Expanded endoscopic endonasal approach for extending suprasellar and third ventricular lesions

Objective: Surgical access to the third ventricle can be achieved through various corridors depending on the location and extent of the lesion; however, traditional transcranial approaches risk damage to multiple critical neural structures. Methods: Endonasal approach similar to corridor of the reverse third ventriculostomy (ERTV) was surgically simulated in eight cadaveric heads. Fiber dissections were additionally performed within the third ventricle along the endoscopic route. Additionally, we present a case of ERTV in a patient with craniopharyngioma extending into the third ventricle. Results: The ERTV allowed adequate intraventricular visualization along the third ventricle. The extracranial step of the surgical corridor included a bony window in the sellar floor, tuberculum sella and the lower part of the planum sphenoidale. ERTV provided an intraventricular surgical field along the foramen of Monro to expose an area bordered by the fornix anteriorly, thalamus laterally, anterior commissure anterior superiorly, posterior commissure, habenula and pineal gland posteriorly, and aqueduct of Sylvius centered posterior inferiorly. Conclusion: The third ventricle can safely be accessed through ERTV either above or below the pituitary gland. ERTV provides a wide exposure of the third ventricle through the tuber cinereum and offers access to the anterior part as far as the anterior commissure and pre-commissural part of fornix and the whole length of the posterior part. Endoscopic ERTV may be a suitable alternative to transcranial approaches to access the third ventricle in selected patients.

Section: Resultsmentioning

confidence: 99%

Section: Ertv In Relation To the Lesion And Its Predicted Distortion ...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Endoscopic Endonasal Approach to the Third Ventricle Using the Surgical Corridor of the Reverse Third Ventriculostomy: Anatomo-Surgical Nuances

Çamlar

Turkis

Bayramlı

et al. 2022

“…Accordingly, different growth patterns of tumors within the third ventricle may affect surgical access 4 ; therefore, ERTV may be more suitable for lesions that can expand the surgical path naturally to reach the third ventricle from the sellar region. 30 We are aware of the fact that endoscopic endonasal transtuber cinereum route to third ventricle have been used in most of the surgeries for craniopharyngiomas, since these suprasellar tumors mostly arise in the vicinity of the pituitary stalk, thus, creating the tumor's own portal to expand into the third ventricle.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Endonasal Approach to the Third Ventricle Using the Surgical Corridor of the Reverse Third Ventriculostomy: Anatomo-Surgical Nuances

Çamlar

Turkis

Bayramlı

et al. 2022

Objective Surgical access to the third ventricle can be achieved through various corridors depending on the location and extent of the lesion; however, traditional transcranial approaches risk damage to multiple critical neural structures. Methods Endonasal approach similar to corridor of the reverse third ventriculostomy (ERTV) was surgically simulated in eight cadaveric heads. Fiber dissections were additionally performed within the third ventricle along the endoscopic route. Additionally, we present a case of ERTV in a patient with craniopharyngioma extending into the third ventricle. Results The ERTV allowed adequate intraventricular visualization along the third ventricle. The extracranial step of the surgical corridor included a bony window in the sellar floor, tuberculum sella, and the lower part of the planum sphenoidale. ERTV provided an intraventricular surgical field along the foramen of Monro to expose an area bordered by the fornix anteriorly, thalamus laterally, anterior commissure anterior superiorly, posterior commissure, habenula and pineal gland posteriorly, and aqueduct of Sylvius centered posterior inferiorly. Conclusion The third ventricle can safely be accessed through ERTV either above or below the pituitary gland. ERTV provides a wide exposure of the third ventricle through the tuber cinereum and offers access to the anterior part as far as the anterior commissure and precommissural part of fornix and the whole length of the posterior part. Endoscopic ERTV may be a suitable alternative to transcranial approaches to access the third ventricle in selected patients.

“…8 9 Skull base reconstruction, which plays an essential role in preventing postoperative cerebrospinal fluid leaks, brain herniation, tension pneumocephalus, and meningitis, severely restricted the application and development of the extended endonasal approaches. The multilayer reconstruction technique 10 (fat, fascia lata inlay, and onlay, nasoseptal ﬂap covering the whole defect, plus Dura Seal or other ﬁbrin glue) is predominant method in many countries around the world. In this study, we used the biomembrane inlay inside of the dura, served as the first layer to achieve watertight closure.…”

Section: Discussionmentioning

confidence: 99%

Clinical Efficacy of the Multilayered Skull Base Reconstruction Using In Situ Bone Flap in Endoscopic Endonasal Approach for Craniopharyngioma

Zhou

Hei

Soto

et al. 2021

Objective The aim of the study is to summarize and analyze the efficacy of the multilayered skull base reconstruction using in situ bone flap in endoscopic endonasal approach (EEA) for craniopharyngiomas. Methods A retrospective review of 65 patients who underwent resection of their histopathology confirmed craniopharyngiomas performed at a single institution. Based on the team's understanding and mastery of skull base reconstruction techniques, patients were divided into two groups according to the methods of reconstruction in two periods. First (March 2015 through August 2016), osseous reconstruction was not adopted and served as the control group (34 cases). Second (September 2016 through July 2019), in situ bone flap repair of the skull base (complete osseous reconstruction) served as observation group (31 cases). The length of hospitalization and nasal exudation, bed rest time of hospital discharge, the incidence of cerebrospinal fluid leaks, lumbar drainage, and intracranial/pulmonary infections were collected and compared. Results Compared with the control group, patients in the observation group had obviously less lumbar drainage and CSF leakage (p < 0.05), but had no significant difference in cases of re-operation, meningitis, and pulmonary infection. At the meantime, cases of nasal exudation, bed rest, and hospitalization of the observation group were significantly reduced (p < 0.05) in the observation group. Conclusion The multilayered reconstruction technique (especially using in situ bone flap, combined with vascularized pedicled nasoseptal flap) is a safe and effective method in achieving watertight closure after EEEA, and can significantly reduce the incidence of cerebrospinal fluid leaks, and facilitate rehabilitation in skull base reconstruction of craniopharyngiomas.