undesirable adverse events. With the recent advent of endoscopic technology in the field of neurosurgery, a wide range of skull base regions have become safely accessible. 1 , 5 , 11 , 12 , 20 , 21 , 29 , 36 , 46 For the treatment of skull base chondrosarcoma, there are a few reports about the outcomes of endoscopic endonasal surgeries, which commonly achieved sufficient tumor resection with acceptable neurological complications. 42 , 44 , 66 In this study, we present our recent experience of endoscopic transnasal surgery (ETS) for skull base chondrosarcoma. Based on our
Hirotaka Hasegawa, Masahiro Shin, Kenji Kondo, Shunya Hanakita, Akitake Mukasa, Taichi Kin and Nobuhito Saito
Masahiro Shin, Kenji Kondo, Shunya Hanakita, Keigo Suzukawa, Taichi Kin, Masaaki Shojima, Daichi Nakagawa and Nobuhito Saito
tumor (T) was exposed between the medial rectus muscle (med.rM) and the inferior rectus muscle (inf.rM) (as shown in C). ON = optic nerve. Since 2010, we have performed endoscopic transnasal surgery (ETS) for 15 skull base tumors involving the orbit ( Table 1 ), comprising 5 meningiomas (meningothelial, n = 3; atypical, n = 1; anaplastic, n = 1), 4 chordomas, 2 chondrosarcomas in the paranasal sinus, and 4 others (metastasis from systemic myxofibrosarcoma, trigeminal schwannoma, inverted papilloma, and acinic cell carcinoma, n = 1 each). TABLE 1
Omar Choudhri, Stefan A. Mindea, Abdullah Feroze, Ethan Soudry, Steven D. Chang and Jayakar V. Nayak
In this study the authors share their experience using intraoperative spinal navigation and imaging for endoscopic transnasal approaches to the odontoid in 5 patients undergoing C1–2 surgery for basilar invagination at Stanford Hospital and Clinics from 2010 to 2013.
Of these 5 patients undergoing C1–2 surgery for basilar invagination, 4 underwent a 2-tiered anterior C1–2 resection with posterior occipitocervical fusion during a first stage surgery, followed by endoscopic endonasal odontoidectomy in a separate setting. Intraoperative stereotactic navigation was performed using a surgical navigation system in all cases. Navigation accuracy, characterized as target registration error, ranged between 0.8 mm and 2 mm, with an average of 1.2 mm. Intraoperative imaging using a CT scanner was also performed in 2 patients.
Endoscopic decompression of the brainstem was achieved in all patients, and no intraoperative complications were encountered. All patients were extubated within 24 hours after surgery and were able to swallow within 48 hours. After appropriate initial reconstruction of the defect at the craniocervical junction, no postoperative CSF leakage, arterial injury, or need for reoperation was encountered; 1 patient developed mild postoperative velopharyngeal insufficiency that resolved by the 6-month follow-up evaluation. There were no deaths and no patients required tracheostomy placement. The average inpatient stay after surgery varied between 72 and 96 hours, without extended intensive care unit stays for any patient.
Technologies such as intraoperative CT scanning and merged MRI/CT can provide the surgeon with detailed, virtual real-time information about the extent of complex endoscopic vertebral segment resection and brainstem decompression and lessens the prospect of revision or secondary procedures in this challenging surgical corridor. Moreover, patients experience limited morbidity and can tolerate early oral intake after transnasal endoscopic odontoidectomy. Essential to the successful undertaking of these endoscopic adventures is 1) an understanding of the endoscopic nasal, skull base, and neurovascular anatomy; 2) advanced and extended-length instrumentation including navigation; and 3) a team approach between experienced rhinologists and spine surgeons comfortable with endoscopic skull base techniques
Ryosuke Tomio, Masahiro Toda, Agung Budi Sutiono, Takashi Horiguchi, Sadakazu Aiso and Kazunari Yoshida
E xpanded endoscopic transnasal surgeries for skull base lesions have recently become popular. Some expert surgeons performed endoscopic transclival removal of tumors such as meningiomas, chordomas, and pituitary adenomas and reported a risk of abducens nerve injuries with such surgeries. 4 , 5 , 7 , 10 The microsurgical anatomy of the abducens nerve (cranial nerve VI) has been described many times by wellknown authors such as Dorello, Destrieux, and Laconetta. 1 , 2 , 8 The relationship of the abducens nerve and Grüber's ligament in the petroclival
Andrew R. Conger, M.S., Joshua Lucas, Gabriel Zada, Theodore H. Schwartz and Aaron A. Cohen-Gadol
the realm of endoscopic transnasal surgery and associated operative corridors for removal of large craniopharyngiomas previously considered inoperable through this route. Copious irrigation is recommended following craniopharyngioma resection, as the tumor contents can be caustic to normal neurological structures and incite chemical meningitis. Fig. 11 The tumor is sharply dissected from the mammillary bodies. Indiscriminate traction of the tumor is avoided. The tumor is dissected away from the optic tracts and branches of the basilar artery. From The
Masahiro Shin, Hirotaka Hasegawa, Satoru Miyawaki, Akinobu Kakigi, Tsuguto Takizawa, Kenji Kondo, Taketo Shiode, Taichi Kin and Nobuhito Saito
surgical field under the microscope to that of the endoscope at the end of surgery. Details of the surgical approaches are shown in Video 1 . VIDEO 1. The video clip illustrates the endoscopic transmastoid posterior petrosal approach (EPPAP) in a case of recurrent chondrosarcoma invading the left petrous regions after multiple transcranial surgeries and endoscopic transnasal surgery (see case 4 demonstrated in Fig. 3 ). Preoperative MRI revealed the tumor extensively involving the petrous bone, the cerebellopontine angle, and the posterior cranial fossa and
Mayu Omata Shunsaku Takayanagi Shota Tanaka Keisuke Ueki Nobuhito Saito 05 2018 28 07 2017 128 5 1428 1437 10.3171/2016.12.JNS161444 2016.12.JNS161444 Role of endoscopic transnasal surgery for skull base chondrosarcoma: a retrospective analysis of 19 cases at a single institution Hirotaka Hasegawa Masahiro Shin Kenji Kondo Shunya Hanakita Akitake Mukasa Taichi Kin Nobuhito Saito 05 2018 7 07 2017 128 5 1438 1447 10.3171/2017.1.JNS162000 2017.1.JNS162000 Wavelength-specific lighted suction instrument for 5-aminolevulinic acid fluorescence-guided resection of deep
Masahiro Shin, Kenji Kondo, Shunya Hanakita, Hirotaka Hasegawa, Masanori Yoshino, Yu Teranishi, Taichi Kin and Nobuhito Saito
success in those paramedian territories, skull base tumors in the lateral regions remain a therapeutic challenge. Particularly for the petrous region, there have been numerous anatomical studies using cadaveric specimens or radiographic models. 9 , 21 , 25 , 37 However, in terms of clinical cases, most of the pathologies addressed using this method have been cystic inflammatory lesions such as cholesterol granuloma or petrous apicitis. 12 , 22 , 36 , 41 Reports remain quite limited regarding experiences with endoscopic transnasal surgery aimed at radical resection of
Jamie J. Van Gompel, Giorgio Frank, Ernesto Pasquini, Matteo Zoli, Jason Hoover and Giuseppe Lanzino
interest in the application of TNE therapy for sellar and anterior cranial fossa lesions. With increased experience, surgeons have tackled more formidable pathologies such as larger and more technically difficult anterior fossa meningiomas. 2 Advantages of TNE over transcranial approaches include minimization of brain retraction and optic apparatus manipulation, earlier identification of the pituitary gland, and a cosmetically appealing postoperative result with no visible scar. Endoscopic transnasal surgery is also appealing to patients because it is perceived as being
Takahide Nejo, Shota Tanaka, Masako Ikemura, Masashi Nomura, Shunsaku Takayanagi, Masahiro Shin, Tetsuo Ushiku, Junji Shibahara, Nobuhito Saito and Akitake Mukasa
, Bittinger MA , Driggers EM , : Cancer-associated IDH1 mutations produce 2-hydroxyglutarate . Nature 462 : 739 – 744 , 2009 8 Hao S , Hong CS , Feng J , Yang C , Chittiboina P , Zhang J , : Somatic IDH1 mutation in a pituitary adenoma of a patient with Maffucci syndrome . J Neurosurg 124 : 1562 – 1567 , 2016 9 Hasegawa H , Shin M , Kondo K , Hanakita S , Mukasa A , Kin T , : Role of endoscopic transnasal surgery for skull base chondrosarcoma: a retrospective analysis of 19 cases at a single institution . J Neurosurg