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Endoscopic endonasal surgery

Doo-Sik Kong, Stephanie Ming Young, Chang-Ki Hong, Yoon-Duck Kim, Sang Duk Hong, Jung Won Choi, Ho Jun Seol, Jung-Il Lee, Hyung Jin Shin, Do-Hyun Nam, Kyung In Woo
OBJECTIVE Cranioorbital tumors are complex lesions that involve the deep orbit, floor of the frontal bone, and lesser and greater wing of the sphenoid bone. The purpose of this study was to describe the clinical and ophthalmological outcomes with an endoscopic transorbital approach (TOA) in the management of cranioorbital tumors involving the deep orbit and intracranial compartment. METHODS The authors performed endoscopic TOAs via the superior eyelid crease incision in 18 patients (16 TOA alone and 2 TOA combined with a simultaneous endonasal endoscopic resection) with cranioorbital tumors from September 2016 to November 2017...
September 14, 2018: Journal of Neurosurgery
Shunya Hanakita, Moujahed Labidi, Kentaro Watanabe, Sebastien Froelich
Objective  While the endoscopic endonasal approach (EEA) has gained widespread acceptance for the resection of clivus chordomas, conventional transcranial approaches still have a crucial role in craniocervical junction (CCJ) chordoma surgery. In repeat surgery, a carefully planned treatment strategy is needed. We present a surgical treatment plan combining an EEA and a far-lateral craniotomy with endoscopic assistance (EA) in the salvage surgery of a recurrent CCJ chordoma. Case Presentation  A 37-year-old woman who had undergone partial resection of a chordoma extending from the mid-clivus to the CCJ...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Masahiro Toda, Kenzo Kosugi, Hiroyuki Ozawa, Kaoru Ogawa, Kazunari Yoshida
Objective  The main purpose of this article is to assess the effectiveness and safety of surgery via the endoscopic endonasal approach (EEA) for cavernous sinus (CS) lesion in patients with nonfunctioning pituitary adenomas (NFPA). Design  Retrospective study. Setting  Keio University Hospital. Participants  Thirty patients who underwent CS surgery via the EEA between 2009 and 2017 for Knosp grade 4 NFPA with pre- and postoperative magnetic resonance imaging available for volumetric analysis. Main Outcome Measures  Clinical presentation, extent of resection, and surgical complications...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Matteo Zoli, Federica Guaraldi, Ernesto Pasquini, Giorgio Frank, Diego Mazzatenta
Introduction  The endoscopic endonasal approach (EEA) might seem an "unnatural" route for intradural lesions such as meningiomas. The aim of this study is to critically revise our management of anterior skull base meningiomas to consider, in what cases it may be advantageous. Material and Methods  Each consecutive case of anterior skull base meningioma operated on through an EEA or combined endoscopic-transcranial approach at our institution, between 2003 and 2017, have been included. Tumors were classified on the basis of their location and intra or extracranial extension...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Philippe Lavigne, Daniel L Faden, Eric W Wang, Carl H Snyderman
Objective  The nasoseptal flap (NSF) is considered the primary vascularized flap for reconstruction of dural defects with endoscopic endonasal surgery (EES) of the skull base. However, the complications and morbidities associated with this reconstructive flap are poorly understood. This article presents a systematic review of the complications and morbidities related to the use of the NSF in skull base surgery. Method  A systematic review of the literature based on published guidelines was performed to identify potential complications and morbidities related to the NSF...
October 2018: Journal of Neurological Surgery. Part B, Skull Base
Philippe Lavigne, Eric W Wang, Juan C Fernandez-Miranda
The optimal treatment for skull base chordomas is gross total resection followed by radiotherapy and not radiation of partially resected tumors. Supratotal resection, defined as removal beyond all involved bone and dura, is ideal but difficult to achieve. In this video, we present the case of a 37-yr-old man with new onset of progressive cranial nerve sixth palsy and a skull base lesion compatible with clival chordoma. He underwent partial surgical resection at an outside institution via transcranial approach, with significant tumor residual at the clivus, dorsum sella, posterior clinoids, and petrous apex, extensive dural invasion, and intradural extension with attachment to the basilar artery and its long perforating branches...
September 4, 2018: Operative Neurosurgery (Hagerstown, Md.)
Emanuele La Corte, Iyan Younus, Francesca Pivari, Adelina Selimi, Malte Ottenhausen, Jonathan A Forbes, David J Pisapia, Georgiana A Dobri, Vijay K Anand, Theodore H Schwartz
PURPOSE: To describe the clinical, radiographic and surgical outcomes in a cohort of patients with BRAF V600E mutant papillary craniopharyngiomas. METHODS: A retrospective review was performed to identify all patients with a histological diagnosis of CP operated upon at a single institution between 2005 and 2017. All cases with adequate material were sequenced to confirm the presence of BRAF V600E mutation. RESULTS: Sixteen patients were included in the present study...
September 5, 2018: Pituitary
Werner Hosemann, Thomas Kühnel, Rainer Weber
In endonasal endoscopic sinus surgery continuous progress has been made in the last decade due to better understanding of microanatomy, gains in adjunctive medicative therapy and technical innovations. Moreover, continuous research and clinical trials on innovative stents and spacers with and without defined drug eluting features may be mentioned in this context. A narrative review of the current development status and its therapeutic options referring to the latter is presented.
September 2018: Laryngo- Rhino- Otologie
Denis A Golbin, Anastasia P Ektova, Maxim O Demin, Nikolay Lasunin, Vasily A Cherekaev
Nasal chondromesenchymal hamartoma (NCMH) is a rare benign tumor of the sinonasal tract in children with possible orbit and skull base involvement. We present the 57th published observation of this kind of tumor. A 25-month-old female patient presented with recurrent mass lesion of the sinonasal tract. According to her history, she had feeding difficulties and nasal obstruction since birth. She underwent partial resection at eight months of age via transfacial approach in the local hospital. Due to progression of tumor remnants, a second surgery was performed using an endoscopic endonasal approach resulting in subtotal resection...
June 28, 2018: Curēus
Pratima Nayak, Alaa S Montaser, Jie Hu, Daniel M Prevedello, Lawrence S Kirschner, Luma Ghalib
Context: The development of diabetes insipidus (DI) following transsphenoidal resection of pituitary adenomas has been associated with higher postsurgical morbidity and longer hospitalizations. Identifying these patients promptly and efficiently can lead to improved health care outcomes. Objective: We evaluated our institution's incidence of DI following pituitary adenoma resection and assessed for preoperative risk factors that were associated with postoperative DI...
September 1, 2018: Journal of the Endocrine Society
Jun W Jeon, Steve S Cho, Shayoni Nag, Love Buch, John Pierce, YouRong S Su, Nithin D Adappa, James N Palmer, Jason G Newman, Sunil Singhal, John Y K Lee
BACKGROUND: Near-infrared (NIR) tumor contrast is achieved through the "second-window ICG" technique, which relies on passive accumulation of high doses of indocyanine green (ICG) in neoplasms via the enhanced permeability and retention effect. OBJECTIVE: To report early results and potential challenges associated with the application of second-window ICG technique in endonasal endoscopic, ventral skull-base surgery, and to determine potential predictors of NIR signal-to-background ratio (SBR) using endoscopic techniques...
August 16, 2018: Operative Neurosurgery (Hagerstown, Md.)
Min-Seok Rha, Sewon Jeong, Hyung-Ju Cho, Joo-Heon Yoon, Chang-Hoon Kim
OBJECTIVE: This study aimed to reveal diagnosis, management, and treatment outcome characteristics of sinonasal pleomorphic adenoma and to identify predictors for disease recurrence. METHODS: This study comprised a retrospective review of data from seven patients with sinonasal pleomorphic adenoma who were treated by the authors at a tertiary medical center between January 2005 and May 2017. In addition, the MEDLINE database was searched for literature published in English...
August 16, 2018: Auris, Nasus, Larynx
Charlotte Yin, Bi Yi Chen
Background: Tension pneumocephalus from skull base surgery is a rare occurrence that mandates urgent neurosurgical attention. Case Description: We describe a case of tension pneumocephalus secondary to an endoscopic endonasal resection of an adamantinomatous craniopharyngioma and how it was successfully managed at our institution. Conclusion: Our experience reflects that definitive treatment of tension pneumocephalus is required with multilayered dural repair, but temporising measures should be used immediately to prevent neurological deterioration prior to the definitive repair...
2018: Surgical Neurology International
Keisuke Yoshida, Masahiro Toda, Takenori Akiyama, Satoshi Takahashi, Masaaki Nishimoto, Hiroyuki Ozawa, Yuichi Ikari, Kazunari Yoshida
BACKGROUND: Posterior pituitary tumor is rare and its optimal surgical strategy is not determined yet. Surgical removal of posterior pituitary tumors is often complicated by their hypervascularity. Prevention and preparation for excessive hemorrhage is crucial for safe resection. CASE DESCRIPTION: A 69 year-old woman presented with bitemporal hemianopsia and was found to have a sellar tumor with suprasellar extension, resembling a pituitary adenoma. Microscopic transsphenoidal resection was attempted, but was interrupted by a massive intraoperative hemorrhage...
August 6, 2018: World Neurosurgery
Cristian A Naudy, Juan C Yanez-Siller, Paulo M Mesquita Filho, Matias Gomez G, Bradley A Otto, Ricardo L Carrau, Daniel M Prevedello
BACKGROUND: The origin of the ophthalmic artery is within the surgical field of endoscopic endonasal approaches (EEAs) to the suprasellar and parasellar regions. However, its anatomy from the endoscopic point-of-view has not been adequately elucidated. OBJECTIVE: To highlight the anatomy of the ophthalmic artery origin from an endoscopic endonasal perspective. METHODS: The origin of the ophthalmic artery was studied bilaterally under endoscopic visualization, after performing transplanum/transtubercular EEAs in 17 cadaveric specimens (34 arteries)...
July 31, 2018: Operative Neurosurgery (Hagerstown, Md.)
Krunal Patel, Angelos G Kolias, Thomas Santarius, Richard J Mannion, Ramez W Kirollos
BACKGROUND: Endoscopic endonasal surgery (EES) is increasingly used for olfactory groove meningiomas (OGMs). The role of EES for large (≥4 cm) or complex OGMs is debated. Specific imaging features have been reported to affect the degree of gross total resection (GTR) and complications following EES for OGMs. The influence of these factors on transcranial resection (TCR) is unknown. OBJECTIVE: To examine the impact of specific imaging features on outcome following TCR to provide a standard for large and endoscopically less favorable OGMs against which endoscopic outcomes can be compared...
July 31, 2018: Operative Neurosurgery (Hagerstown, Md.)
Chris R Marcellino, Maria Peris-Celda, Michael J Link, Janalee K Stokken
A 52-yr-old woman was referred to a tertiary medical center for evaluation of 2 yr of progressive visual symptoms and 1 yr of retro-orbital pressure. Her ophthalmologic exam was unrevealing except for mild asymmetrical impairment in color perception. A gadolinium contrast-enhanced magnetic resonance image of the head showed a left extraconal orbital apex lesion consistent with cavernous hemangioma. Computed tomography reveled bony remodeling of the medial-inferior orbital walls with superior orbital fissure expansion...
July 31, 2018: Operative Neurosurgery (Hagerstown, Md.)
Courtney Chou, Carl Snyderman, Dennis Phillips, Joseph Darby
Objectives To analyze difficult airway situations affecting patients after endoscopic endonasal surgery (EES) for skull base tumors and to develop an airway management algorithm. Study Design Case series with chart review. Setting Single tertiary care center. Subjects and Methods Eleven difficult airway events occurred among patients after EES for skull base tumors, as identified through a retrospective review of our institutional Difficult Airway Management Team registry from January 2008 to March 2016. Data from these events included patient demographics, event characteristics, airway management techniques, and outcomes...
August 7, 2018: Otolaryngology—Head and Neck Surgery
Gary L Gallia, Anthony O Asemota, Ari M Blitz, Andrew P Lane, Wayne Koch, Douglas D Reh, Masaru Ishii
OBJECTIVE Olfactory neuroblastoma (ONB) is a rare malignant neoplasm of the sinonasal cavity. Surgery has been and remains a mainstay of treatment for patients with this tumor. Open craniofacial resections have been the treatment of choice for many decades. More recently, experience has been growing with endoscopic approaches in the management of patients with ONB. The object of this study is to report the authors' experience over the past 11 years with ONB patients treated with purely endonasal endoscopic techniques...
August 3, 2018: Journal of Neurosurgery
Gautam U Mehta, Franco DeMonte, Shirley Y Su, Michael E Kupferman, Ehab Y Hanna, Shaan M Raza
Chondrosarcomas of the skull base are malignant tumors for which surgery is the primary therapeutic option. Gross-total resection has been demonstrated to improve survival in patients with these tumors. Chondrosarcomas arising from the petroclival synchondrosis harbor particularly unique anatomical considerations that have long been a barrier to achieving such a resection. Endoscopic endonasal transpterygoid approaches have been recently used to gain improved access to such lesions; however, these approaches have classically relied on a medial to lateral transclival trajectory, which provides limited exposure for complete resection of lateral disease...
August 3, 2018: Journal of Neurosurgery
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