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Alexandre B Todeschini, Mostafa Shahein, Alaa S Montaser, Douglas Hardesty, Bradley A Otto, Ricardo L Carrau, Daniel M Prevedello
A 42-yr-old female presented with an olfactory groove meningioma causing progressive vision loss and anosmia. Given the size of the tumor, we opted for a 2-stage surgery: endoscopic endonasal approach (EEA) followed by a craniotomy. Stage I surgery was a transcribriform transplanum EEA using a binostril 4-hand/2 surgeons (ENT and neuro) technique, with the patient positioned supine with the head slightly turned to the right side and tilted to the left, fixed in a 3-pin head clamp, under imaging guidance, in which we drilled out all the affected skull base bone, devascularized and debulked the tumor...
April 16, 2018: Operative Neurosurgery (Hagerstown, Md.)
Murat Kutlay, Abdullah Durmaz, İlker Özer, Cahit Kural, Çağlar Temiz, Serdar Kaya, İlker Solmaz, Mehmet Daneyemez, Yusuf Izci
OBJECTIVE: With the use of multiple endoscopic endonasal surgical corridors, extended endoscopic endonasal approaches (EEEAs) are now being used to treat a wide range of ventral skull base lesions. Our aim was to present our experience with EEEAs to the ventral skull base lesions. PATIENTS AND METHODS: The study group consisted of 106 patients (57 men and 49 women) who underwent surgery for skull base lesions using EEEAs from 2010 to 2017. The EEEA was most commonly used for giant pituitary macroadenomas, sinonasal malignancies, cerebrospinal fluid (CSF) leaks, meningiomas, craniopharyngiomas, and fibro-osseous lesions...
February 21, 2018: Clinical Neurology and Neurosurgery
Neil Majmundar, Naveed Kamal, Renuka Reddy, Jean A Eloy, James K Liu
The endoscopic endonasal transcribriform approach (EETA) has become a useful strategy in the treatment of various anterior skull base pathology, including meningoencephaloceles, olfactory groove meningiomas, schwannomas, esthesioneuroblastomas, and other sinonasal malignancies. However, not all pathologies are optimally treated through this approach due to tumor size, extent of the lesion, vascular involvement, and the presence of intact olfaction. One must be prepared to use a transcranial approach if the EETA is not favorable...
February 13, 2018: Journal of Neurosurgical Sciences
James K Liu, Zachary S Mendelson, Gurkirat Kohli, Jean Anderson Eloy
BACKGROUND: Reconstruction of large anterior skull base (ASB) defects after an endoscopic endonasal transcribriform approach (EEA-TC) remains a challenge despite the advent of the vascularized pedicled nasoseptal flap (PNSF). OBJECTIVE: We describe a relaxing PNSF slit incision that extends the anterior and posterior reach of the PNSF to maximize tensionless flap coverage of transcribriform ASB defects. METHODS: A retrospective chart review was conducted on 20 consecutive patients who underwent EEA-TC and subsequent PNSF reconstruction with a relaxing slit incision...
February 5, 2018: World Neurosurgery
Francisco J D MacArthur, Gerald W McGarry
OBJECTIVES/HYPOTHESIS: To develop a tool for the calculation of surgical skull base defects and endonasal flap dimensions on preoperative computed tomography (CT) to aid surgical planning. STUDY DESIGN: Case series. METHODS: A literature search was conducted to identify all endonasal flaps. There were five basic models identified. These are the nasoseptal flap, anterior lateral nasal wall flap, bipedicled anterior septal flap, posterior pedicled inferior turbinate flap, and middle turbinate flap...
October 9, 2017: Laryngoscope
T Radulesco, M Penicaud, P Dessi, J Michel
Over the past 10 to 20 years, endoscopic endonasal surgery has become for many teams the preferred treatment for sinonasal tumors. Technical advances in the field of surgical instrumentation (good visualization, hemostasis…) and the progress of imaging guidance (to avoid neurovascular complication) has made those procedures simpler and safer. Nevertheless, endonasal endoscopic procedures require a trained surgical team of ENT specialist and neurosurgeon. Endoscopic endonasal surgery has been reported to be feasible for all types of sinonasal tumors whether benign tumors such as inverted papillomas, or malignant tumors...
September 2017: Journal of Stomatology, Oral and Maxillofacial Surgery
Andrew S Venteicher, Jay I Kumar, Emma A Murphy, Stacey T Gray, Eric H Holbrook, William T Curry
The endoscopic, endonasal transcribriform approach (EETA) is an important technique used to directly access the anterior skull base and is increasingly being used in the management of olfactory groove meningiomas (OGMs). As this approach requires removal of the cribriform plate and olfactory epithelium en route to the tumor, patients are anosmic postoperatively. Here, we report the development of phantosmia and dysgeusia in two patients who underwent EETAs for OGMs, which has not yet been reported in the literature...
June 2017: Journal of Neurological Surgery. Part B, Skull Base
Pinghua Wu, Huikun Zeng, Ying Guan, Ligen Mo, Danke Su
OBJECTIVES: To help surgeons locating anatomic landmarks when performing endoscopic endonasal transcribriform approach to anterior skull base. METHODS: High-resolution axial computed tomography (CT) images at thickness of 0.6 mm, and reconstructed 0.41-mm thick gapless sagittal and coronal CT images were taken from 123 subjects. Using mimics software, first located elementary points and line: nasal spine, midpoint of posterior hard palate and the line between them; then located measured points right/left posterior and anterior points; measured distances between measured points and from measured points to nasal spine and angles between lines connecting measured points to nasal spine and the basic line...
June 2017: Journal of Craniofacial Surgery
Alfonso Santamaría, Cristóbal Langdon, Mauricio López-Chacon, Arturo Cordero, Joaquim Enseñat, Ricardo Carrau, Manuel Bernal-Sprekelsen, Isam Alobid
OBJECTIVES/HYPOTHESIS: To evaluate the versatility of the pericranial flap (PCF) to reconstruct the ventral skull base, using the frontal sinus as a gate for its passage into the sinonasal corridor "money box approach." STUDY DESIGN: Anatomic-radiological study and case series. METHODS: Various approaches and their respective defects (cribriform, transtuberculum, clival, and craniovertebral junction) were completed in 10 injected specimens...
November 2017: Laryngoscope
A Samy Youssef, Raghuram Sampath, Jacob L Freeman, Jameson K Mattingly, Vijay R Ramakrishnan
BACKGROUND: Loss of olfaction has been considered inevitable in endoscopic endonasal resection of olfactory groove meningiomas. Olfaction preservation may be feasible through an endonasal unilateral transcribriform approach, with the option for expansion using septal transposition and contralateral preservation of the olfactory apparatus. METHODS: An expanded unilateral endonasal transcribriform approach with septal transposition was performed in five cadaver heads...
October 2016: Acta Neurochirurgica
Andrea Gennaro Ruggeri, Martina Cappelletti, Benedetta Fazzolari, Nicola Marotta, Roberto Delfini
BACKGROUND: Traditionally, the surgical removal of tuberculum sellae meningioma (TSM) and olfactory groove meningioma (OGM) requires transcranial approaches and microsurgical techniques, but in the last decade endoscopic expanded endonasal approaches have been introduced: transcribriform for OGMs and transtuberculum-transplanum for TSM. A comparative analysis of the literature concerning the two types of surgical treatment of OGMs and TSM is, however, difficult. METHODS: We conducted a literature search using the PubMed database to compare data for endoscopic and microsurgical techniques in the literature...
April 2016: World Neurosurgery
Osaama H Khan, Roheen Raithatha, Paolo Castelnuovo, Vijay K Anand, Theodore H Schwartz
BACKGROUND: The Draf III (modified endoscopic Lothrop) procedure has been proposed to extend the endonasal transethmoidal, transfovea ethmoidalis, and transcribriform approach through the back wall of the frontal sinus. The exposure is time-consuming and increases the risk of cerebrospinal fluid leak, and the indications for use are not well described. There are few data quantifying the advantage it conveys over the approach without the Draf III procedure. METHODS: An endoscopic, endonasal transfovea, transcribriform approach was performed in 5 fresh, injected cadaveric heads...
January 2016: World Neurosurgery
James K Liu, Jean Anderson Eloy
Anterior skull base (ASB) schwannomas are extremely rare and can often mimic other pathologies involving the ASB such as olfactory groove meningiomas, hemangiopericytomas, esthesioneuroblastomas, and other malignant ASB tumors. The mainstay of treatment for these lesions is gross-total resection. Traditionally, resection for tumors in this location is performed through a bifrontal transbasal approach that can involve some degree of brain retraction or manipulation for tumor exposure. With the recent advances in endoscopic skull base surgery, various ASB tumors can be resected successfully using an expanded endoscopic endonasal transcribriform approach through a "keyhole craniectomy" in the ventral skull base...
January 2012: Neurosurgical Focus
Aaron Wessell, Ameet Singh, Zachary Litvack
Objectives We present a case of olfactory preservation after a unilateral transcribriform transethmoidal endoscopic resection of esthesioneuroblastoma. We also discuss the oncologic results of endoscopic and transcranial approaches and describe the potential benefits and limitations of an endoscopic approach. Setting Single academic medical center. Participant and Design The clinical course of a 28-year-old patient who underwent endoscopic en bloc resection of esthesioneuroblastoma through a unilateral transcribriform transethmoidal approach was reviewed...
August 2014: Journal of Neurological Surgery Reports
Matei A Banu, Oszkar Szentirmai, Lino Mascarenhas, Al Amin Salek, Vijay K Anand, Theodore H Schwartz
OBJECTIVES: Postoperative pneumocephalus is a common occurrence after endoscopic endonasal skull base surgery (ESBS). The risk of cerebrospinal fluid (CSF) leaks can be high and the presence of postoperative pneumocephalus associated with serosanguineous nasal drainage may raise suspicion for a CSF leak. The authors hypothesized that specific patterns of pneumocephalus on postoperative imaging could be predictive of CSF leaks. Identification of these patterns could guide the postoperative management of patients undergoing ESBS...
October 2014: Journal of Neurosurgery
Danielle M Blake, Qasim Husain, Vivek V Kanumuri, Peter F Svider, Jean Anderson Eloy, James K Liu
Sinonasal and anterior skull base (ASB) schwannomas are rare entities. The majority of these lesions are found within the sinonasal tract, although some have intracranial extension via invasion of the ASB. Often, these tumors can be confused for other entities, especially olfactory groove meningiomas and esthesioneuroblastomas in the olfactory groove region, and juvenile nasopharyngeal angiofibromas in the infratemporal fossa. We present a single institutional series of four patients with sinonasal and ASB schwannomas that were resected purely via an endoscopic endonasal approach...
August 2014: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Jivianne T Lee, Todd T Kingdom, Timothy L Smith, Michael Setzen, Seth Brown, Pete S Batra
BACKGROUND: The introduction of advanced endoscopic techniques has facilitated significant growth in the field of endoscopic skull base surgery (SBS). The purpose of this study is to evaluate the impact of endoscopic SBS on the clinical practice patterns of the American Rhinologic Society (ARS) membership. METHODS: A 23-item survey vetted by the ARS Board of Directors was electronically disseminated to the ARS membership from February 5, 2013, to March 31, 2013...
February 2014: International Forum of Allergy & Rhinology
B Verillaud, D Bresson, E Sauvaget, E Mandonnet, B Georges, R Kania, P Herman
No abstract text is available yet for this article.
September 2013: European Annals of Otorhinolaryngology, Head and Neck Diseases
Pete S Batra, Jivianne Lee, Samuel L Barnett, Brent A Senior, Michael Setzen, Dennis H Kraus
BACKGROUND: The objective of this study was to evaluate the potential impact of advanced endoscopic techniques on the current practice patterns in skull base surgery. METHODS: A 20-item written survey approved by the American Rhinologic Society (ARS) and North American Skull Base Society (NASBS) was conducted at the 22nd Annual NASBS meeting in Las Vegas, NV, from February 17 to 19, 2012. The target group included 212 practicing skull base surgeons. RESULTS: Seventy-nine physicians (37...
August 2013: International Forum of Allergy & Rhinology
Jean Anderson Eloy, Pratik A Shukla, Osamah J Choudhry, Rahul Singh, James K Liu
OBJECTIVES/HYPOTHESIS: The endoscopic endonasal transcribriform approach (EETA) is a viable alternative option for resection of selected anterior skull base (ASB) tumors. However, this technique results in the creation of large cribriform defects. Some have reported the use of a rigid substitute for ASB reconstruction to prevent postoperative frontal lobe sagging. We evaluate the degree of frontal lobe sagging using our triple-layer technique [fascia lata, acellular dermal allograft, and pedicled nasoseptal flap (PNSF)] without the use of rigid structural reconstruction for large cribriform defects...
December 2012: Laryngoscope
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