The Endonasal Endoscopic Approach to Pathologies of the Anterior Craniocervical Junction: Analytical Review of Cases Treated at Four European Neurosurgical Centres

Chibbaro, Salvatore; Ganau, Mario; Cébula, H.; Nannavecchia, Beniamino; Todeschi, Julien; Romano, Antonio; Debry, Christian; Proust, F.; Olivi, Alessandro; Gaillard, Stéphane; Visocchi, Massimiliano

doi:10.1007/978-3-319-62515-7_28

Cited by 14 publications

(10 citation statements)

References 31 publications

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“…Transsphenoidal approaches have been widely implemented and are nowadays considered safe and effective approaches to the intra- and parasellar regions [ 26 , 27 , 28 , 29 ]. Although the transsphenoidal microscope-assisted approach was the first to be developed and widely used in the past [ 20 , 21 ], most recently, the use of EEA-TPP to reach the sellar and parasellar spaces and the development of enhanced endoscopic technology with high-definition cameras, screens, and endoscopes lighting [ 17 , 18 , 30 , 31 ] have improved quality performance metrics of endoscopic surgery [ 32 ]. However, supra- and lateral sellar extension, fibrous texture, and significant vascularization make endoscopic excision difficult, potentially dangerous, and seem to be correlated with incomplete EoR [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Primary Endoscopic Endonasal Management of Giant Pituitary Adenomas: Outcome and Pitfalls from a Large Prospective Multicenter Experience

Chibbaro¹,

Signorelli

Milani

et al. 2021

Cancers

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Purpose: To evaluate factors influencing clinical and radiological outcome of extended endoscopic endonasal transtuberculum/transplanum approach (EEA-TTP) for giant pituitary adenomas (GPAs). Methods: We recruited prospectively all consecutive GPAs patients undergoing EEA-TTP between 2015 and 2019 in 5 neurosurgical centers. Preoperative clinical and radiologic features, visual and hormonal outcomes, extent of resection (EoR), complications and recurrence rates were recorded and analyzed. Results: Of 1169 patients treated for pituitary adenoma, 96 (8.2%) had GPAs. Seventy-eight (81.2%) patients had visual impairment, 12 (12.5%) had headaches, 3 (3.1%) had drowsiness due to hydrocephalus, and 53 (55.2%) had anterior pituitary insufficiency. EoR was gross or near-total in 46 (47.9%) and subtotal in 50 (52.1%) patients. Incomplete resection was associated with lateral suprasellar, intraventricular and/or cavernous sinus extension and with firm/fibrous consistence. At the last follow-up, all but one patient (77, 98.7%) with visual deficits improved. Headache improved in 8 (88.9%) and anterior pituitary function recovered in 27 (50.9%) patients. Recurrence rate was 16.7%, with 32 months mean recurrence-free survival. Conclusions: EEA-TTP is a valid option for GPAs and seems to provide better outcomes, lower rate of complications and higher EoR compared to one- or multi-stage microscopic, non-extended endoscopic transsphenoidal, and transcranial resections.

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Section: Discussionmentioning

confidence: 99%

Primary Endoscopic Endonasal Management of Giant Pituitary Adenomas: Outcome and Pitfalls from a Large Prospective Multicenter Experience

Chibbaro¹,

Signorelli

Milani

et al. 2021

Cancers

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“…This trend was implemented at any given spinal segments (cervical, thoracic, and lumbar), and for a wide range of pathologies, such as: degenerative stenosis, disc herniations, synovial cysts, traumatic or pathological fractures, and even deformities. [1][2][3][4][5][6] The use of the endoscope for lumbar discectomies (percutaneous endoscopic lumbar discectomy, PELD) was fostered by the development of high-resolution endoscopes, optics, and digital cameras which allowed to gain some edges over MISS performed with the aid of microscope or surgical loupes alone. Many different PELD techniques are available nowadays, they include the microendoscopic discectomy, as well as a number of system for endoscopic spine surgery.…”

Section: Introductionmentioning

confidence: 99%

A Pilot Study of Percutaneous Interlaminar Endoscopic Lumbar Sequestrectomy: A Modern Strategy to Tackle Medically-Refractory Radiculopathies and Restore Spinal Function

et al. 2019

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Objective: Angled scopes allow 360° visualization, which makes percutaneous endoscopic techniques (percutaneous endoscopic lumbar discectomy, PELD) particularly attractive for sequestrectomies, which entail the removal of extruded lumbar disc fragments that have migrated caudally or cranially between the ligaments, foramina, and neural structures, while preserving the disc. Although many different PELD techniques are currently available, not all of them are suitable for sequestrectomies; furthermore, long-term follow-up data are unfortunately lacking. Methods: A pilot study was conducted on a cohort of 270 patients with lumbar radiculopathy undergoing minimally invasive spine surgery (PELD or microdiscectomy), of whom only 7 were eligible for endoscopic interlaminar sequestrectomy with disc preservation. The patients' baseline conditions and clinical outcomes were measured with the Oswestry Disability Index and a visual analogue scale. Long-term follow-up was conducted using satisfaction questionnaires that were based on the MacNab criteria and administered by medical/nursing personnel not involved in their primary surgical management. Results: EasyGo system was eventually used in 5 PELD cases. No dural tears, infections, or nerve root injuries were recorded in patients undergoing sequestrectomy. Surgical events, including blood loss and overall length of hospital stay, did not differ significantly among the 270 patients. In the group treated with endoscopic sequestrectomy, no recurrences or complications were noted during a follow-up of 3 years, and an excellent degree of satisfaction was reported. Conclusion: We provide OCEBM (Oxford Centre for Evidence-Based Medicine) level 3 evidence that interlaminar endoscopic sequestrectomy is a tailored and well-tolerated surgical option; nonetheless, a cost-effectiveness analysis assessing the interval until return to working activities and long-term benefits is warranted.

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“…The less-invasive endoscopic endonasal approach allows similar degree of decompression in the craniocervical joint [ 53 , 54 ]. This surgical technique could be an alternative or complementary approach for the decompression of the upper cervical spine [ 54 – 56 ].…”

Section: Discussionmentioning

confidence: 99%

Preoperative management and postoperative complications associated with transoral decompression for the upper cervical spine

Wang

Feng

et al. 2022

BMC Musculoskelet Disord

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Purpose This review aimed to describe the preoperative management and postoperative complications associated with transoral decompression of the upper cervical spine, and to clarify the risk factors, related issues and complication management. Methods Studies on transoral decompression for the upper cervical spine were reviewed systematically. The preoperative management and postoperative complications associated with transoral decompression for upper cervical deformities were analyzed. Results Evidence suggests that preoperative management in patients undergoing transoral decompression for the upper cervical spine is closely related to the occurrence of postoperative complications. Hence, preoperative surgical planning, preoperative preparation, and oral nursing care should be seriously considered in these patients. Moreover, while being established as an effective and safe method, transoral decompression is associated with several postoperative complications, which could be prevented by elaborate preoperative management, improved surgical skills, and appropriate precautionary measures. Conclusions The effectiveness and safety of transoral decompression has been improved by the constant development of operative techniques and advanced auxiliary diagnostic and therapeutic methods, with the understanding of the anatomical structure of the craniocervical joint. Therefore, the incidence rates of postoperative complications have decreased. The application of individualized anterior implants and less-invasive endoscopic endonasal approach has improved the effectiveness of transoral decompression and reduced the associated complications.

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The Endonasal Endoscopic Approach to Pathologies of the Anterior Craniocervical Junction: Analytical Review of Cases Treated at Four European Neurosurgical Centres

Cited by 14 publications

References 31 publications

Primary Endoscopic Endonasal Management of Giant Pituitary Adenomas: Outcome and Pitfalls from a Large Prospective Multicenter Experience

Primary Endoscopic Endonasal Management of Giant Pituitary Adenomas: Outcome and Pitfalls from a Large Prospective Multicenter Experience

A Pilot Study of Percutaneous Interlaminar Endoscopic Lumbar Sequestrectomy: A Modern Strategy to Tackle Medically-Refractory Radiculopathies and Restore Spinal Function

Preoperative management and postoperative complications associated with transoral decompression for the upper cervical spine

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