Endoscopic Transnasal Craniotomy and the Resection of Craniopharyngioma

Stamm, Aldo Cassol; Vellutini, Eduardo; Harvey, Richard J.; Nogeira, João Flávio; Herman, Diego R.

doi:10.1097/mlg.0b013e318170b5dc

Cited by 77 publications

(54 citation statements)

References 29 publications

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“…Some authors have described their own protocols for reconstruction of the sella according to the tumor extension or intraoperative findings 2,3,4,5,8 ; however, the pedicled nasoseptal flap was not included as an option in these other protocols. Since Hadad et al 9 described vascular pedicle nasoseptal flap as a novel reconstruction technique in 2006 (Hadad-Bassagasteguy flap; HBF), it has been reported that this flap can function well to separate the intradural space from the nasosinusal cavity 6,10,11,12,15 . They reported a 4.7% rate of postoperative CSF fistula in a sample of 43 patients including 20 pituitary adenomas, all of which had presented intraoperative CSF fistula and required reoperations 9 .…”

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Endoscopic combined “transseptal/transnasal” approach for pituitary adenoma: reconstruction of skull base using pedicled nasoseptal flap in 91 consecutive cases

Fujimoto

Balsalobre²,

Santos³

et al. 2015

Arq. Neuro-Psiquiatr.

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ARTICLEEndoscopic combined "transseptal/transnasal" approach for pituitary adenoma: reconstruction of skull base using pedicled nasoseptal flap in 91 consecutive cases O acesso endoscópico transeptal/transnasal em cirurgias de resseção de adenoma de hipófise: reconstrução da base do crânio combinado com a criação do flap naso-septal pediculado em 91 pacientes consecutivos Transsphenoidal surgery using a microscope is an established, less invasive surgery for pituitary adenomas. The advent of the endoscope for endonasal transsphenoidal surgery has provided a wider and more close-up panoramic view that has made more detailed, delicate procedures feasible and safer. Furthermore, recent advance in high definition (HD) imaging have made it possible to clearly differentiate a cleavage plane between a tumor and the cavernous sinus or the arachnoid membrane, likely contributing to improvements in patient outcomes. However, the ABSTRACT Objective: The purpose of this study was to describe the endoscopic combined "transseptal/transnasal" approach with a pedicled nasoseptal flap for pituitary adenoma and skull base reconstruction, especially with respect to cerebrospinal fluid (CSF) fistula. Method: Ninety-one consecutive patients with pituitary adenomas were retrospectively reviewed. All patients underwent the endoscopic combined "transseptal/transnasal" approach by the single team including the otorhinolaryngologists and neurosurgeons. Postoperative complications related to the flap were analyzed. Results: Intra-and postoperative CSF fistulae were observed in 36 (40%) and 4 (4.4%) patients, respectively. Among the 4 patients, lumbar drainage and bed rest healed the CSF fistula in 3 patients and reoperation for revision was necessary in one patient. Other flap-related complications included nasal bleeding in 3 patients (3.3%). Conclusion: The endoscopic combined "transseptal/transnasal" approach is most suitable for a two-surgeon technique and a pedicled nasoseptal flap is a reliable technique for preventing postoperative CSF fistula in pituitary surgery.Keywords: cerebrospinal fluid fistula, endoscopic endonasal approach, pedicled nasoseptal flap, pituitary adenoma. RESUMOObjetivo: O objetivo deste estudo foi descrever o acesso endoscópico transeptal/transnasal combinado com a criação do flap nasoseptal pediculado para reconstrução da base do crânio em cirurgias de resseção de adenoma de hipófise, especialmente nos casos que ocorrem fístula líquido cefalorraquidiano (FLC). Método: Noventa e um pacientes consecutivos portadores de adenoma de hipófise foram retrospectivamente revisados. Complicações pós-operatórias relacionadas ao flap foram analisadas. Resultados: Fístulas líquido cefalorraquidiano intra e pós-operatórias foram observadas em 36 (40%) e 4 (4,4%) dos pacientes, respectivamente. Entre os 4 pacientes, drenagem lombar e repouso absoluto foram suficientes para o fechamento da fístula e intervenção cirúrgica foi necessária em apenas um paciente. Outra complicação relacionada ao flap foi o sangramento em 3 (3,3%)...

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Endoscopic combined “transseptal/transnasal” approach for pituitary adenoma: reconstruction of skull base using pedicled nasoseptal flap in 91 consecutive cases

Fujimoto

Balsalobre²,

Santos³

et al. 2015

Arq. Neuro-Psiquiatr.

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“…However, longer followup studies are needed to confirm its long-term effectiveness. [10][11][12][13][14]19,23,24,30,32,[35][36][37]40,41,57,60 implications for cP treatment strategy…”

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Growth patterns of craniopharyngiomas: clinical analysis of 226 patients

Pan¹,

Qi²,

Liu³

et al. 2016

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OBJECT Craniopharyngiomas (CPs) are rare epithelial tumors that are often associated with an enigmatic and unpredictable growth pattern. Understanding the growth patterns of these tumors has a direct impact on surgical planning and may enhance the safety of radical tumor removal. The aim of this study was to analyze the growth patterns and surgical treatment of CPs with a focus on the involvement of the hypothalamopituitary axis and the relationship of the tumor to the arachnoid membrane and surrounding structures. METHODS Clinical data from 226 consecutive patients with primary CP were retrospectively reviewed. Tumor location and the relationship of the tumor to the third ventricle floor and the pituitary stalk were evaluated using preoperative MRI and intraoperative findings. A topographic classification scheme was proposed based on the site of tumor origin and tumor development. The clinical relevance of this classification on patient presentation and outcomes was also analyzed. RESULTS The growth of CPs can be broadly divided into 3 groups based on the site of tumor origin and on tumor-meningeal relationships: Group I, infrasellar/infradiaphragmatic CPs (Id-CPs), which mainly occurred in children; Group II, suprasellar subarachnoid extraventricular CPs (Sa-CPs), which were mainly observed in adults and rarely occurred in children; and Group III, suprasellar subpial ventricular CPs (Sp-CPs), which commonly occurred in both adults and children. Tumors in each group may develop complex growth patterns during vertical expansion along the pituitary stalk. Tumor growth patterns were closely related to both clinical presentation and outcomes. Patients with Sp-CPs had more prevalent weight gain than patients with Id-CPs or Sa-CPs; the rates of significant weight gain were 41.7% for children and 16.7% for adults with Sp-CPs, 2.2% and 7.1% for those with Id-CPs, and 12.5% and 2.6% for those with Sa-CPs (p < 0.001). Moreover, patients with Sp-CPs had increased hypothalamic dysfunction after radical removal; 39% of patients with Sp-CPs, 14.5% with Id-CPs, and 17.4% with Sa-CPs had high-grade hypothalamic dysfunction in the first 2 postoperative years (p < 0.001). CONCLUSIONS The classification of CPs based on growth pattern may elucidate the best course of treatment for this formidable tumor. More tailored, individualized surgical strategies based on tumor growth patterns are mandatory to provide long-term tumor control and to minimize damage to hypothalamic structures. Differences in the distribution of growth patterns between children and adults imply that hierarchical comparison is necessary when investigating outcomes and survival across treatment paradigms in patients with CP.

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“…1 The expanded endonasal approach (EEA) and its modifications provide access to the anterior skull base, planum, sphenoid, sella, clivus, cervical spine, and infratemporal fossa via the two nostrils. [2][3][4][5][6][7][8][9] This approach enables endoscopic extradural and intradural tumor resection and skull base reconstruction in a single procedure.…”

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confidence: 99%