ligaments are densely attached to the posterior clinoid process. CN III enters the cavernous sinus through the oculomotor triangle, lateral to the posterior clinoid process and interclinoid ligament. Ant. = anterior; Cav. = cavernous; Clin. = clinoid; CN = cranial nerve; Diaph. = diaphragma; ICA = internal carotid artery; Interclin. = interclinoid; Lig. = ligament; Oculom. = oculomotor; Petroclin. = petroclinoid; Pit. = pituitary; Post. = posterior; Triang. = triangle. The endoscopic endonasal approach is an alternative surgical route to lesions located in the
Juan C. Fernandez-Miranda, Paul A. Gardner, Milton M. Rastelli Jr., Maria Peris-Celda, Maria Koutourousiou, David Peace, Carl H. Snyderman and Albert L. Rhoton Jr.
Hiroki Ohata, Takeo Goto, Alhusain Nagm, Narasinga Rao Kannepalli, Kosuke Nakajo, Hiroki Morisako, Hiroyuki Goto, Takehiro Uda, Shinichi Kawahara and Kenji Ohata
R ecently , the use of the endoscopic endonasal approach (EEA) for resection of skull base tumors has been increasing. However, due to the limited exposure with routine EEA, it is difficult to remove tumors that extend behind the posterior clinoid process (PCP) and dorsum sellae. 2 , 5 , 9 , 13 , 15 Critical neurovascular structures (internal carotid artery [ICA], cavernous sinus, pituitary gland), PCP, and dorsum sellae obstruct tumor visualization. 1 , 4 , 11 , 14 Posterior clinoidectomy gives an excellent wider operative view and allows radical resection of
Joseph D. Chabot, Chirag R. Patel, Marion A. Hughes, Eric W. Wang, Carl H. Snyderman, Paul A. Gardner and Juan C. Fernandez-Miranda
T he endoscopic endonasal approach (EEA) has become increasingly more common in the management of ventral skull base lesions. Originally developed for resection of intrasellar lesions, anterior, posterior, and lateral extension of EEA provides access to lesions of the ventral skull base from the frontal sinus to the superior cervical spine, and laterally to the medial middle cranial fossa. 10 , 19 , 21 , 23 , 24 , 29 , 34 , 43 , 44 Compared with traditional microscopic approaches, EEA may avoid brain manipulation and cosmetic defects, but it was originally
Shannon Fraser, Paul A. Gardner, Maria Koutourousiou, Mark Kubik, Juan C. Fernandez-Miranda, Carl H. Snyderman and Eric W. Wang
reported no benefit to lumbar drain placement 3 or have demonstrated increased complication rates associated with drain placement. 13 , 14 Here, to our knowledge, we present the largest series to date of endonasal intradural skull base tumor resections. We sought to identify whether patient-specific factors (BMI, sex, tumor pathology, and tumor location) and perioperative interventions (lumbar drain and type of reconstruction) are independent risk factors for the development of postoperative CSF leak after an endoscopic endonasal approach (EEA) for the resection of
Paolo Castelnuovo, Davide Lepera, Mario Turri-Zanoni, Paolo Battaglia, Andrea Bolzoni Villaret, Maurizio Bignami, Piero Nicolai and Iacopo Dallan
.3%) and perioperative mortality (4.7%) rates. 7 Significant advances in endoscopic and minimally invasive surgical approaches have revolutionized the treatment of anterior skull base cancers. Selected lesions can be removed without facial incision or external craniotomy by using a purely endonasal endoscopic approach. Data from several centers worldwide have clearly demonstrated that endoscopic endonasal surgery, when properly planned and in expert hands, can be considered a sound alternative to traditional open approaches, with comparable oncological control rates but
Nathan T. Zwagerman, Matthew J. Tormenti, Zachary J. Tempel, Eric W. Wang, Carl H. Snyderman, Juan C. Fernandez-Miranda and Paul A. Gardner
associated with basilar invagination may require a palatal split, and limited jaw opening requires a mandibular split 34 or tracheostomy, all of which add morbidity and significant discomfort for the patient. Finally, damage to the oral cavity structures from retraction may cause upper airway swelling and obstruction to the point that tracheostomy may be required. 25 , 28 Following the introduction of the endoscope for the transsphenoidal approach, 19 the endoscopic endonasal approach (EEA) has been successfully applied to other skull base pathologies. 21–24 In the
Andrea Ruggeri, Joaquim Enseñat, Alberto Prats-Galino, Antonio Lopez-Rueda, Joan Berenguer, Martina Cappelletti, Matteo De Notaris and Elena d'Avella
anatomical study was to revisit this technique of ICA proximal control from the endoscopic endonasal route. The surgical technique, anatomical consideration, and possible clinical applications are discussed. Methods To perform this study, 10 fresh human cadaver heads were dissected at the Laboratory of Surgical Neuroanatomy in the Human Anatomy and Embryology Unit, Faculty of Medicine, Universitat de Barcelona, Spain. The surgical positioning of the head was simulated in the dissection laboratory; each head was slightly extended, turned 10° toward the surgeon, and
Alaa S. Montaser, Juan M. Revuelta Barbero, Alexandre Todeschini, André Beer-Furlan, Russell R. Lonser, Ricardo L. Carrau and Daniel M. Prevedello
A 69-year-old female with incidental diagnosis of a dorsum sellae meningioma had shown significant tumor growth after initial conservative management. The procedure started with a microscopic sublabial transsphenoidal approach to the sella and the suprasellar space. Due to limitations to a safe dissection and removal of the retrosellar component, the surgery was converted to a purely endoscopic endonasal approach with left hemi-transposition of the pituitary gland, followed by drilling of the dorsum sellae and removal of the left posterior clinoid process. A complete tumor resection was achieved, and a multilayer skull base reconstruction was performed without complications.
The video can be found here: https://youtu.be/BEolyK-To_A.
Masaaki Taniguchi, Nobuyuki Akutsu, Katsu Mizukawa, Masaaki Kohta, Hidehito Kimura and Eiji Kohmura
genu of the carotid artery is restricted. The recent evolution of the endoscopic endonasal approach widened the surgical target to the diverse skull base regions, 1 , 9 , 11 including the jugular tubercle and occipital condyle, by the so-called far-medial approach. 6 , 18 However, a reliable access route to the IPA in relation to the surrounding structures, such as the ET and the foramen lacerum (FL), is not yet established. We conducted an anatomical study simulating the actual endoscopic endonasal surgery and searched for the access corridor to the IPA. In
Salvatore Di Maio, Luigi M. Cavallo, Felice Esposito, Vita Stagno, Olga Valeria Corriero and Paolo Cappabianca
experience with the extended endoscopic endonasal approach 4 to the planum sphenoidale and tuberculum sellae, 3 , 11 , 22 we have begun to widen our surgical indications to include the above-mentioned selected cases of pituitary adenomas. In this article we present our preliminary results with the extended endonasal approach in the management of pituitary adenomas. Methods Study Design This study is a retrospective outcome review of pituitary adenomas removed via an extended endoscopic endonasal approach tailored to the suprasellar area. Selection criteria