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Transsphenoidal approach anatomic

P L Kalinin, O I Sharipov, I N Pronin, M A Kutin, D V Fomichev, B A Kadashev, A N Shkarubo, S N Alekseev, L I Astaf'eva, O F Tropinskaya, G F Dobrovol'sky, E I Shul'ts, D N Andreev, I A Voronina, A B Kurnosov
INTRODUCTION: Pituitary adenomas are benign growths that invade the cavernous sinus (CS) in 10-15% of cases. There are different types of microsurgical and endoscopic approaches enabling resection of tumors from the CS cavity that is a relatively small and hard to reach anatomical structure comprising eloquent neurovascular structures. MATERIAL AND METHODS: A study group included 97 patients with pituitary adenomas (PAs) invading the CS. PAs were resected using an endoscopic technique: adenomas were resected from the CS cavity through a standard endoscopic endonasal transsphenoidal approach in 62 cases; a lateral extended transsphenoidal endoscopic approach was used in 35 cases...
2016: Zhurnal Voprosy Neĭrokhirurgii Imeni N. N. Burdenko
A Zoghlami, N Bon Mardion, F Callonnec, D Dehesdin, F Proust, J-P Marie
INTRODUCTION: Skull base meningoencephaloceles are rare congenital malformations. The two cases of transalar transsphenoidal malformation reported here differ from the classical transsphenoidal meningoencephalocele. CASE REPORTS: Case 1 was a three-and-a-half-year-old boy and case 2 was a 36-year-old man. Both cases presented with clinical features of recurrent meningitis. Surgical management of case 1 was performed via an intradural infratemporal fossa craniotomy with reoperation 2years later...
July 15, 2016: European Annals of Otorhinolaryngology, Head and Neck Diseases
Alessandro Pesce, Michele Acqui, Marco Cimatti, Riccardo Caruso, Venceslao Wierzbicki, Antonino Raco
Primary lymphomas of the skull base are exceedingly rare and thus not commonly dealt with in everyday clinical practice. Primary diffuse large B cell lymphoma is the most commonly found (30-40% of primary non-Hodgkin lymphomas of the bone). This article reports a case of primary lymphoma of the skull base and reviews all the relevant literature in the PubMed, National Institutes of Health Library, and Google Scholar databases to outline the clinical, diagnostic, and surgical traits of this yet widely unexplored pathology...
May 11, 2016: Journal of Neurological Surgery. Part A, Central European Neurosurgery
Yahya Ahmadipour, Elias Lemonas, Homajoun Maslehaty, Sophia Goericke, Boris A Stuck, Nicolai El Hindy, Ulrich Sure, Oliver Mueller
The transsphenoidal approach to the sellar region has been introduced more than a 100 years ago. It is the accepted standard operative corridor to pathologies of the pituitary gland and surrounding structures. There are anatomical landmarks within the sphenoid sinus that are used for orientation directing to the sella floor or the cavernous sinus. Yet, little data can be found on the consistency of these landmarks. It is the aim of this study to evaluate the reliability of these anatomical landmarks for the surgeon's orientation...
April 21, 2016: European Archives of Oto-rhino-laryngology
O I Sharipov, M A Kutin, P L Kalinin, D V Fomichev, V A Lukshin, A B Kurnosov
INTRODUCTION: Doppler ultrasound (DUS) has been widely used in neurosurgical practice to diagnose various cerebrovascular diseases. This technique is used in transsphenoidal surgery to identify the localization of intracranial arteries when making an approach or during tumor resection. MATERIAL AND METHODS: To identify the cavernous segment of the internal carotid artery (ICA) and/or basilar artery during endoscopic transsphenoidal surgery, we used a combined device on the basis of a click line curette («Karl Storz») and a 16 MHz Doppler probe (Lassamed)...
2016: Zhurnal Voprosy Neĭrokhirurgii Imeni N. N. Burdenko
Prashant Chittiboina, S Lalith Talagala, Hellmut Merkle, Joelle E Sarlls, Blake K Montgomery, Martin G Piazza, Gretchen Scott, Abhik Ray-Chaudhury, Russell R Lonser, Edward H Oldfield, Alan P Koretsky, John A Butman
OBJECTIVE Pituitary MR imaging fails to detect over 50% of microadenomas in Cushing's disease and nearly 80% of cases of dural microinvasion. Surface coils can generate exceptionally high-resolution images of the immediately adjacent tissues. To improve imaging of the pituitary gland, a receive-only surface coil that can be placed within the sphenoid sinus (the endosphenoidal coil [ESC]) during transsphenoidal surgery (TSS) was developed and assessed. METHODS Five cadaver heads were used for preclinical testing of the ESC...
March 18, 2016: Journal of Neurosurgery
Do Hyun Kim, Yong-Kil Hong, Sin-Soo Jeun, Yong Jin Park, Soo Whan Kim, Jin Hee Cho, Boo Young Kim, Sungwoo Han, Young Hoon Jung, Yong Joo Lee, Sung Won Kim
OBJECTIVE: We evaluated postoperative changes in nasal cavity dimensions and their effects on nasal functions and symptoms. STUDY DESIGN: Case series with chart review. SETTING: Tertiary referral center. SUBJECTS AND METHODS: We studied patients who underwent binostril, 4-hand endoscopic endonasal transsphenoidal approach surgery with the bilateral modified nasoseptal rescue flap technique. Pre- and postoperative paranasal computed tomography scans were used to assess nasal cavity dimensional changes at 4 levels...
June 2016: Otolaryngology—Head and Neck Surgery
Cristian Ferrareze Nunes, Daniel Monte-Serrat Prevedello, Ricardo Luis Carrau, Clóvis Orlando Pereira da Fonseca, José Alberto Landeiro
BACKGROUND: The medial opticocarotid recess (MOCR) is located in the posterior wall of the sphenoid sinus, medial to the junction of the optic canal (OC) and the carotid prominence (CP). There is controversy in the literature in relation to the presence of the MOCR and its constancy, which is relevant when approaching the skull base through an endoscopic route. METHODS: The morphometric relations of the MOCR with the surrounding structures were studied in 18 cadaveric specimens after endoscopic endonasal approach (EEA)...
February 2016: Acta Neurochirurgica
Xuefei Deng, Shijun Chen, Ya Bai, Wen Song, Yongchao Chen, Dongxue Li, Hui Han, Bin Liu
PURPOSE: Vascular complications induced by intercavernous sinus injury during dural opening in the transsphenoidal surgery may contribute to incomplete tumour resections. Preoperative neuro-imaging is of crucial importance in planning surgical approach. The aim of this study is to correlate the microanatomy of intercavernous sinuses with its contrast-enhanced magnetic resonance venography (CE-MRV). METHODS: Eighteen human adult cadavers and 24 patients were examined based on autopsy and CE-MRV...
2015: PloS One
Ye Cheng, Haiyang Xu, Yong Chen, Songbai Xu, Hongquan Yu, Siwen Zhang, Yan Feng, Gang Zhao
PURPOSE: The aim of this study is to locate pterygopalatine fossa (PPF) and the opening of its communicating canals by accessing the relationship between PFF and the endoscopic landmarks such as the tubercular recess (TR) and middle lowest point of sellar floor (SF) as well as analyze the relation between PPF and important structures such as internal carotid artery (ICA) and optic canal (OC). MATERIALS AND METHODS: Computer topographic angiography (CTA) images of 118 PPF regions were reviewed...
September 2015: Journal of Craniofacial Surgery
G Rene Alvarez Berastegui, Shaan M Raza, Vijay K Anand, Theodore H Schwartz
Visual deterioration after dopamine-agonist treatment of prolactinomas associated with empty sella syndrome and secondary optic apparatus traction is a rare event. Chiasmapexy has been described as a viable treatment option, although few cases exist in the literature. Here, a novel endonasal endoscopic approach to chiasmapexy is described and its efficacy is demonstrated in a case report. A 55-year-old female patient with a history of a giant prolactinoma and 14 years of treatment using dopaminergic agonist therapy presented to our institution with a 1-month history of visual changes...
April 2016: Journal of Neurosurgery
Kosaku Amano, Tomokatsu Hori, Takakazu Kawamata, Yoshikazu Okada
Cerebrospinal fluid (CSF) leakage is a common but sometimes serious complication after transsphenoidal surgery (TSS). To avoid this postsurgical complication, we usually repair the CSF leaking area using an autologous material, such as fat, fascia, or muscle graft and sometimes nasonasal septal flap. In this report, we propose a technique using a novel autologous material, sphenoid sinus mucosa (SSM), to repair intraoperative CSF leakage or prevent it postoperatively. On 26 February 2007, we introduced the technique of using SSM to repair or prevent CSF leakage in TSS...
January 2016: Neurosurgical Review
Marija Mavar-Haramija, Alberto Prats-Galino, Juan A Juanes Méndez, Anna Puigdelívoll-Sánchez, Matteo de Notaris
A three-dimensional (3D) model of the skull base was reconstructed from the pre- and post-dissection head CT images and embedded in a Portable Document Format (PDF) file, which can be opened by freely available software and used offline. The CT images were segmented using a specific 3D software platform for biomedical data, and the resulting 3D geometrical models of anatomical structures were used for dual purpose: to simulate the extended endoscopic endonasal transsphenoidal approaches and to perform the quantitative analysis of the procedures...
October 2015: Journal of Medical Systems
Burak Cabuk, Savas Ceylan, Ihsan Anik, Mehtap Tugasaygi, Selcuk Kizir
AIM: To determine the feasibility, advantages, and disadvantages of using a robot for holding and maneuvering the endoscope in transnasal transsphenoidal surgery. MATERIAL AND METHODS: The system used in this study was a Stewart Platform based robotic system that was developed by Kocaeli University Department of Mechatronics Engineering for positioning and holding of endoscope. After the first use on an artificial head model, the system was used on six fresh postmortem bodies that were provided by the Morgue Specialization Department of the Forensic Medicine Institute (Istanbul, Turkey)...
2015: Turkish Neurosurgery
Naoki Wakuta, Tetsuya Ueba, Hiroshi Abe, Tooru Inoue, Manfred Tschabitscher
Knowledge of anatomy visualized endoscopically is necessary to perform endoscopic surgical procedures safely. The cavernous sinuses are complicated structures with major blood vessels and nerves seated deeply in the center of the skull base. Anatomical orientation during surgery is essential for deep and narrow skull base surgery. While performing surgery involving the cavernous sinuses, understanding of the structures identifiable via a transsphenoidal view can allow comprehension of the relationship between a lesion and the surrounding structures, thus preventing intraoperative complications...
2014: Neurologia Medico-chirurgica
Youxiong Yang, Guowen Zhan, Jianchun Liao, Ruishan Dang, Hongli Wang, Yang Li, Xiaote Zhang
The aim of this study was to investigate the relationship between the morphological characteristics of the sphenoid sinus and endoscopic localization of the cavernous sinus (CS) using an extended endoscopic endonasal transsphenoidal approach. Thirty sides of CS in 15 adult cadaver heads were dissected to simulate the extended endoscopic endonasal transsphenoidal approach, and the morphology of the sphenoid sinus and anatomic structures of CS were observed. The opticocarotid recess (OCR), ophthalmomaxillary recess (V1V2R), and maxillomandibular recess (V2V3R) in the lateral wall of the sphenoid sinus were presented in 16 sides (53...
September 2015: Journal of Craniofacial Surgery
Shousen Wang, Jinchao Zhang, Liang Xue, Liangfeng Wei, Zhiyu Xi, Rumi Wang
BACKGROUND: The anatomical structures of anterior area of sphenoid sinus are observed by CT reconstruction of radiographic images in some studies. However, the detailed anatomic information of the extended transsphenoidal approach is still incomplete. METHOD: Fifteen cases (30 sides) of adult cadaveric skulls and 20 cases (40 sides) of bleached adult dry skulls were observed and measured under microscope. CT imaging data were obtained from 12 patients. RESULTS: Anatomy of anterior area of sphenoid sinus and sphenopalatine artery observed from CT three-dimensional reconstructed images was consistent with that observed from adult cadaveric skulls and bleached adult dry skulls...
2015: International Journal of Clinical and Experimental Medicine
Elena García-Garrigós, Juan José Arenas-Jiménez, Irene Monjas-Cánovas, Javier Abarca-Olivas, Jesús Julián Cortés-Vela, Javier De La Hoz-Rosa, Maria Dolores Guirau-Rubio
In the last 2 decades, endoscopic endonasal transsphenoidal surgery has become the most popular choice of neurosurgeons and otolaryngologists to treat lesions of the skull base, with minimal invasiveness, lower incidence of complications, and lower morbidity and mortality rates compared with traditional approaches. The transsphenoidal route is the surgical approach of choice for most sellar tumors because of the relationship of the sphenoid bone to the nasal cavity below and the pituitary gland above. More recently, extended approaches have expanded the indications for transsphenoidal surgery by using different corridors leading to specific target areas, from the crista galli to the spinomedullary junction...
July 2015: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Figen Govsa, Mehmet Asim Ozer
AIM: The sphenoid ostium (SO) is an anatomical reference in transsphenoidal approach surgery. MATERIAL AND METHODS: The morphological features of the SO were studied in 352 skull base by 3D-Doctor Demo version. RESULTS: The mean diameters of the SO were measured as 5.8 ± 1.3 mm (right) and 5.9 ± 1.2 mm (left), respectively. The mean distance from the SO to the midline was measured as 2.3 ± 1.1 mm (right) and 1.8 ± 0.9 mm (left), respectively...
2015: Turkish Neurosurgery
Robert G Louis, Amy Eisenberg, Garni Barkhoudarian, Chester Griffiths, Daniel F Kelly
Introduction Given advancements in endoscopic image quality, instrumentation, surgical navigation, skull base closure techniques, and anatomical understanding, the endonasal endoscopic approach has rapidly evolved into a widely utilized technique for removal of sellar and parasellar tumors. Although pituitary adenomas and Rathke cleft cysts constitute the majority of lesions removed via this route, craniopharyngiomas, clival chordomas, parasellar meningiomas, and other lesions are increasingly removed using this approach...
October 2014: International Archives of Otorhinolaryngology
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