanaan¹,

Gardner²,

Yeaney

et al. 2008

PED

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Olfactory schwannomas are rare tumors of the anterior skull base that are possibly derived from ectopic Schwann cells, perivascular neural tissue, or sensory nerves of the meninges. The authors report the case of a 14-year-old boy with an olfactory schwannoma that extended inferiorly through the cranial base and superiorly into the frontal lobe. Because of the growth characteristics of the tumor and the significant overlying frontal lobe edema, the lesion was approached via an endonasal endoscopic route, as a strategy to minimize brain retraction. This tumor was characterized radiographically as contrast-enhancing with cystic areas and erosion into bone. The tumor showed immunoreactivity for S100 protein and leukocyte antigen 7 (CD57) but not epithelial membrane antigen, supporting the diagnosis of olfactory schwannoma. A gross-total resection was achieved. This approach represents a novel application of endoscopic endonasal surgery to the pediatric neurosurgical context, as well as a favorable outcome in an extremely unusual tumor type, that should be applicable to other appropriately selected pediatric brain tumors.

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“…Several studies have described the reconstructive options following an expanded EEA to the skull base. 2,[5][6][7][8]20,21 In particular, in collaboration with our colleagues, Hadad et al, 22 we first introduced the vascularized pedicled NSF that has been the workhorse ever since and the primary reason for a substantial decrease in postoperative CSF leak and infection rates. 22 Based on our algorithm and experience, the NSF can be successfully placed over the majority of defects, regardless of the size and amount of CSF leak.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Endonasal Reconstructive Methods to the Anterior Skull Base

Chakravarthi

Gonen

Monroy-Sosa

et al. 2017

Seminars in Plastic Surgery

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Endoscopic approaches and techniques to the anterior skull base, sellar, and parasellar regions have contributed significantly to the field of skull base surgery, facilitating the resection of complex skull base lesions with a minimal surgical footprint. The most clinically significant complication with these approaches has been the incidence of postoperative cerebrospinal fluid (CSF) leak. 1 Once the initial feasibility and efficacy were established, demonstrating improved neurological outcomes, reconstruction, CSF leaks became the primary challenge. The expanded endoscopic endonasal approach (EEA) followed the same progression as open skull base surgery such that reconstruction from grafts to vascularized flaps allowed a concomitant reduction in CSF leak rates, which are now in the range of 1 to 5%. [2][3][4] The EEAs have been organized into the following corridors along the coronal and sagittal planes, which span the entire ventral anterior, middle, and posterior cranial fossa, providing access via a series of modular approaches; specifically, the transfrontal, transcribriform, transplanum-transtuberculum, transsellar, transclival, transodontoid, and respective coronal modules. 5 The reconstruction is primarily dependent on the anatomic region and module undertaken relative to the availability of local and regional vascularized pedicled flaps. Several attempts at categorizing reconstruction options have been described, the most notable is by Patel et al. 6 There exists significant literature on the use of grafts, and as stated, as the EEA approaches evolved, so has the reconstruction from grafts to flaps. To avoid reiteration, in this article, we outline a pragmatic algorithmic approach focused exclusively on vascularized flap reconstruction; explicitly, we share with the readers our specific reconstruction algorithm that we have been using over the past decade to AbstractThe success of expanded endoscopic endonasal approaches (EEAs) to the anterior skull base, sellar, and parasellar regions has been greatly aided by the advancement in reconstructive techniques. In particular, the pedicled vascularized flaps have been developed and effectively cover skull base defects of varying sizes with a significant reduction in postoperative CSF leaks. There are two aims to this review: (1) We will provide our current, simplified reconstruction algorithm. (2) We will describe, in detail, the relevant anatomy, indications/contraindications, and surgical technique, with a particular emphasis on the nasoseptal flap (NSF). The inferior turbinate flap (ITF), middle turbinate flap (MTF), pericranial flap (PCF), and temporoparietal fascial flap (TPFF) will also be described. The NSF should be the primary option for reconstruction of majority of skull base defects following endonasal endoscopic surgery. In general, for the planum, cribriform, and upper two-thirds of the clivus, the NSF is ideal. For the lower-third of the clivus, the NSF may not be adequate and may require additional reconstructive options. Although limited in...

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Fully endoscopic expanded endonasal approach treating skull base lesions in pediatric patients

Cited by 142 publications

References 23 publications

Surgical management of primary central nervous system germ cell tumors

Surgical management of primary central nervous system germ cell tumors

Expanded endoscopic endonasal resection of an olfactory schwannoma

Endoscopic Endonasal Reconstructive Methods to the Anterior Skull Base

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