Failure of Skull Base Defects Reconstruction after Endonasal Surgery. Complications, Treatment Options and Outcomes

Pashaev, Bakhtiyar; Danilov, V. I.; Vagapova, Gulnar; Bochkarev, Vladimir; Pichugin, Arseniy; Alekseev, Andrey; Nasibullina, Farida

doi:10.1055/s-0036-1579928

Cited by 2 publications

(4 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For posterior fossa defects, reconstruction often includes autologous fat, fascia lata, and a pedicled nasoseptal flap. 27,28,[60][61][62][63] We hypothesize that preserving the nasopharyngeal mucosa may decrease the risk of postoperative CSF leak. 22 Additionally, postoperative lumbar drainage has been shown to significantly decrease the risk of postoperative CSF leak for large posterior fossa defects.…”

Section: Discussionmentioning

confidence: 99%

“…22 Additionally, postoperative lumbar drainage has been shown to significantly decrease the risk of postoperative CSF leak for large posterior fossa defects. [61][62][63] Despite the advancement of techniques and the growing experience of skull base surgeons, CSF leak remains a significant issue with reported rates of 16.5% for EETCAs with multilayer reconstruction. 27…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Endoscopic Endonasal Middle-Inferior Clivectomy, Odontoidectomy, and Far-Medial Approach

Agosti

Alexander

Leonel

et al. 2023

J Neurol Surg B Skull Base

View full text Add to dashboard Cite

Introduction: The clival, paraclival, and craniocervical junction regions are challenging surgical targets. To approach these areas, endoscopic endonasal transclival approaches (EETCAs) and their extensions (far-medial approach and odontoidectomy) have gained popularity as they obviate manipulating and working between neurovascular structures. Although several cadaveric studies have further refined these contemporary approaches, few provide a detailed step-by-step description. Thus, we aim to didactically describe the steps of the EETCAs and their extensions for trainees. Methods: Six formalin-fixed cadaveric head specimens were dissected. All specimens were latex-injected using a six-vessel technique. Endoscopic endonasal middle and inferior clivectomies, far-medial approaches, and odontoidectomy were performed. Results: Using angled endoscopes and surgical instruments, an endoscopic endonasal midclivectomy and partial inferior clivectomy were performed without nasopharyngeal tissue disruption. To complete the inferior clivectomy, far-medial approach, and partially remove the anterior arch of C1 and odontoid process, anteroinferior transposition of the Eustachian-nasopharynx complex was required by transecting pterygosphenoidal fissure tissue, but incision in the nasopharynx was not necessary. Full exposure of the craniocervical junction necessitated bilateral sharp incision and additional inferior mobilization of the posterior nasopharynx. Unobstructed access to neurovascular anatomy of the ventral posterior fossa and craniocervical junction was provided. Conclusion: EETCAs are a powerful tool for the skull-base surgeon as they offer a direct corridor to the ventral posterior fossa and craniocervical junction unobstructed by eloquent neurovasculature. To facilitate easier understanding of the EETCAs and their extensions for trainees, we described the anatomy and surgical nuances in a didactic and step-by-step fashion.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Endoscopic Endonasal Middle-Inferior Clivectomy, Odontoidectomy, and Far-Medial Approach

Agosti

Alexander

Leonel

et al. 2023

J Neurol Surg B Skull Base

View full text Add to dashboard Cite

show abstract

“…For posterior fossa defects, reconstruction often includes autologous fat, fascia lata, and a pedicled nasoseptal flap. 28,29,[61][62][63][64] We hypothesize that preserving the nasopharyngeal mucosa may decrease the risk of postoperative CSF leak. 23 Additionally, postoperative lumbar drainage has been shown to significantly decrease the risk of postoperative CSF leak for large posterior fossa defects.…”

Section: Discussionmentioning

confidence: 99%

“…23 Additionally, postoperative lumbar drainage has been shown to significantly decrease the risk of postoperative CSF leak for large posterior fossa defects. [62][63][64] Despite the advancement of techniques and the growing experience of skull base surgeons, CSF leak remains a significant issue with reported rates of 16.5% for EETCAs with multilayer reconstruction. 28…”

Section: Discussionmentioning

confidence: 99%

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Endoscopic Endonasal Clivectomy, Odontoidectomy, and Far Medial Approach

Agosti

Yohan

Leonel

et al. 2023

32nd Annual Meeting North American Skull Base Society

View full text Add to dashboard Cite

Introduction:The clival, paraclival, and craniocervical junction regions are challenging surgical targets. To approach these areas, endoscopic endonasal transclival approaches (EETCAs) and their extensions (far-medial approach and odontoidectomy) have gained popularity as they obviate manipulating and working between neurovascular structures. Although several cadaveric studies have further refined these contemporary approaches, few provide a detailed step-by-step description. Thus, we aim to didactically describe the steps of the EETCAs and their extensions for trainees.Methods: Six formalin-fixed cadaveric head specimens were dissected. All specimens were latexinjected using a six-vessel technique. Endoscopic endonasal middle and inferior clivectomies, farmedial approaches, and odontoidectomy were performed.Results: Using angled endoscopes and surgical instruments, an endoscopic endonasal midclivectomy and partial inferior clivectomy were performed without nasopharyngeal tissue disruption. To complete the inferior clivectomy, far-medial approach, and partially remove the anterior arch of C1 and odontoid process, anteroinferior transposition of the Eustachiannasopharynx complex was required by transecting pterygosphenoidal fissure tissue, but incision in the nasopharynx was not necessary. Full exposure of the craniocervical junction necessitated bilateral sharp incision and additional inferior mobilization of the posterior nasopharynx.Unobstructed access to neurovascular anatomy of the ventral posterior fossa and craniocervical junction was provided. Conclusion:EETCAs are a powerful tool for the skull-base surgeon as they offer a direct corridor to the ventral posterior fossa and craniocervical junction unobstructed by eloquent neurovasculature. To facilitate easier understanding of the EETCAs and their extensions for trainees, we described the anatomy and surgical nuances in a didactic and step-by-step fashion.

show abstract

Failure of Skull Base Defects Reconstruction after Endonasal Surgery. Complications, Treatment Options and Outcomes

Cited by 2 publications

References 0 publications

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Endoscopic Endonasal Middle-Inferior Clivectomy, Odontoidectomy, and Far-Medial Approach

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Endoscopic Endonasal Middle-Inferior Clivectomy, Odontoidectomy, and Far-Medial Approach

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Endoscopic Endonasal Clivectomy, Odontoidectomy, and Far Medial Approach

Contact Info

Product

Resources

About