Endoscopic endonasal resection of skull base chondrosarcomas: technique and early results

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

doi:10.3171/2014.11.jns14827

Cited by 43 publications

(38 citation statements)

References 36 publications

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“…7,25 Early technical limitations resulting in a historical association with CSF leaks have largely been eliminated at many centers employing strategies including vascularized nasoseptal flaps, intrathecal dye injection, and multilayer closure techniques. 26 Transtuberculum-transplanum corridors to the suprasellar cistern and third ventricle are among the most recent extensions of the EEA, with technique centered on careful negotiation of the optic nerves, chiasm, pituitary gland, and infundibulum, as well as on successful closure of high-flow CSF leaks.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic endonasal versus open transcranial resection of craniopharyngiomas: a case-matched single-institution analysis

Moussazadeh

Prabhu

Bander

et al. 2016

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104

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OBJECTIVE The authors compared clinical and radiological outcomes after resection of midline craniopharyngiomas via an endoscopic endonasal approach (EEA) versus an open transcranial approach (TCA) at a single institution in a series in which the tumors were selected to be equally amenable to gross-total resection (GTR) with either approach. METHODS A single-institution retrospective review of previously untreated adult midline craniopharyngiomas was performed. Lesions were evaluated by 4 neurosurgeons blinded to the actual approach used to identify cases that were equally amenable to GTR using either an EEA or TCA. Radiological and clinical outcome data were assessed. RESULTS Twenty-six cases amenable to either approach were identified, 21 EEA and 5 TCA. Cases involving tumors that were resected via a TCA had a trend toward larger diameter (p = 0.10) but were otherwise equivalent in preoperative clinical and radiological characteristics. GTR was achieved in a greater proportion of cases removed with an EEA than a TCA (90% vs 40%, respectively; p = 0.009). Endoscopic resection was associated with superior visual restoration (63% vs 0%; p < 0.05), a decreased incidence of recurrence (p < 0.001), lower increase in FLAIR signal postoperatively (−0.16 ± 4.6 cm3 vs 14.4 ± 14.0 cm3; p < 0.001), and fewer complications (20% vs 80% of patients; p < 0.001). Significantly more TCA patients suffered postoperative cognitive loss (80% vs 0; p < 0.0001). CONCLUSIONS An EEA is a safe and effective approach to suprasellar craniopharyngiomas amenable to GTR. For this select group of cases, the EEA may provide higher rates of GTR and visual improvement with fewer complications compared with a TCA.

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Section: Discussionmentioning

confidence: 99%

Endoscopic endonasal versus open transcranial resection of craniopharyngiomas: a case-matched single-institution analysis

Moussazadeh

Prabhu

Bander

et al. 2016

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104

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“…Endoscopic endonasal surgery (EES), has emerged as an effective approach for the resection of pituitary adenomas, 7,13 craniopharyngiomas, 15,20 suprasellar meningioma, 25,27 chordomas, 14 and chondrosarcomas. 32 While the endoscope provides a wide-angle, high-definition view of the surgical field, 9 this surgical modality is greatly augmented by the use of intraoperative neuronavigation platforms. These systems create maps from preoperative magnetic resonance imaging (MRI) and computed tomography (CT) imaging and allow the real-time tracking of surgical instruments’ position during surgery, thereby allowing the surgeon to see what lies beyond the view of the endoscope.…”

Section: Introductionmentioning

confidence: 99%

First Application of 7-T Magnetic Resonance Imaging in Endoscopic Endonasal Surgery of Skull Base Tumors

et al. 2017

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Background Successful endoscopic endonasal surgery for the resection of skull base tumors is reliant on preoperative imaging to delineate pathology from the surrounding anatomy. The increased signal-to-noise ratio afforded by 7T MRI can be used to increase spatial and contrast resolution, which may lend itself to improved imaging of skull base. In this study, we apply a 7T imaging protocol to patients with skull base tumors and compare the images to clinical standard of care. Methods Images were acquired at 7T on 11 patients with skull base lesions. Two neuroradiologists evaluated clinical 1.5T, 3T, and 7T scans for detection of intracavernous cranial nerves and ICA branches. Detection rates were compared. Images were utilized for surgical planning and uploaded to a neuronavigation platform and used to guide surgery. Results Image analysis yielded improved detection rates of cranial nerves and ICA branches at 7T. 7T images were successfully incorporated into preoperative planning and intraoperative neuronavigation. Conclusion Our study represents the first application of 7T MRI to the full neurosurgical workflow for endoscopic endonasal surgery. We detected higher rates of cranial nerves and ICA branches at 7T MRI compared to 3T and 1.5 T, and found that integration of 7T into surgical planning and guidance was feasible. These results suggest a potential for 7T MRI to reduce surgical complications. Future studies comparing standardized 7T, 3T, and 1.5 T MRI protocols in a larger number of patients are warranted to determine the relative benefit of 7T MRI for endonasal endoscopic surgical efficacy.

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“…Due to their ventral trajectory, potential advantages of endoscopic endonasal approaches (EEAs) include the possibility of accessing multiple skull base compartments, even bilaterally, in a single procedure while avoiding retraction or manipulation of neurovascular structures; this is exceptionally displayed during endonasal resection of chondrosarcomas. 2,[4][5][6] Hence, herein the authors describe their indications, contraindications, surgical technique and anatomy, complication management, and perioperative care for the endoscopic endonasal resection of skull base chondrosarcomas. Nevertheless, one must be aware that this is a heterogeneous group that may present in a wide variety of scenarios; thus, we will focus on describing the rationale behind surgically addressing those lesions located mainly in the petroclival region with involvement of neighboring compartments.…”

Section: Introductionmentioning

confidence: 99%

“…Abbreviations: CPA, cerebellopontine angle; CSF, cerebrospinal fluid; GTR, gross total resection; NTR, near total resection; STR, subtotal resection.Data from Refs 2,[4][5][6][27][28][29][30][31][32]. consults are dictated by the patient's response to surgery in terms of nasal healing and crusting.…”

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confidence: 99%

The Endoscopic Endonasal Approach for Removal of Petroclival Chondrosarcomas

Filho

Prevedello

Dolci

et al. 2015

Neurosurgery Clinics of North America

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Endoscopic endonasal resection of skull base chondrosarcomas: technique and early results

Abstract: According to the authors' experience, the endoscopic endonasal route is a safe and effective approach for the resection of appropriately selected petroclival chondrosarcomas.

Cited by 43 publications

References 36 publications

Endoscopic endonasal versus open transcranial resection of craniopharyngiomas: a case-matched single-institution analysis

Endoscopic endonasal versus open transcranial resection of craniopharyngiomas: a case-matched single-institution analysis

First Application of 7-T Magnetic Resonance Imaging in Endoscopic Endonasal Surgery of Skull Base Tumors

The Endoscopic Endonasal Approach for Removal of Petroclival Chondrosarcomas

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