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Ilya Laufer, Vijay K. Anand and Theodore H. Schwartz

All patients had suprasellar lesions and a normal-sized sella. The sphenoid sinus was examined and believed adequate to permit a transsphenoidal, transtuberculum transplanum approach to the suprasellar cistern. The demographics, presenting symptoms, lesion type and location, and outcome for each patient are shown in Table 1 . There were five meningiomas, four craniopharyngiomas, and one Rathke cleft cyst. All patients had undergone preoperative visual field testing and comprehensive endocrinological evaluation. Three patients with tuberculum sellae meningiomas and

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Victor Garcia-Navarro, Guido Lancman, Amancio Guerrero-Maldonado, Vijay K. Anand and Theodore H. Schwartz

particulate material. Likewise, the tip of the instrument, where the aspiration occurs, is not easily visualized with a colinear, parallel endoscope, which provides better visualization for the side of the instrument. 4 , 5 Craniopharyngiomas, adenomas, and chordomas have a recurrence rate directly correlated with the percent of resection. 11 An ideal instrument for achieving this goal using endoscopic visualization would be a long, narrow side-cutting instrument whose tip and noncutting side could be placed in proximity to critical neurovascular structures for resection

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Edward D. McCoul, Vijay K. Anand and Theodore H. Schwartz

* Characteristic No. (%) anatomical site  sella 42 (63.6)  suprasellar cistern 26 (39.4)  cavernous sinus 13 (19.7)  clivus 9 (13.6)  sphenoid sinus 4 (6.1)  ethmoid sinus 4 (6.1)  planum sphenoidale 3 (4.5)  olfactory fossa 2 (3.0)  pterygopalatine fossa 2 (3.0)  petrous apex 1 (1.5)  odontoid 1 (1.5) pathology  pituitary adenoma 38 (57.6)  chordoma 6 (9.1)  encephalocele 6 (9.1)  meningioma 3 (4.5)  craniopharyngioma 2 (3.0)  other benign 8 (12.1)  other

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Kunal S. Patel, Ricardo J. Komotar, Oszkar Szentirmai, Nelson Moussazadeh, Daniel M. Raper, Robert M. Starke, Vijay K. Anand and Theodore H. Schwartz

algorithm. This protocol has been implemented since January 2010 with minimal variations. This algorithm takes into account the pathological features of the lesion and intraoperative CSF leakage level to determine what closure technique to implement. LD = lumbar drainage; NS = nasoseptal. Patient Groups Intrasellar Lesions These include pituitary adenomas, intrasellar Rathke cleft cyst or arachnoid cysts, and intrasellar craniopharyngiomas. For tumors < 2.5 cm in diameter or with < 1 cm suprasellar extension, we do not place a lumbar drain and do not harvest a

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Matei A. Banu, Amancio Guerrero-Maldonado, Heather J. McCrea, Victor Garcia-Navarro, Mark M. Souweidane, Vijay K. Anand, Linda Heier, Theodore H. Schwartz and Jeffrey P. Greenfield

: Specific measurements according to lesion location in 29 pediatric patients with skull base lesions who underwent an EEA * Location Pathology No. of Pts Age (yrs) NSD NDD NVD VCD MaxWmT MaxWiT ICD TA sellar, parasellar pituitary adenoma 16 16.4 ± 3.5 68.1 (66.0–70.1) 83.4 (80.7–86.1) 55.6 (52.9–58.3) 28.6 (26.2–31.0) 12.4 (11.0–13.8) 9.8 (8.4–11.2) 15.4 (13.8–17.0) 15.4 (13.8–17.0) suprasellar craniopharyngioma 3 12.0 ± 1.7 56.7 (54.9–58.5) 72.0 (68.7–75.4) 49.7 (46

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Osaama H. Khan, M.Sc., Vijay K. Anand and Theodore H. Schwartz

. Craniopharyngiomas . J Neurosurg 109 : 1 – 5 , 2008 6 Ceylan S , Koc K , Anik I : Endoscopic endonasal transsphenoidal approach for pituitary adenomas invading the cavernous sinus . J Neurosurg 112 : 99 – 107 , 2010 . (Erratum in J Neurosurg 112:210, 2010) 7 Ceylan S , Koc K , Anik I : Extended endoscopic transphenoidal approach for tuberculum sellae meningiomas . Acta Neurochir (Wien) 153 : 1 – 9 , 2011 8 Coppens J , Couldwell W , Olfactory groove meningiomas . Pamir MN , Black PM , Fahlbusch R : Meningiomas: A Comprehensive

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Matei A. Banu, Oszkar Szentirmai, Lino Mascarenhas, Al Amin Salek, Vijay K. Anand and Theodore H. Schwartz

. Results Patient Cohort Of 526 patients in our endonasal endoscopic database, there were 258 patients meeting the inclusion criteria, 145 males (56.2%) and 113 females (43.8%). The mean age (± SEM) at the time of surgery was 50.4 ± 17 years (range 5–87 years). Pathological examination revealed the following: 141 pituitary adenomas (54.7%), 34 meningiomas (13.2%), 31 craniopharyngiomas (12%), 17 metastases and carcinomas (6.6%), 14 Rathke's/epidermoid cysts (5.4%), 11 chordomas (4.3%), and 10 meningoencephaloceles/spontaneous CSF leaks (3.9%). The mean follow

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Kunal S. Patel, Shaan M. Raza, Edward D. McCoul, Aikaterini Patrona, Jeffrey P. Greenfield, Mark M. Souweidane, Vijay K. Anand and Theodore H. Schwartz

T he management of craniopharyngiomas is fraught with challenges that not only hinder achievement of optimal oncological outcomes but potentially have adverse effects on the quality of life (QOL). At time of presentation, and certainly after treatment, craniopharyngiomas can be associated with visual field defects, endocrinopathies, hypothalamic syndromes, increased cardiovascular risk, and neurocognitive sequelae. 7 , 9 , 33 , 37 , 46 Although considered benign tumors, their location can impact critical structures such as the optic nerves and chiasm

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Matei A. Banu, Alpesh Mehta, Malte Ottenhausen, Justin F. Fraser, Kunal S. Patel, Oszkar Szentirmai, Vijay K. Anand, Apostolos J. Tsiouris and Theodore H. Schwartz

212 – 220 , 2006 12 Fliss DM , Zucker G , Cohen A , Amir A , Sagi A , Rosenberg L , : Early outcome and complications of the extended subcranial approach to the anterior skull base . Laryngoscope 109 : 153 – 160 , 1999 13 Frank G , Pasquini E , Doglietto F , Mazzatenta D , Sciarretta V , Farneti G , : The endoscopic extended transsphenoidal approach for craniopharyngiomas . Neurosurgery 59 : 1 Suppl 1 ONS75 – ONS83 , 2006 14 Fraser JF , Anand VK , Schwartz TH : Endoscopic biopsy sampling of tophaceous

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Shaan M. Raza, Matei A. Banu, Angela Donaldson, Kunal S. Patel, Vijay K. Anand and Theodore H. Schwartz

, either through a lumbar puncture or lumbar drain. Lumbar drains were generally used for patients in whom a high-flow CSF leak was expected, such as intradural tumors (meningiomas, craniopharyngiomas, intradural chordomas) and pituitary macroadenomas > 2.5 cm in diameter with > 1 cm suprasellar extension. 16 Given that the endonasal approach exposure typically requires 1 hour, the approximate time from administration to visualization of CSF was the same. Our endoscopic endonasal techniques have been described elsewhere. 4 , 5 , 7 , 12 , 14 , 18–20 Visualization was