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Jennifer L. Quon, Lily H. Kim, Peter H. Hwang, Zara M. Patel, Gerald A. Grant, Samuel H. Cheshier and Michael S. B. Edwards

The development of this surgical approach has been concurrent with advancements in microscopic and endoscopic technology, allowing improved visualization through a narrow opening. 3 , 13 Compared with the microscope, differently angled lens endoscopes offer a wider field of view for the resection of parasellar and suprasellar lesions. 5 , 14 Unlike in adults, for pediatric skull base lesions a craniotomy has been the favored approach until recently. The transnasal endoscopic approach may be limited by pediatric anatomy such as an absent or incompletely pneumatized

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Federico Di Rocco, Vincent Couloigner, Patricia Dastoli, Christian Sainte-Rose, Michel Zerah and Gilles Roger

T he goal of surgery in frontobasal defects is to prevent retrograde infections such as meningitis or brain abscesses. Because severe complications, especially damage of the brain parenchyma, can occur during intracranial procedures, extracranial approaches were developed, including external ethmoidectomy (by Dohlman in 1948 3 ), the transnasal approach (by Hirsch in 1952 4 ), and the intranasal route (by Vrabec and Hallberg in 1964 17 ). Since its appearance in the early 1980s, the transnasal endoscopic approach has progressively become the first

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Zachary L. Hickman, Michael M. McDowell, Sunjay M. Barton, Eric S. Sussman, Eli Grunstein and Richard C. E. Anderson

this article we present our most recent experience with the transnasal endoscopic approach for the same indication, adding 2 additional cases to the literature and including the first report of reoperation following an initial transnasal approach. Operative Technique For the endoscopic transnasal approach to the CVJ and rostral cervical spine, the patient is positioned supine followed by oral fiberoptic endotracheal intubation and initiation of electrophysiological monitoring. The head is secured in a Mayfield head holder in a slightly flexed position to allow

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Savas Ceylan, Kenan Koc and Ihsan Anik

Object

In this report, the authors describe their experience with surgical access to the cavernous sinus via a fully transnasal endoscopic approach in 20 cases. Clinical and endocrinological follow-up are discussed.

Methods

The authors used an endoscopic transsphenoidal approach in 192 patients with pituitary adenomas between September 1997 and January 2008, adding a cavernous sinus approach in 20 patients with invasive tumors during the last 5 years of this period. Parasellar extension of the tumor was measured according to the Knosp Scale. Radical tumor removal was achieved in 13 (65%) of 20 patients, and subtotal removal in 7 (35%). The authors used recently defined cavernous sinus approaches in the first 14 cases, including the paraseptal approach in 6, middle turbinectomy in 7, and contralateral middle turbinectomy in 1 case. Combined approaches rather than defined standard cavernous sinus approaches were used in 4 cases and an extended approach in 2.

Results

The tumors included nonsecretory adenomas in 5 cases (25%), growth hormone–secreting adenomas in 7 (35%), prolactin-secreting adenomas in 4 (20%), and adrenocorticotropic hormone–secreting adenomas in 4 cases (20%). Normal growth hormone and insulin-like growth factor 1 levels were achieved in 4 patients (57%) with growth hormone adenomas, and remission criteria were obtained in 3 patients with prolactinomas and 3 patients with adrenocorticotropic hormone–secreting adenomas.

Conclusions

Compared with transcranial and microscopic transsphenoidal surgery, endoscopic transsphenoidal surgery offers a wide exposure for cavernous sinus medial wall adenomas that enables removal of the adenoma from the medial cavernous sinus wall. Because of the necessity for multidisciplinary treatment to achieve satisfactory results, Gamma Knife surgery and medical therapy should be supplementary treatment options after endoscopic transsphenoidal surgery.

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Ilya Laufer, Jeffrey P. Greenfield, Vijay K. Anand, Roger Härtl and Theodore H. Schwartz

the literature, reporting on a patient in whom a microscope-assisted transoral approach was not possible due to the patient's micrognathia. We wished to validate and reproduce this transnasal endoscopic approach to the CMJ and contribute several operative nuances to the literature. Case Report Examination This 25-year-old man with a history of non-achondroplastic dwarfism and juvenile RA presented with progressive occipital headache, neck pain, and intermittent paresthesias in bilateral upper extremities. Chronic steroid therapy for his arthritis

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Sukhdeep S. Jhawar, Maximiliano Nunez, Paolo Pacca, Daniel Seclen Voscoboinik and Huy Q. Truong

endoscopic approach, we identified lower cranial nerves from their origin to their extracranial course, with relation to the pharyngeal internal carotid artery (ICA), RCL muscle, and vertebral artery (VA). The eustachian tube (ET) is a useful landmark for the pharyngeal ICA, behind which are lower cranial nerves. The ET runs parallel and anterior to the petrous ICA, and it enters the petrous bone just medial to the ascending pharyngeal ICA before it enters into the petrous canal. The ET is removed to allow exposure of the pharyngeal ICA and petroclival synchondrosis, which

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James K. Liu, Steven D. Schaefer, Augustine L. Moscatello and William T. Couldwell

-weighted MR image. Lower Right: Coronal Gd-enhanced T 1 -weighted MR image. Fig. 2. Case 4. Coronal (left) and axial (right) CT scans obtained in a 42-year-old man who presented with sinusitis, polyps, and nasal obstruction. The images reveal AFS with extensive paranasal sinus involvement extending into the frontal sinus and the adjacent epidural space. Fungal debris was removed entirely through a transnasal endoscopic approach. All patients underwent endoscopic resection of fungal debris, which was performed using a transnasal and/or a

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Ercole Galassi, Ernesto Pasquini, Giorgio Frank and Gianluca Marucci

positioned supine with the head in a neutral position. After a bifrontal craniotomy and midline transection of the falx were performed, a standard extradural–intradural subfrontal exposure allowed microsurgical dissection and piecemeal complete excision of the firm, calcified, intracranial component, which had extensively eroded the cribriform plate and entered the intradural subarachnoid space. The surrounding dura mater had to be excised as well because it appeared to have been infiltrated by the tumor. A simultaneous transnasal endoscopic approach was accomplished by an

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Omar Choudhri, Stefan A. Mindea, Abdullah Feroze, Ethan Soudry, Steven D. Chang and Jayakar V. Nayak

adapted with permission from Nayak JV, Mindea SA: Transnasal endoscopic approach to the craniocervical junction. In: Rhinology: Diseases of the Nose, Sinuses, and Skull Base , Kennedy DW and Hwang PH, eds., Thieme, 2012. CSJ = clival septum junction; CV = clivus; C1 = anterior arch of C-1; ET = eustachian tube; NP = nasopharynx. Intraoperative Navigation and Imaging Protocol All patients undergoing extended skull base C1–2 surgeries complete a single thin-slice sinus and nasopharynx CT scan to delineate bone anatomy such as the hard palate, sphenoid sinus

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Ricardo J. Komotar, Hannah E. Goldstein and Jeffrey N. Bruce

Grant Christopher Alvarez-Breckenridge, MD, PhD, Massachusetts General Hospital Genomic characterization of melanoma’s metastatic genetic drivers to the brain and predictors of response to immune checkpoint blockade Pricilla Brastianos, MD 2016 CNS Columbia Softball Pediatric Brain Tumor Award Jennifer L. Quon, MD, Stanford Medicine Transnasal endoscopic approach for pediatric skull base tumors: a case series 2016 AANS Columbia Softball Pediatric Brain Tumor Award Ian F. Pollack, MD, University of Pittsburgh Immune responses and clinical outcome after glioma