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Cranial base endoscopic surgery

Lee A Zimmer, Norberto Andaluz
Endoscopic transsphenoidal surgery for pituitary tumors is an increasingly common practice. Little has been reported on the incidence and treatment of postoperative epistaxis in this population. The aim of this study was to analyze the incidence of postoperative epistaxis and formulate a treatment algorithm based on our experience. We performed a case series with chart review. A total of 434 consecutive patients who had endoscopic transsphenoidal pituitary surgery were identified between April 2006 and November 2013...
March 2018: Ear, Nose, & Throat Journal
Francisco Vaz-Guimaraes, Maria Koutourousiou, John R de Almeida, Elizabeth C Tyler-Kabara, Juan C Fernandez-Miranda, Eric W Wang, Carl H Snyderman, Paul A Gardner
OBJECTIVE Epidermoid and dermoid cysts may be found along the cranial base and are commonly resected via open transcranial approaches. The use of endoscopic endonasal approaches for resection of these tumors has been rarely reported. METHODS The authors retrospectively reviewed the medical records of 21 patients who underwent endoscopic endonasal surgery for epidermoid and dermoid cyst resection at the University of Pittsburgh Medical Center between January 2005 and June 2014. Surgical outcomes and variables that might affect the extent of resection and complications were analyzed...
March 16, 2018: Journal of Neurosurgery
Daniel L Faden, Marion A Hughes, Philippe Lavigne, Brian T Jankowitz, Eric W Wang, Juan C Fernandez-Miranda, Paul A Gardner, Carl H Snyderman
BACKGROUND: Nontraumatic pseudoaneurysms of the cranial base are rare and present unique diagnostic and treatment dilemmas compared with both true aneurysms and pseudoaneurysms outside of the cranial base. There is a dearth of knowledge regarding the management of these complicated lesions. METHODS: Nontraumatic pseudoaneurysms of the cranial base internal carotid artery (ICA) were retrospectively identified at the University of Pittsburgh Medical Center through a key word search of cranial base cases from 2010 to 2017...
February 27, 2018: International Forum of Allergy & Rhinology
Tara L Braun, Bradley S Eisemann, Olushola Olorunnipa, Edward P Buchanan, Laura A Monson
BACKGROUND: Premature fusion of the metopic suture leads to a range of clinical presentations, with more severe patients presenting characteristically with trigonocephaly. Endoscopic-assisted correction of craniosynostosis is emerging as an alternative to the gold-standard open cranial vault remodeling. While there are several documented benefits of endoscopic correction, the management of craniosynostosis varies widely in the literature with little consensus as to the preferred timing and surgical technique for repair...
February 14, 2018: Journal of Craniofacial Surgery
Daniele Marchioni, Marco Carner, Davide Soloperto, Luca Bianconi, Andrea Sacchetto, Luca Sacchetto, Barbara Masotto, Livio Presutti
Objective Vestibular schwannoma (VS) is a benign tumor of the lateral skull base. Different microscopic surgical techniques are described in literature: the retrosigmoid and translabyrinthine approaches are used to treat big tumors located in the cerebellopontine angle, and the middle cranial fossa approach is utilized for small tumors with good hearing preservation. The expanded transcanal transpromontorial (ExpTT) approach is a combined microscopic-endoscopic technique previously indicated for Koos stage I and II VS and now proposed for larger VS, up to 3 cm in diameter, with linear progression into the cerebellopontine angle and touching the brainstem...
February 1, 2018: Otolaryngology—Head and Neck Surgery
Masahiro Shin, Masaaki Shojima, Kenji Kondo, Hirotaka Hasegawa, Shunya Hanakita, Akihiro Ito, Taichi Kin, Nobuhito Saito
OBJECTIVE: Skull base meningiomas carry a nonnegligible risk of recurrence. In particular, those arising from the sphenoid wings or middle cranial fossa penetrate into extracranial regions, uncommonly showing massive expansion into the craniofacial regions on recurrence. The role of endoscopic endonasal surgery for those intractable lesions remains unclear. METHODS: We performed endoscopic endonasal craniofacial surgery for 8 recurrent meningiomas invading into the pterygopalatine fossa, infratemporal fossa, nasopharynx, paranasal sinus, or orbit, comprising 2 meningothelial and 1 fibrous meningiomas (World Health Organization [WHO] grade I), 3 atypical and 1 clear cell meningiomas (grade II), and 1 anaplastic meningioma (grade III)...
January 12, 2018: World Neurosurgery
Dimitrios Paraskevopoulos, Shlomi Constantini, Jarnail Bal, Jonathan Roth
BACKGROUND: Following a prior systematic review of currently available endoscope holders (EH), we aspired to detect trends, task-specific preferences and pitfalls of EH in various cranial neuroendoscopic procedures. METHODS: A questionnaire was disseminated to members of the International Federation of Neuroendoscopy (IFNE). The questionnaire evaluated indications and pitfalls of EH in different applications, in particular, differentiating between intraventricular and skull base endoscopy, as well as sub-categories of these two main fields...
January 2, 2018: World Neurosurgery
David L Penn, William T Burke, Edward R Laws
Non-functional pituitary adenomas (NFPAs) are benign tumors of the pituitary gland that do not over-secrete hormonal products, therefore, they are generally detected through symptoms of mass effect, including headache, vision loss, or hypopituitarism. There are multiple pathological subtypes of NFPAs, such as null cell adenomas, silent gonadotrophs, silent somatotrophs, silent corticotrophs, and silent subtype 3, all of which can be classified based on immunohistochemical studies and electron microscopy. Despite these numerous pathological subtypes, surgical resection remains the first-line treatment for NFPAs...
December 26, 2017: Pituitary
Alberto Di Somma, Norberto Andaluz, Luigi Maria Cavallo, Matteo de Notaris, Iacopo Dallan, Domenico Solari, Lee A Zimmer, Jeffrey T Keller, Mario Zuccarello, Alberto Prats-Galino, Paolo Cappabianca
OBJECTIVE Recent studies have proposed the superior eyelid endoscopic transorbital approach as a new minimally invasive route to access orbital lesions, mostly in otolaryngology and maxillofacial surgeries. The authors undertook this anatomical study in order to contribute a neurosurgical perspective, exploring the anterior and middle cranial fossa areas through this purely endoscopic transorbital trajectory. METHODS Anatomical dissections were performed in 10 human cadaveric heads (20 sides) using 0° and 30° endoscopes...
December 15, 2017: Journal of Neurosurgery
Qiu-Hang Zhang, Zhen-Lin Wang, Hong-Chuan Guo, Feng Kong, Bo Yan, Ming-Chu Li, Ge Chen, Jian-Tao Liang, Yu-Hai Bao, Feng Ling
BACKGROUND: Some problems have been found in the usually adopted combined approach for the removal of intra-extracranial tumors in skull base. Herein, we described a pure endoscopic transnasal or transoral approach (ETA) for the removal of intra-extracranial tumors in various skull base regions. METHODS: Retrospectively, clinical data, major surgical complications, pre- and postoperative images, and follow-up information of a series of 85 patients with intra-extracranial tumors in various skull base regions who were treated by surgery via ETA in our skull base center during the past 10 years were reviewed and analyzed...
December 20, 2017: Chinese Medical Journal
Evgenii Belykh, Kaan Yagmurlu, Nikolay L Martirosyan, Ting Lei, Mohammadhassan Izadyyazdanabadi, Kashif M Malik, Vadim A Byvaltsev, Peter Nakaji, Mark C Preul
Background: Technological innovations based on light amplification created by stimulated emission of radiation (LASER) have been used extensively in the field of neurosurgery. Methods: We reviewed the medical literature to identify current laser-based technological applications for surgical, diagnostic, and therapeutic uses in neurosurgery. Results: Surgical applications of laser technology reported in the literature include percutaneous laser ablation of brain tissue, the use of surgical lasers in open and endoscopic cranial surgeries, laser-assisted microanastomosis, and photodynamic therapy for brain tumors...
2017: Surgical Neurology International
Natalie Oker, Benjamin Verillaud, Michel Wassef, Sébastien Froelich, Damien Bresson, Romain Kania, Philippe Herman
BACKGROUND: The purpose of this study was to investigate the outcome and recurrences for ethmoidal adenocarcinomas treated by exclusive endoscopic surgery in curative intent and investigate the role of the learning curve. METHODS: We conducted a single-center retrospective study, including 60 patients separated in 2 groups (2002-2011 n = 28 and 2012-2015 n = 32). RESULTS: The global survival rate at 5 years was 72.6%, and the global and local recurrence rates were 21...
January 2018: Head & Neck
Giorgio Iaconetta, Domenico Solari, Alessandro Villa, Clotilde Castaldo, Rosa Maria Gerardi, Gianluigi Califano, Stefania Montagnani, Paolo Cappabianca
OBJECTIVE: Only a few anatomic studies of the entire course of the hypoglossal nerve (cranial nerve XII) have been reported. We analyzed all relationships of the 12th nerve with surrounding structures from the brainstem to the tongue through a microscopic perspective. A comprehensive anatomically and clinically oriented classification of its different segments is proposed. METHODS: Ten formalin-fixed adult human cadaveric heads (20 sides) were dissected with the aim to explore the entire course of cranial nerve XII via lateral suboccipital, far lateral partial, or total transcondylar routes...
January 2018: World Neurosurgery
Daniel W Flis, John F Burke, Arnau Benet, Phillip Theodosopoulos, Manish Aghi, Ivan H El-Sayed
OBJECTIVE: To demonstrate the clinical utility of the buccal fat pad to close a variety of skull base defects. METHODS: A retrospective chart review of 5 consecutive patients who underwent endoscopic cranial base surgery with endoscopic harvest of BFPF pedicled along the internal maxillary artery for reconstruction of the skull base from October 2013 until November 2014. RESULTS: All 5 patients had complete take of the BFPFs with mucosalization on post-operative follow up with no reported complications or CSF leaks...
October 5, 2017: World Neurosurgery
Gabriel Zada, Mustafa K Başkaya, Mitesh V Shah
Meningiomas represent the most common primary intracranial neoplasm treated by neurosurgeons. Although multimodal treatment of meningiomas includes surgery, radiation-based treatments, and occasionally medical therapy, surgery remains the mainstay of treatment for most symptomatic meningiomas. Because of the intricate relationship of the dura mater and arachnoid mater with the central nervous system and cranial nerves, meningiomas can arise anywhere along the skull base or convexities, and occasionally even within the ventricular system, thereby mandating a catalog of surgical approaches that neurosurgeons may employ to individualize treatment for patients...
October 2017: Neurosurgical Focus
Blake Harrison Priddy, Cristian Ferrareze Nunes, Andre Beer-Furlan, Ricardo Carrau, Iacopo Dallan, Daniel Monte-Serrat Prevedello
BACKGROUND: In the last decade, endoscopic skull base surgery has significantly developed and generated a plethora of techniques and approaches for access to the cranial ventral floor. However, the exploration for the least-aggressive, maximally efficient approach continues. OBJECTIVE: To describe in detail an anatomical study, along with the technical nuances of a novel endoscopic approach to Meckel's Cave (MC) using a lateral transorbital (LTO) route. METHODS: Eighteen orbits of injected cadaveric specimens were operated on, using an endoscopic LTO approach to MC, middle cranial fossa, and paramedian skull base preserving the orbital rim...
October 1, 2017: Operative Neurosurgery (Hagerstown, Md.)
Douglas R Thompson, David Zurakowski, Charles M Haberkern, Paul A Stricker, Petra M Meier, Carolyn Bannister, Hubert Benzon, Wendy Binstock, Adrian Bosenberg, Alyssa Brzenski, Stefan Budac, Veronica Busso, Samantha Capehart, Franklin Chiao, Franklyn Cladis, Michael Collins, Jordan Cusick, Rachel Dabek, Nicholas Dalesio, Ricardo Falcon, Allison Fernandez, Patrick Fernandez, John Fiadjoe, Meera Gangadharan, Katherine Gentry, Chris Glover, Susan Goobie, Heike Gries, Allison Griffin, Cornelius Botha Groenewald, John Hajduk, Rebecca Hall, Jennifer Hansen, Mali Hetmaniuk, Vincent Hsieh, Henry Huang, Pablo Ingelmo, Iskra Ivanova, Ranu Jain, Jeffrey Koh, Courtney Kowalczyk-Derderian, Jane Kugler, Kristen Labovsky, José Luis Martinez, Razaz Mujallid, Bridget Muldowney, Kim-Phuong Nguyen, Thanh Nguyen, Olutoyin Olutuye, Codruta Soneru, Timothy Petersen, Kim Poteet-Schwartz, Srijaya Reddy, Russell Reid, Karene Ricketts, Daniel Rubens, Rochelle Skitt, Lisa Sohn, Susan Staudt, Wai Sung, Tariq Syed, Peter Szmuk, Brad Taicher, Lisa Tetreault, Rheana Watts, Karen Wong, Vanessa Young, Lillian Zamora
BACKGROUND: The North American Pediatric Craniofacial Collaborative Group (PCCG) established the Pediatric Craniofacial Surgery Perioperative Registry to evaluate outcomes in infants and children undergoing craniosynostosis repair. The goal of this multicenter study was to utilize this registry to assess differences in blood utilization, intensive care unit (ICU) utilization, duration of hospitalization, and perioperative complications between endoscopic-assisted (ESC) and open repair in infants with craniosynostosis...
March 2018: Anesthesia and Analgesia
Edward E Kerr, Ali Jamshidi, Ricardo L Carrau, Raewyn G Campbell, Leo F Ditzel Filho, Bradley A Otto, Daniel M Prevedello
Objectives  The pedicled nasoseptal flap (NSF) has dramatically reduced postoperative cerebrospinal fluid leakage following endoscopic endonasal approach (EEA) surgery. Although rare, its arterial supply may be damaged during harvest or may be preoperatively damaged for numerous reasons. Early recognition permits harvesting a contralateral flap before sacrificing its pedicle as part of the surgical exposure or use of an alternative flap. Design  Technical feasibility study and case series. Setting  Tertiary care university-associated medical center...
October 2017: Journal of Neurological Surgery. Part B, Skull Base
Fuminari Komatsu, Masaaki Imai, Akihiro Hirayama, Naokazu Hayashi, Shinri Oda, Masami Shimoda, Mitsunori Matsumae
BACKGROUND: Skull base reconstruction is an essential technique for repairing cerebrospinal fluid (CSF) leakage. A reliable method for middle cranial fossa (MCF) reconstruction with minimal invasiveness has not been reported. An initial case of endoscopic MCF reconstruction with a subtemporal keyhole is described. CASE DESCRIPTION: A 57-year-old man developed severe meningitis and was diagnosed with spontaneous CSF leakage from bone defects on the tegmen tympani...
December 2017: World Neurosurgery
Juan C Fernandez-Miranda, Nathan T Zwagerman, Kumar Abhinav, Stefan Lieber, Eric W Wang, Carl H Snyderman, Paul A Gardner
OBJECTIVE Tumors with cavernous sinus (CS) invasion represent a neurosurgical challenge. Increasing application of the endoscopic endonasal approach (EEA) requires a thorough understanding of the CS anatomy from an endonasal perspective. In this study, the authors aimed to develop a surgical anatomy-based classification of the CS and establish its utility for preoperative surgical planning and intraoperative guidance in adenoma surgery. METHODS Twenty-five colored silicon-injected human head specimens were used for endonasal and transcranial dissections of the CS...
September 1, 2017: Journal of Neurosurgery
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