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Open access

Mostafa Shahein, Thiago Albonette-Felicio, Giuliano Silveira-Bertazzo, Rafael Martinez-Perez, Marcus Zachariah, Ricardo L. Carrau, and Daniel M. Prevedello

Chordomas are rare tumors that occur at an incidence rate of 0.8 per 100,000. Thirty-five percent of chordomas occur in the spheno-occipital region. We present a case of a clival chordoma that had severe brainstem compression. The patient had a 1-year history of slurred speech and left facial weakness (House-Brackmann 3). The endoscopic endonasal transclival approach gave a panoramic view of the region without the necessity of brain retraction or manipulation of the surrounding cranial nerves. Gross-total resection was achieved and no CSF leak was encountered postoperatively. The left facial weakness improved to House-Brackmann 1.

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Open access

Rafael Martínez-Pérez, Marcus Zachariah, Ruychen Li, Giuliano Silveira-Bertazzo, Ricardo L. Carrau, and Daniel M. Prevedello

Atypical trigeminal schwannomas (ATSs) are notorious for their ability to invade the skull base. An expanded endoscopic endonasal approach (eEEA) provides direct access to the tumor with no need for cerebral retraction or manipulation of neurovascular structures. Herein, we present a case of a large temporal fossa extradural lesion with secondary invasion of the sella, clivus, and temporal and infratemporal fossae in a 49-year-old male with severe vision loss. A transpterygoid transmaxillary approach was performed. Gross-total removal was achieved and pathology revealed the diagnosis of ATS. Visual function fully recovered in the right side and the patient has been uneventfully followed since surgery.

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Restricted access

Takuma Hara, Marcus A. Zachariah, Ruichun Li, Rafael Martinez-Perez, Ricardo L. Carrau, and Daniel M. Prevedello


Aerosol-generating procedures, including endoscopic endonasal surgery (EES), are a major risk for physicians during the COVID-19 pandemic. Techniques for reducing aerosolization and risk of transmission of COVID-19 during these procedures would be valuable to the neurosurgical community. The authors aimed to simulate the generation of small-particle aerosols during EES and craniectomy in order to develop methods to reduce the spread of aerosolized particles, and to test the effectiveness of these methods.


This study was performed at the Anatomical Laboratory for Visuospatial Innovations in Otolaryngology and Neurosurgery at The Ohio State University. The following two scenarios were used to measure three different particle sizes (0.3, 2.5, and 10 µm) generated: 1) drilling frontotemporal bone, simulating a craniectomy; and 2) drilling sphenoid bone, simulating an endonasal approach. A suction mask device was created with the aim of reducing particle release. The presence of particles was measured without suction, with a single Frazier tip suction in the field, and with the suction mask device in addition to the Frazier suction tip. Particles were measured 12 cm from the craniectomy or endonasal drilling region.


In the absence of any aerosol-reducing devices, the number of particles measured during craniectomy was significantly higher than that generated by endonasal drilling. This was true regardless of the particle size measured (0.3 µm, p < 0.001; 2.5 µm, p < 0.001; and 10 µm, p < 0.001). The suction mask device reduced the release of particles of all sizes measured in the craniectomy simulation (0.3 µm, p < 0.001; 2.5 µm, p < 0.001; and 10 µm, p < 0.001) and particles of 0.3 µm and 2.5 µm in the single Frazier suction simulation (0.3 µm, p = 0.031; and 2.5 µm, p = 0.026). The suction mask device further reduced the release of particles of all sizes during EES simulation (0.3 µm, p < 0.001; and 2.5 µm, p < 0.001) and particles of 0.3 µm and 2.5 µm in the single Frazier suction simulation (0.3 µm, p = 0.033; and 2.5 µm, p = 0.048). Large particles (10 µm) were not detected during EES.


The suction mask device is a simple and effective means of reducing aerosol release during EES, and it could potentially be used during mastoidectomies. This could be a valuable tool to reduce the risk of procedure-associated viral transmission during the COVID-19 pandemic.