What Are the Limits of Endoscopic Sinus Surgery?: The Expanded Endonasal Approach to the Skull Base

Snyderman, Carl H.; Pant, Harshita; Carrau, Ricardo L.; Prevedello, Daniel M.; Gardner, Paul A.; Kassam, Amin

doi:10.2302/kjm.58.152

Cited by 204 publications

(203 citation statements)

References 26 publications

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“…We completely agree with Prof. Ciric's philosophy when he stated in a published paper (33) : "a virtuoso is one who knows the relevant anatomy perfectly, correctly applies microsurgical technique, masters endoscopic skills, nds the optimal solution to speci c surgical problems, and applies wise judgment, with consummate respect for his or her patients. " (34) . Regarding our learning curve, a retrospective analysis of our practice during the transition period between the use of the microscopic and the pure endoscopic technique for sellar and parasellar lesions convinced our group to convert to a fully endoscopic procedure, since we found that the endoscope improved our ability to di erentiate normal pituitary gland from tumour.…”

Section: Resultsmentioning

confidence: 99%

Endoscopic endonasal surgery for skull base tumours: technique and preliminary results in a consecutive case series report

Esenat¹,

Notaris²,

Sanchez³

et al. 2013

Rhin

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Section: Resultsmentioning

confidence: 99%

Endoscopic endonasal surgery for skull base tumours: technique and preliminary results in a consecutive case series report

Esenat¹,

Notaris²,

Sanchez³

et al. 2013

Rhin

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“…The surgical technique of EES for anterior skull base tumors has already been described in detail. 7,12,13,17,18,24,26,37 As a result of this direct approach to the tumor from below, EES provides wide visualization of the whole skull base, complete resection of all abnormal bone and mucosa underlying the tumor, early devascularization of the meningioma, and direct visualization of the neurovascular structures of the suprasellar and infrachiasmatic region from below, allowing for a safe tumor resection with minimal neurovascular manipulations (Figs. 5 and 6).…”

Section: Anterior (Subfrontal and Supraorbital) Approachmentioning

confidence: 99%

“…7,8,12,13,[16][17][18]24,26,37 Endoscopic endonasal surgery provides panoramic visualization and wide access to the anterior skull base from below, allowing for total resection of the involved/diseased bone and mucosa and early devascularization of the tumor with no frontal lobe manipulation. Large tumors with encasement of the surrounding arteries remain challenging to treat regardless of the approach, but EES presents its own advantages and limitations.…”

mentioning

confidence: 99%

Endoscopic endonasal surgery for olfactory groove meningiomas: outcomes and limitations in 50 patients

Koutourousiou

Fernández-Miranda

Wang

et al. 2014

FOC

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107

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Object Recently, endoscopic endonasal surgery (EES) has been introduced in the management of skull base tumors, with constantly improving outcomes and increasing indications. The authors retrospectively reviewed the effectiveness of EES in the management of olfactory groove meningiomas. Methods Between February 2003 and December 2012, 50 patients (64% female) with olfactory groove meningiomas underwent EES at the University of Pittsburgh Medical Center. The authors present the results of EES and analyze the resection rates, clinical outcome, complications, and limitations of this approach. Results Forty-four patients presented with primary tumors, whereas six were previously treated elsewhere. The patients’ mean age was 57.1 years (range 27–88 years). Clinical presentation included altered mental status (36%), visual loss (30%), headache (24%), and seizures (20%). The mean maximum tumor diameter was 41.6 mm (range 18–80 mm). All patients underwent EES, which was performed in stages in 18 giant tumors. Complete tumor resection (Simpson Grade I) was achieved in 66.7% of the 45 patients in whom it was the goal, and 13 (28.9%) had near-total resection (> 95% of the tumor). Tumor size, calcification, and absence of cortical cuff from vasculature were significant factors that influenced the degree of resection (p = 0.002, p = 0.024, and p = 0.028, respectively). Tumor residual was usually at the most lateral and anterior tumor margins. Following EES, mental status was improved or normalized in 77.8% of the cases, vision was improved or restored in 86.7 %, and headaches resolved in 83.3 %. There was no postoperative deterioration of presenting symptoms. Complications were increased in tumors > 40 mm and included CSF leakage (30%), which was significantly associated with lobular tumor configuration (p = 0.048); pulmonary embolism/deep vein thrombosis, more commonly in elderly patients (20%); sinus infections (10%); and delayed abscess months or years after EES (6%). One patient had an intraoperative vascular injury resulting in transient hemiparesis (2%). There were no perioperative deaths. During a mean follow-up period of 32 months (median 22 months, range 1–115 months), 1 patient underwent repeat EES for tumor regrowth. Conclusions Endoscopic endonasal surgery has shown good clinical outcomes regardless of patient age, previous treatment, or tumor characteristics. Tumor size > 40 mm, calcification, and absence of cortical vascular cuff limit GTR with EES; in addition, large tumors are associated with increased postoperative complications. Significant lateral and anterior dural involvement may represent indications for using traditional craniotomies for the management of these tumors. Postoperative CSF leakage remains a problem that necessitates innovations in EES reconstruction techniques.

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“…На основании полу-ченных результатов были сформулированы основ-ные черты трансназальной хирургии при злокаче-ственных опухолях. У пациентов детского возраста из-за анатомических особенностей и измененного строения в результате опухолевой деформации в большинстве случаев эндоскопические трансна-зальные операции носят характер биопсии и необ-ходимы для постановки диагноза [17]. В последнее десятилетие ХХ века в медицинской литературе стали появляться обзорные статьи, включающие сведения о результатах эндоназальных эндоско-пических операций при злокачественных опухо-лях [18].…”

Section: Discussionunclassified

Clinical Significance of Transnasal Endoscopic Surgery in the Treatment of Children With Localized Parameningeal Sarcomas

et al. 2017

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ОБОСНОВАНИЕСаркомы костей и мягких тканей чаще встречают-ся у пациентов моложе 21 года. Рабдомиосаркома (РМС) -основной гистологический тип сарком дет-ского возраста, который составляет до 6% всех опу-холей у пациентов младше 15 лет. РМС чаще (36%) локализуется в органах головы и шеи. По лока-лизации саркомы головы и шеи разделяют на два анатомических региона -пара-и непараменин-геальный, различающиеся прогнозом заболева-ния. К параменингеальной локализации относятся опухоли, расположенные в полости носа, носоглот-ке, околоносовых пазухах, среднем ухе, височной кости, а также в подвисочной и крылонебной ямках [1]. Другие морфологические варианты сарком мягких тканей параменингеальной локализации и саркомы костей основания черепа составляют не более 1% среди всех злокачественных опухолей детского возраста. Лечебные подходы основаны на проведении полихимиотерапии (ПХТ) в предоперационном периоде и лучевой терапии при чувствительности опухоли к лучевому воздействию.Результаты международных исследовательских групп IRS 1 и COG 2 убедительно доказали влияние на исход лечения детей с РМС таких независимых факторов, как локализация первичной опухоли, размер, инвазия в соседние органы и ткани, а так-же метастатическое поражение региональных лим-фатических узлов и наличие отдаленных метастазов

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What Are the Limits of Endoscopic Sinus Surgery?: The Expanded Endonasal Approach to the Skull Base

Cited by 204 publications

References 26 publications

Endoscopic endonasal surgery for skull base tumours: technique and preliminary results in a consecutive case series report

Endoscopic endonasal surgery for skull base tumours: technique and preliminary results in a consecutive case series report

Endoscopic endonasal surgery for olfactory groove meningiomas: outcomes and limitations in 50 patients

Clinical Significance of Transnasal Endoscopic Surgery in the Treatment of Children With Localized Parameningeal Sarcomas

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