Endoscopic endonasal surgery for Clival Chordomas – a single institution experience and short term outcomes

Yousaf, Jawad; Afshari, Fardad T.; Ahmed, Shahzada; Chavda, Swarupsinh; Sanghera, Paul; Paluzzi, Alessandro

doi:10.1080/02688697.2019.1567683

Cited by 15 publications

(12 citation statements)

References 20 publications

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“…In our series, patient 2 and 6 are examples of such tumors. Previous series have come to the same conclusion (Wang, Wang, et al, 2019; Yousaf et al, 2019). The FM approach aims at expanding exposure relevant to resection of Wang type III lesions (Figure 2) (Wang, Chae, et al, 2019).…”

Section: Discussionsupporting

confidence: 61%

“…These findings are concordant with previous studies. In a study of 65 consecutive patients, the largest series to date, Zoli et al had a 58.7% rate of GTR with 3.8% of patients developing permanent neurological sequelae, similar numbers when compared with other, smaller case series (Dehdashti et al, 2008; Fraser et al, 2010; Yousaf et al, 2019; Zoli et al, 2018).…”

Section: Discussionmentioning

confidence: 63%

“…Chordomas are locally aggressive, slow‐growing tumors that develop from remnants of the embryological notochord along the spinal axis and midline skull base structures (Figure 1) (Sen et al, 2010; Yousaf et al, 2019). Clival chordomas carry a poor prognosis, with a mean survival between 6 and 24 months if left untreated and a 5‐year survival of 50%–85% with standard treatment (Yousaf et al, 2019). The treatment of choice for patients with clival chordomas is gross total resection (GTR) followed by adjuvant proton beam therapy (Fernandez‐Miranda, et al, 2014; Hayashi et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

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Contemporary surgical management of skull base chordomas—Anatomical reflections on a single center experience retrospective case series

et al. 2022

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Chordoma, a rare, locally aggressive tumor can affect the central skull base, usually centered at the midline. Complete surgical resection remains mainstay of therapy in case of primary as well as recurrent tumors. Owing to their secluded location, surgical resection of skull base chordomas remains a challenge, even though the recent advancement of endoscopic endonasal approaches has had a significant positive impact on the management of these patients. Endoscopic endonasal approaches have been shown to significantly reduce surgical morbidity when compared to traditional open approaches; however, the classical endoscopic transclival midline approach fails to sufficiently expose parts of many skull base chordomas. More recent refinements of the technique, such as the interdural pituitary transposition and posterior clinoidectomy, the transpterygoid plate approach and the transcondylar far medial approach enable the surgeon the increase the resection rate in these patients. This retrospective case series focuses on anatomical aspects in the surgical management of patients with skull base chordomas. We outline the surgical anatomy of contemporary endoscopic approaches to the skull base based intraoperative illustrations as well as pre‐ and postoperative 3D reconstructed CT and MR images if our patients. This article should help the clinical choose the most appropriate approach and be aware of relevant anatomy as well as potential shortcomings of a given approach.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 63%

Section: Introductionmentioning

confidence: 99%

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Contemporary surgical management of skull base chordomas—Anatomical reflections on a single center experience retrospective case series

et al. 2022

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“…Because it is better to hold the endoscope by hand for fine adjustment during operation, handling of endoscope by a skilled “scopist” like an assistant doing four hands approach during endonasal endoscopic surgery[ 19 , 21 ] is the most ideal. Therefore, educating surgeons regarding manual holding the endoscope are important.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of endoscope-assisted surgery under exoscopic view in skull base surgery: A technical note

Yano¹,

Hiraoka²,

Morita³

et al. 2022

Surgical Neurology International

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Background: The use of the exoscope has been increasing in the field of neurosurgery, as it can set the visual axis freely, enabling the surgeon to operate in a comfortable posture. Although endoscope-assisted surgery for compensation of insufficient surgical field is useful under the microscope, we report that using an endoscope in exoscopic surgery is safer and more useful. Methods: The exoscope used was ORBEYE. All surgical procedures were performed exoscopically from the beginning of the surgery. When endoscopic observation was required during the operation, the endoscope was inserted under observation by an exoscope. The exoscopic screen was 4K-3D and endoscopic screen was 4K-2D, the operation was performed while observing both screens at the same time. The endoscope was held manually or by a mechanical holder. Results: Twenty-two cases, including 14 requiring microvascular decompression (MVD) and eight requiring tumor removal, were performed by endoscopic-assisted exoscopic surgery. The endoscope could be inserted safely because its relationship with the surrounding structure could be observed under the exoscope, and the operator could observe both screens without moving the head. Fourteen of 22 patients required additional endoscopic treatment. Satisfactory two-handed operation was performed in 13 cases. Symptomatology disappeared in all cases of MVD, and sufficient tumor resection was achieved. Conclusion: Exoscopic surgery provides excellent surgical view that is not inferior to conventional microsurgery. As a large space can be secured between the scope and the surgical field, it is safer and easier to manipulate the endoscope under the exoscope.

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“…By now, most interventions of the paranasal sinuses and an increasing part of frontal skull base surgery can be managed endoscopically [10]. Even pathologies beyond the skull base such as pituitary gland tumors [8], clivus chordomas [16] and basilar apex aneurysm [9] can be treated by an endoscopic endonasal approach.…”

Section: Introductionmentioning

confidence: 99%

A third hand to the surgeon: the use of an endoscope holding arm in endonasal sinus surgery and well beyond

Hintschich

Fischer

Seebauer

et al. 2021

Eur Arch Otorhinolaryngol

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Background Extended endoscopic endonasal operations of the sinuses and the frontal skull base require a bimanual action of the surgeon in many cases. Thus, typically an assistant guides the endoscope and centers the field of view. In this study, we investigate in which cases an endoscope holding arm can be used alternatively. Materials and methods The electromagnetic system ENDOFIXexo was used in different surgical interventions of the paranasal sinuses and beyond questioning ergonomics and geometrical limitations. The realized degrees of freedom were documented, and a topography of possible applications compiled. Results The presented system is limited by the anatomy of the anterior ethmoid and dynamic working conditions in the sagittal direction. Especially in extended interventions in the posterior ethmoid, in which parts of the nasal septum have been resected and a static position of the endoscope is desired the surgeon can greatly benefit from the robotic arm. Moreover, through the high flexibility of the endoscopic arm surgeries of the pharynx and larynx were performed, questioning the current gold standard of microscope-assisted surgical procedures. Conclusion Under the impression of an urging staff shortage and due to its unlimited patience, the ENDOFIXexo arm seems promising. Taking into account the complex anatomy and the limited access, we especially see a favorable field of application in the surgery of the pituitary gland and skull base tumors.

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Endoscopic endonasal surgery for Clival Chordomas – a single institution experience and short term outcomes

Cited by 15 publications

References 20 publications

Contemporary surgical management of skull base chordomas—Anatomical reflections on a single center experience retrospective case series

Contemporary surgical management of skull base chordomas—Anatomical reflections on a single center experience retrospective case series

Usefulness of endoscope-assisted surgery under exoscopic view in skull base surgery: A technical note

A third hand to the surgeon: the use of an endoscope holding arm in endonasal sinus surgery and well beyond

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