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Christoph P. Hofstetter, Ameet Singh, Vijay K. Anand, Ashutosh Kacker and Theodore H. Schwartz

included 4 days of lumbar CSF drainage, stool softeners, and bed rest. More than 3 years later, the patient continues to do well. However, a recent study has indicated that the durability of a repaired skull base defect should be assessed over a longer period. 17 Conclusions Transpterygoid and extended transpterygoid approaches can provide the necessary exposure to address a wide range of anterolateral skull base lesions. These may include small lateral sphenoid sinus encephaloceles, benign and malignant sinonasal tumors, and other tumors of the neural cell origin

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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

Endoscopic endonasal approaches for midline anterior skull base lesions have evolved over the past decade. 5 , 7 , 8 , 10 , 28 , 39 , 55 , 57 , 82 , 83 , 87 Initial series described the use of these techniques primarily for pituitary lesions, 6 , 30 , 48 , 56 , 59 but as experience grew, the endoscopic endonasal approach was applied to sellar lesions with suprasellar extension 29 , 55 , 63 and then to a variety of extrasellar lesions of the midline skull base that carry a greater risk of postoperative CSF leakage. 12 , 13 , 24 , 68 One of the difficulties of endoscopic

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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

process of skull base maturation, intimate relationships arise between ossifying structures and neurovascular anatomy. Pneumatization of the sphenoid sinus is a stepwise process following an established anterior-posterior trend. It directly impacts the course of 2 vital structures, the internal carotid artery (ICA) and the optic nerve. Furthermore, pediatric skull base lesions can significantly alter the local anatomy by delaying or disrupting the developmental process. Tumors obliterating the pneumatizing sinus, impinging on expanding bony and neurovascular structures

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

of resection during the postoperative hospital stay, which gave us the necessary control data with which to compare the pattern of air in patients without a suspected CSF leak. Risk of CSF Leaks Associated With ESBS The risk of CSF leak and its prevention have been a primary focus in the evolution of ESBS. 10 , 19 , 35 While the incidence of CSF leaks after transsphenoidal surgery ranges from 1.5% to 10.3%, 43 rates associated with extended approaches for invasive skull base lesions have been reported to be as high as 19.4% in large series. 19 More

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Nelson Moussazadeh, Charles Kulwin, Vijay K. Anand, Jonathan Y. Ting, Caryn Gamss, J. Bryan Iorgulescu, Apostolos John Tsiouris, Aaron A. Cohen-Gadol and Theodore H. Schwartz

, Ahn BJ , : Cranial chondrosarcoma and recurrence . Skull Base 20 : 149 – 156 , 2010 5 Bloch OG , Jian BJ , Yang I , Han SJ , Aranda D , Ahn BJ , : A systematic review of intracranial chondrosarcoma and survival . J Clin Neurosci 16 : 1547 – 1551 , 2009 6 Ceylan S , Koc K , Anik I : Extended endoscopic approaches for midline skull-base lesions . Neurosurg Rev 32 : 309 – 319 , 2009 7 Crockard HA , Cheeseman A , Steel T , Revesz T , Holton JL , Plowman N , : A multidisciplinary team approach to skull

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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

20. Embarrassed 0 1 2 3 4 5 21. Sense of taste/smell 0 1 2 3 4 5 22. Blockage/congestion of nose 0 1 2 3 4 5 Wen class is a functional classification system that categorizes patients as follows: I, independent; II, independent with some deficit; III, partially dependent; and IV, totally dependent. 44 Although the ASBQ was originally intended to assess QOL after craniotomy for anterior skull base lesions, it was recently validated for endonasal endoscopic surgery. 4 In addition, by using this measure, our results can

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

, hemorrhage/apoplexy, metastases); Group 2, CSF leaks/encephaloceles; Group 3, suprasellar lesions (craniopharyngiomas, xanthogranulomas, epidermoids, Rathke cleft cysts); Group 4, anterior skull base lesions (olfactory groove meningiomas, tuberculum sellae/planum meningiomas, esthesioneuroblastoma, chondro-sarcoma); Group 5, posterior skull base lesions (cavernous sinus meningioma/lymphoma/hemangioma/hemangio-pericytoma metastases, ependymoma, trigeminal schwannoma, sphenoid wing meningioma, chordoma); Group 6, intranasal lesions with/without skull base invasion (juvenile

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João Paulo Almeida, Sacit B. Omay, Sathwik R. Shetty, Yu-Ning Chen, Armando S. Ruiz-Treviño, Buqing Liang, Vijay K. Anand, Benjamin Levine and Theodore H. Schwartz

portion of the orbit and inferomedial components of SOMs that may enter into the infratemporal fossa and lateral sphenoid sinus. 13–15 , 39 , 50 , 52 However, resection of lateral skull base lesions, such as lateral sphenoid meningiomas, remains one of the major limitations of the endoscopic endonasal approach. Recently, a multiportal transorbital and endonasal approach has been proposed as a new minimally invasive option to reach the lateral orbit and middle fossa. 20 , 22 , 41 These approaches are particularly suited for patients with predominant hyperostosis and