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Extended Transnasal Endoscopic Approach for Skull Base Tumors and Tumors of the Orbit


Authors: R. Lipina 1;  P. Matoušekihash2 2,3 2,3
Authors‘ workplace: Neurochirurgická klinika FN Ostrava 1;  ORL klinika FN Ostrava 2;  LF Ostravské univerzity 3
Published in: Cesk Slov Neurol N 2012; 75/108(3): 326-332
Category: Original Paper

Overview

Aim:
The aim of the paper was to evaluate our experience with the extended endoscopic transnasal approach in resection of tumors of the skull base and orbit, as an alternative to the transcranial microscopic approach.

Material and methods:
Between April 2009 and September 2011, 13 patients underwent surgery using the extended transnasal endoscopic approach. The surgery was to treat meningioma in two patients, craniopharyngioma in five patients, epidermoid cyst in one patient, lymphoma of the pterygopalatine fossa in one patient and tumors of the orbit in four patients (histologically these were neurofibroma, leiomyoma, metasthasis and optic glioma).

Results:
Radical excision was achieved in eight patients in total. Of these, two patients had meningioma, three patients had craniopharyngioma, one patient had epidermoid cyst and two patients had orbital tumors. Partial resection, biopsy or decompression of the orbit and optic canal was performed in the remaining patients. Postoperative cerebrospinal fluid leak requiring transnasal endoscopic reoperation occurred in three patients and three patients experienced transient diabetes insipidus.

Conclusion:
The extended endoscopic transnasal approach is an alternative method for resection of tumors of the skull base and orbit. At present, this technique should be indicated as the first-choice method for resections of medial orbital tumors. Long-term results are required before a conclusion on the advantage of endoscopic approach over the transcranial microscopic approach of the skull base tumors can be made.

Key words:
skull base – orbit – endoscopy – transnasal surgery – craniopharyngioma – meningioma


Sources

1. Jankowski R, Auque J, Simon C, Marchal JC, Hepner H, Wayoff M. Endoscopic pituitary surgery. Laryngoscope 1992; 102(2): 198–202.

2. Jho HD, Carrau RL. Endoscopic endonasal trans­sphenoidal surgery: experience with fifty patients. J Neurosurg 1997; 87(1): 44–51.

3. Cappabianca P, Alfieri A, de Divitiis E. Endoscopic endonasal transsphenoidal approach to the sella: towards functional endoscopic pituitary surgery (FEPS). Minim Invasive Neurosurg 1998; 41(2): 66–73.

4. Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL. Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurg Focus 2005; 19(1): E3.

5. Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL. Expanded endonasal approach: the rostrocaudal axis. Part II. Posterior clinoids to the foramen magnum. Neurosurg Focus 2005; 19(1): E4.

6. Kassam A, Gardner P, Snyderman CH, Mintz A, Carrau R. Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa. Neurosurg Focus 2005; 19(1): E6.

7. Snyderman CH, Pant H, Carrau RL, Prevedello D, Gardner P, Kassam AB. What are the limits of endo­scopic sinus surgery? The expanded endonasal approach to the skull base. Keio J Med 2009; 58(3): 152–160.

8. Laufer I, Anand VK, Schwartz TH. Endoscopic, endonasal extended transsphenoidal, transplanum trans­tuberculum approach for resection of suprasellar leasions. J Neurosurg 2007; 106(3): 400–406.

9. Frank G, Pasquini E, Mazzatenta D. Extended transsphenoidal approach. J Neurosurg 2001; 95(5): 917–918.

10. Zada G, Kelly DF, Cohen P, Wang C, Swerdloff R. Endonasal transsphenoidal approach for pituitary adenomas and other sellar laesions: an asessment of efficacy, safety, and patients impressions. J Neurosurg 2003; 98(2): 350–358.

11. Schwartz TH, Fraser JF, Brown S, Tabaee A, Kacker A, Anand VK. Endoscopic cranial base surgery: Clasification of operative approaches. Neurosurgery 2008; 62(5): 991–1005.

12. Náhlovský J, Česák T, Látr I, Čáp J, Žižka J, Krajina A. Komplikace transsfenoidálních operací u našich nemocných – příčiny, řešení. Cesk Slov Neurol N 2004; 67/100(2): 112–119.

13. Sameš M, Vachata P, Saur K, Budíková M. Přímý transnazální miniinvazivní přístup pro mikrochirurgickou resekci adenomů hypofýzy. Cesk Slov Neurol N 2005; 68/101(5): 337–341.

14. Higgins TS, Courtemanche CH, Karakla D, Strasnick B, Singh RV, Koen JL et al. Analysis of transnasal endoscopic versus transseptal microscopic approach for excision of pituitary tumors. Am J Rhinol 2008; 22(6): 649–652.

15. Goudakos JK, Markou KD, Georgalas C. Endoscopic versus microscopic trans-sphenoidal pituitary surgery: a systematic review and meta-analysis. Clin Otolaryngol 2011; 36(3): 212–220.

16. Fahlbusch R, Gerganov VM. Comment on Endonasal versus transcranial resection. Neurosurg Focus 2011; 30(5): E16.

17. Van Gompel JJ, Frank G, Pasquini E, Zoli M, Hoover J, Lanzino G. Expanded endonasal endoscopic resection of anterior fossa meningiomas: report of 13 cases and meta-analysis of the literature. Neurosurg Focus 2011; 30(5): E15.

18. Cavallo LM, Briganti F, Cappabianca P, Maiuri F, Valente V, Tortora F et al. Hemorrhagic vascular complications of endoscopic transsphenoidal surgery. Minim Invasive Neurosurg 2004; 47(3): 145–50.

19. Cappabianca P, Cavallo LM, Colao A, de Divitiis E. Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas. J Neurosurg 2002; 97(2): 293–298.

20. Fatemi N, Dusick JR, de Paiva Neto MA, Kelly DF. The endonasal microscopic approach for pituitary adenomas and other parasellar tumors: a 10-year experience. Neurosurgery 2008; 63 (4 Suppl 2): 244–256.

21. de Divitiis E, Cappabianca P, Cavallo LM, Esposito F, Divitiis O, Messina A. Extended endoscopic transsphenoidal approach for extrasellar craniopharyngiomas. Neurosurgery 2007; 61 (ONS Suppl 2): 219–228.

22. Kassam AB, Prevedello DM, Carrau RL, Snyderman CH, Thomas A, Gardner P et al. Endoscopic endonasal skull base surgery: analysis of complications in the authors’ initial 800 patients. J Neurosurg 2011; 114(6): 1544–1568.

23. Reisch P, Perneczky A. Ten-year experience with supraorbital subfrontal approach through an eyebrow incision. Neurosurgery 2005; 57 (4 Suppl): 242–255.

24. Nakamura M, Roser F, Struck M, Vorkapic P, Samii M. Tuberculum sellae meningiomas: clinical outcome considering different surgical approaches. Neurosurgery 2006; 59(5): 1019–1029.

25. de Divitiis E, Esposito F, Cappabianca P, Cavallo LM, de Divitiis O. Tuberculum sellae meningiomas: high route or low route? A series of 51 consecutive cases. Neurosurgery 2008; 62(3): 556–563.

26. Fatemi N, Dusick JR, de Paiva Neto MA, Malkasian D, Kelly DF. Endonasal versus supra-orbital keyhole removal of craniopharyngiomas and tuberculum sellae meningiomas. Neurosurgery 2009; 64 (5 Suppl 2): 269–286.

27. Kitano M, Taneda M, Nakao Y. Postoperative improvement in visual function in patients with tuberculum sellae meningiomas: results of the extended transsphenoidal and transcranial approaches. J Neuro­surg 2007; 107(2): 337–346.

28. Gardner PA, Kassam AB, Thomas A, Snyderman CH, Carrau RL, Mintz AH et al. Endoscopic endonasal resection of anterior cranial base meningiomas. Neurosurgery 2008; 63(1): 36–52.

29. Samii M, Samii A. Surgical management of craniopharyngiomas. In: Schmidek HH (ed). Operative Neurosurgical Techniques: Indications, Methods and Results. Philadelphia: W.B. Saunders, 2000: 489–502.

30. Šteňo J. Microsurgical topography of craniopharyngiomas. Acta Neurochir Suppl (Wien) 1985; 35: 94–100.

31. Šteňo J, Bízik I, Šteňo A, Matejčík V. Craniopharyngiomas in children: how radical should the surgeon be? Childs Nerv Syst 2011; 27: 41–54.

32. Steno J, Malácek M, Bízik I. Tumor-third ventricular relationships in supradiaphragmatic craniopharyngiomas: correlation of morphological, magnetic resonance imaging, and operative findings. Neurosurgery 2004; 54(5): 1051–1060.

33. Kassam AB, Gardner PA, Snyderman CH, Carrau RL, Mintz AH, Prevedello DM. Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based upon the infundibulum. J Neurosurg 2008; 108(4): 715–28.

34. Stamm AC, Vellutini E, Balsalobre L. Craniopharyngioma. Otolaryngol Clin North Am 2011; 44(4): 937–952.

35. Kassam A, Thomas A, Carrau RL, Snyderman CH, Vescan A, Prevedello D, Mintz A, Gardner P. Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery 2008; 63 (ONS Suppl 1): 44–52.

36. Kassam A, Carrau RL, Snyderman CH, Gardner P, Mintz A. Evolution of reconstructive techniques following endoscopic expanded endonasal approaches. Neurosurg Focus 2005; 19(1): E8.

37. Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 2006; 116(10): 1882–1886.

Labels
Paediatric neurology Neurosurgery Neurology

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Czech and Slovak Neurology and Neurosurgery

Issue 3

2012 Issue 3

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