Extended Endoscopic Approaches to the Skull Base

Castelnuovo, Paolo; Locatelli, Davide; Mauri, Sílvia; Bernardi, Fiorenza De

doi:10.1007/978-3-7091-6084-8_9

Cited by 18 publications

(14 citation statements)

References 16 publications

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“…Recently, a variety of techniques for the reconstruction of skull base defects have been reported. 5,7,[14][15][16][17][18] Based on more than 800 endoscopic endonasal approaches to the sellar region and skull base, we have noticed that the most effective closure method is the extradural technique. 7) Therefore, in this case we used a thin layer of synthetic dural substitute in an``overlay'' position, between the dural tear and the bone, 7) covered by autologous mucoperichondrium harvested from the removed middle nasal turbinate, and positioned with the mucosal surface facing the sphenoidal cavity.…”

Section: Discussionmentioning

confidence: 99%

“…3,[5][6][7]18) In this manner, even limited incisions to the abdomen or leg to harvest fascia lata or fat tissue can be avoided, as previous reconstructions have generally been performed using abdominal fat or fascia lata. 1,5,6,9,18) Nevertheless, no consensus has yet been established regarding the material or combination of materials and methods that can be considered the optimal remedy for repairing osteodural defects, with each option providing a similar number of pros and cons. The choice of adequate technique and materials to be used should therefore be addressed in each case based on the experience of the surgeon and the features of the osteodural defect.…”

Section: Discussionmentioning

confidence: 99%

“…18,20,22) The widespread application of endoscopic endonasal techniques extending beyond the sellar region 2,4,11) has recently led neurosurgeons and otorhinolaryngological surgeons to advocate this technique as a possible treatment option for CSF leaks. 5,6,15,18,22) We report a case of traumatic ethmoidal leak that was successfully treated using a purely endoscopic endonasal method.…”

Section: Introductionmentioning

confidence: 99%

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Purely Endoscopic Repair of Traumatic Cerebrospinal Fluid Rhinorrhea From the Anterior Skull Base -Case Report-

Komatsu

Cavallo

et al. 2011

Neurol. Med. Chir.(Tokyo)

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A 38-year-old woman presented with a case of post-traumatic ethmoidal cerebrospinal fluid (CSF) leak that was repaired using a purely endoscopic endonasal approach. Six weeks after a mild domestic maxillofacial trauma, she started complaining of clear, watery discharge from the left nostril and headache. Neuroimaging investigations disclosed a linear fracture of the left anterior ethmoidal roof without evidence of large bony breaches or any brain tissue damage. After conservative medical treatment with carbonic anhydrase inhibitors failed, she was referred to our hospital for surgical repair of the osteodural defect. An endoscopic endonasal transethmoidal approach was successfully performed, and an overlay technique was used to reconstruct the defect. The patient was discharged without clinical evidence of CSF rhinorrhea and no leaks were apparent at the 3-month follow-up clinical and radiological examinations. Post-traumatic CSF rhinorrhea occurs in cases of dural tears associated with small bone breaks, most frequently involving the anterior skull base. Recovery is often spontaneous following only bed rest, or with medical treatments such as inhibitors of carbonic anhydrase diuretics, steroids, or eventually stool softeners to help reduce CSF pressure. Surgical repair is required when first-line conservative treatment proves ineffective. The present case shows that the endoscopic endonasal technique for the management of CSF leaks provides a less invasive surgical route to achieve valid dural repair.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Purely Endoscopic Repair of Traumatic Cerebrospinal Fluid Rhinorrhea From the Anterior Skull Base -Case Report-

Komatsu

Cavallo

et al. 2011

Neurol. Med. Chir.(Tokyo)

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“…Indeed, in these cases, after tumor removal the whole ventricular system is opened to the suprasellar cisterns, and the plastic repair should be resistant to high CSF pressure. 7,21 The size of the bone and dura opening is relevant for postoperative CSF leakage. In this setting, the risk of a postoperative CSF leak is increased by coughing and vomiting after emergence from anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…In this setting, the risk of a postoperative CSF leak is increased by coughing and vomiting after emergence from anesthesia. 7 Thus, special care would be taken to have a smooth arousal from anesthesia, minimizing the effects of these maneuvers. Furthermore, careful observation and patient monitoring should be performed in the first days after surgery to detect any CSF leak early, avoiding the development of meningitis.…”

Section: Discussionmentioning

confidence: 99%

Expanding indications for the extended endoscopic endonasal approach to hypothalamic gliomas: preliminary report

Zoli¹,

Mazzatenta²,

Valluzzi³

et al. 2014

FOC

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Object In the last decade the indications for the endoscopic endonasal approach have been progressively expanded to include lesions that have not been traditionally considered amenable to resection through the transsphenoidal route. In this study, the authors analyze their experience with hypothalamic gliomas treated via the endoscopic endonasal approach. Methods Consecutive cases of hypothalamic gliomas treated since 2007 via an endoscopic endonasal approach were reviewed. Preoperative and postoperative neuroimaging as well as endocrinological, neurological, and visual symptoms were analyzed to assess the surgical outcome. Signs and symptoms of hypothalamic dysfunction including body mass index (BMI), memory, sleep-wake rhythm, and polyphagia were prospectively collected pre- and postoperatively to assess hypothalamic function. Quality of life was evaluated using the Katz scale. Results In the initial phase the endoscopic endonasal approach was adopted in 3 cases with a palliative intent, to obtain a biopsy sample or for debulking of the mass followed by radio- or chemotherapy. In 2 later cases it was successfully adopted to achieve gross-total tumor resection. Complications consisted of 2 postoperative CSF leaks, which required an endoscopic endonasal reintervention. Visual deficit improved in 3 cases and normalized in the other 2. Four patients developed diabetes insipidus, and 3 an anterior panhypopituitarism. All patients had a moderate increase in BMI. No patients presented with any other signs of hypothalamic damage, and their quality of life at follow-up is normal. Conclusions Despite the limitations of a short follow-up and small sample, the authors’ early experience with the endoscopic endonasal approach has revealed it to be a direct, straightforward, and safe approach to third ventricle astrocytomas. It allowed the authors to perform tumor resection with the same microsurgical technique: dissecting the tumor with 2 hands, performing a central debulking, and controlling the bleeding with bipolar coagulation. The main limitations were represented by some anatomical conditions, such as the position of the chiasm and the anterior communicating artery complex and, finally, by the challenge of watertight plastic repair. To definitively evaluate the role of this approach in hypothalamic gliomas, a comparison with transcranial series would be necessary, but due to the rarity of these cases such a study is still lacking. The authors observed that more aggressive surgery is associated with a worse endocrinological outcome; thus they consider it to be an open question (in particular in prepubertal patients) whether radical removal is an advisable goal for hypothalamic gliomas.