Mucosal-sparing posterior septectomy for endoscopic endonasal approach to the craniocervical junction

Eloy, Jean Anderson; Vázquez, Alejandro; Mady, Leila J.; Patel, Chirag; Goldstein, Ira M.; Liu, James K.

doi:10.1016/j.amjoto.2014.12.005

Cited by 7 publications

(5 citation statements)

References 19 publications

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“…3,5,6,8) Posterior septostomy is effective for EEA to the cranio-cervical junction. 4,9) To the best of our knowledge, there are only two reports about inferior turbinectomy to widen the surgical corridor for EEA. 12,13) Both reports described EEA to the ventral craniocervical junction without detailed description of the surgical procedure.…”

Section: Discussionmentioning

confidence: 99%

“…To widen this surgical corridor, several methods have been so far introduced, such as superior and middle turbinectomy, posterior ethmoidectomy and posterior septectomy, all of which create changes in the nasal physiological environment. [1][2][3][4][5][6][7][8][9] In this study, we iMRI did not cover the entire nasal cavity were excluded. Finally, six cases with and 19 cases without SIT were included in the subsequent retrospective analysis of medical records and radiological data.…”

Section: Introductionmentioning

confidence: 99%

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Submucosal Inferior Turbinectomy to Widen the Surgical Corridor for Endoscopic Endonasal Skull Base Surgery

Uozumi

Taniguchi

Umehara

et al. 2020

Neurol. Med. Chir.(Tokyo)

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The nasal cavity is the exclusive surgical corridor for endoscopic endonasal surgery; however, it is sometimes too narrow to allow extensive surgical maneuvering. Here we show the technique of submucosal inferior turbinectomy (SIT) to widen this surgical corridor. Its effectiveness is evaluated quantitatively by comparing pre-and intraoperative magnetic resonance images. Between March 2015 and October 2018, we performed endoscopic endonasal resection of 57 skull base tumors with 3T intraoperative magnetic resonance imaging (iMRI). Among these resections, cases with previous endonasal surgery and cases for which the iMRI did not cover the entire nasal cavity were excluded. Finally, six cases with and 19 cases without SIT were included in the subsequent retrospective analysis. We measured the dimensions of the narrowest area in inferior nasal cavity on pre-and intraoperative coronal plane gadolinium (Gd)enhanced T1-weighted MR images using dedicated software, and compared them. The incidence rates of postoperative nasal complaints at outpatient clinics were also compared. Considerable widening of the inferior nasal cavity could be achieved with the SIT, which was statistically significant compared with those without the SIT (111.1 ± 56.5% vs. 39.4 ± 59.4%, respectively; P = 0.0093). In terms of the incidence rate of postoperative nasal complaints at 6 months, there was no statistical difference between the groups (33.3% vs. 15.8%, respectively; P = 0.35). SIT is effective for widening the surgical corridor while keeping nasal function and is especially helpful for lower clivus and laterally extended skull base lesions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Submucosal Inferior Turbinectomy to Widen the Surgical Corridor for Endoscopic Endonasal Skull Base Surgery

Uozumi

Taniguchi

Umehara

et al. 2020

Neurol. Med. Chir.(Tokyo)

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“…Additional techniques to support the approach have been proposed. Some authors use the navigation [ 18 , 24 , 28 , 29 , 42 , 68 ]; others offered a technique to preserve the mucosal integrity of the posterior nasal septum and pedicled nasoseptal flap [ 69 ]; the combination with the trans oral approach was also described [ 17 , 70 ]. The main challenge of the EEA to CCJ is the presence of anatomical structures that can limit the surgical approach, including the bony and soft tissues of the nose superiorly and the hard palate inferiorly.…”

Section: Current Status Of Knowledgementioning

confidence: 99%

The endoscopic endonasal approach to cranio-cervical junction: the complete panel

Aldahak¹,

Richter²,

Synèse³

et al. 2017

Pan Afr Med J

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We aim to establish a complete summary on the Endoscopic Endonasal Approach (EEA) to Cranio Cervical Junction (CCJ): evolution since first description, criteria to predict the feasibility and limitations, anatomical landmarks, indications and biomechanical evaluation after performing the approach. A comprehensive literature search to identify all available literature published between March 2002 and June 2015, the articles were divided into four categories according to their main purpose: 1- surgical technique, 2- anatomical landmarks and limitations, 3- literature reviews to identify main indications, 4- biomechanical studies. Thereafter, we demonstrate the approach step-by-step, using 1 fresh and 3 silicon injected embalmed cadaveric specimen heads. 61 articles and one poster were identified. The approach was first described on cadaveric study in 2002, and firstly used to perform odontoidectomy in 2005. The main indication is odontoid rheumatoid pannus and basilar invagination. The nasopalatine line (NPL), the superior nostril-hard palate Line (SN-HP), the naso-axial line (NAxL), the rhinopalatine Line (RPL) and other methods were described to predict the anatomical feasibility of the approach. The craniocervical fusion is potentially unnecessary after removal of < 75% of one occipital condyle. A recent cadaveric study stated the possibility of C1-C2 fusion via EEA. This paper reviews all available clinical and anatomical studies on the EEA to CCJ. The approach marked a significant evolution since its first description in 2002. Because of its lesser complications compared to the transoral approach, the EEA became when feasible, the approach of choice to the ventral CCJ.

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“…Advances in surgical techniques have rendered the craniocervical junction (CCJ) accessible endonasally . Endoscopic endonasal transclival and transodontoid approaches are now routinely performed in leading skull base centers and have become an alternative to the transoral approach that historically has been the gold standard.…”

Section: Introductionmentioning

confidence: 99%

“…With the possibility of an intraoperative cerebrospinal fluid (CSF) leak and the reported success of the PNSF for repair of these defects, preserving the integrity and maximizing the surface area of the PNSF is beneficial during the endoscopic endonasal approach to the CCJ. Previously, we described a mucosal‐sparing technique for the endoscopic endonasal approach to the CCJ that preserves the mucosal integrity of the posterior nasal septum and PNSF . In this report, we use endoscopic endonasal cadaveric dissections with photo and video documentation to describe and provide proof of concept of three additional variations or refinements that achieve the same goal.…”

Section: Introductionmentioning

confidence: 99%

Variations of mucosal-sparing septectomy for endonasal approach to the craniocervical junction

et al. 2016

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Mucosal-sparing posterior septectomy for endoscopic endonasal approach to the craniocervical junction

Cited by 7 publications

References 19 publications

Submucosal Inferior Turbinectomy to Widen the Surgical Corridor for Endoscopic Endonasal Skull Base Surgery

Submucosal Inferior Turbinectomy to Widen the Surgical Corridor for Endoscopic Endonasal Skull Base Surgery

The endoscopic endonasal approach to cranio-cervical junction: the complete panel

Variations of mucosal-sparing septectomy for endonasal approach to the craniocervical junction

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