The endoscopic supraorbital approach to tumors of the middle cranial base

Kabil, Mohamed S; Shahinian, Hrayr K.

doi:10.1016/j.surneu.2006.02.042

Cited by 28 publications

(22 citation statements)

References 8 publications

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“…This strength is further enhanced by endoscopic assistance, which can provide improved visualization of surgical fields. 4,20 Other advantages include simplified skull base closure, reduced risk of CSF leak, and the absence of nasal complications. 19,37 The major weakness of this approach is the potential problem of limited space for manipulation because of the small bone window.…”

Section: Assessment Of Different Approachesmentioning

confidence: 99%

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Individualized surgical strategies for Rathke cleft cyst based on cyst location

Fan¹,

Peng²,

Qi³

et al. 2013

JNS

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R athke cleft cysts (RCCs) are regarded as benign cystic lesions derived from a remnant of the Rathke pouch. They are common findings at autopsy, with a reported incidence of 5% to 33%, and account for 6%-10% of sellar lesions. 3,9,17,32,39,46,49 Although mostly asymptomatic, some RCCs can become sufficiently large to cause compressive effect on surrounding structures, resulting in neurological and endocrine disturbances. As a result, surgical intervention is recommended for symptomatic or at-risk patients.Traditionally, the 2 most common surgical approaches are the endonasal transsphenoidal route and the standard craniotomy. The endonasal approach is typically used for sellar lesions, whereas the craniotomy is indicated for suprasellar lesions. 2,11,38,40 Owing to its reduced invasiveness Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, ChinaObject. An assessment regarding both surgical approaches and the extent of resection for Rathke cleft cysts (RCCs) based on their locations has not been reported. The aim of this study was to report the results of a large series of surgically treated patients with RCCs and to evaluate the feasibility of individualized surgical strategies for different RCCs.Methods. We retrospectively reviewed 87 cases involving patients with RCCs (16 intrasellar, 50 intra-and suprasellar, and 21 purely suprasellar lesions). Forty-nine patients were treated via a transsphenoidal (TS) approach, and 38 were treated via a transcranial (TC) approach (traditional craniotomy in 21 cases and supraorbital keyhole craniotomy in 17). The extent of resection was classified as gross-total resection (GTR) or subtotal resection (STR) of the cyst wall. Patients were thus divided into 3 groups according to the approach selected and the extent of resection: TS/STR (n = 49), TC/STR (n = 23), and TC/GTR (n = 15).Results. Preoperative headaches, visual dysfunction, hypopituitarism, and diabetes insipidus (DI) resolved in 85%, 95%, 55%, and 65% of patients, respectively. These rates did not differ significantly among the 3 groups. Overall, complications occurred in 8% of patients in TS/STR group, 9% in TC/STR group, and 47% in TC/GTR group, respectively (p = 0.002). Cerebrospinal fluid (CSF) leakage (3%), new hypopituitarism (9%), and DI (6%) were observed after surgery. All CSF leaks occurred in the endonasal group, while the TC/GTR group showed a higher rate of postoperative hypopituitarism (p = 0.7 and p < 0.001, respectively). It should be particularly noted that preoperative hypopituitarism and DI returned to normal, respectively, in 100% and 83% of patients who underwent supraorbital surgery, and with the exception of 1 patient who had transient postoperative DI, there were no complications in patients treated with supraorbital surgery. Kaplan-Meier 3-year recurrence-free rates were 84%, 87%, and 86% in the TS/STR, TC/STR, and TC/GTR groups, respectively (p = 0.9).Conclusions. It is reasonable to adopt individualized surgical strategies for RCCs based on cyst location....

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Section: Assessment Of Different Approachesmentioning

confidence: 99%

“…This technique can provide better visualization, avoid brain retraction, and further reduce invasiveness. 4,20 …”

Section: Surgical Techniquesmentioning

confidence: 99%

Individualized surgical strategies for Rathke cleft cyst based on cyst location

Fan¹,

Peng²,

Qi³

et al. 2013

JNS

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“…Batra et al has also described frontal trephination for the treatment of one patient with pneumocephalus after craniectomy . Kabil presented excision of two meningiomas through trephination . Crozier et al and Purkey et al describe the repair of cerebrospinal fluid (CSF) leak resulting from noninflammatory causes through a sole trephination approach in five patients .…”

Section: Resultsmentioning

confidence: 99%

Contemporary applications of frontal sinus trephination: A systematic review of the literature

2015

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Our objective was to perform a systematic review of the literature on contemporary indications and outcomes for frontal sinus trephination and present an illustrative case of an endoscopically assisted repair of a subcutaneous frontal sinus fistula by trephination technique. PubMed and Ovid databases were used as data sources. A systematic review of the English literature was completed to review reports of frontal trephination from 1980 to 2014. Articles meeting inclusion criteria for inflammatory and noninflammatory indications were reviewed. Articles were systematically reviewed and graded by evidence-based medicine level. An illustrative case from our institution is then presented. The systematic review identified 2,621 published studies. Thirty-eight studies were identified for inclusion. The indications, techniques, outcomes, safety, and complications were reviewed for noninflammatory and inflammatory conditions. There were 32 retrospective case series, reports, or cohort studies (level 4), four systematic reviews (level 3), one prospective analysis (level 3), and one meta-analysis (level 2). Due to the heterogeneity of study cases and inclusion criteria, a meta-analysis was not feasible. We also present a novel closure of an anterior skull base defect resulting in a subcutaneous fistula with use of a frontal trephination approach. The frontal sinus trephination should not be regarded as a procedure of the past, as it useful in the armamentarium of the modern sinus and skull base surgeon. This approach provides access for instrumentation for hard-to-reach frontal sinus disease either purely through a trephination approach or as a supplementation to the transnasal endoscopic approach. Evidence supporting frontal sinus trephination is of levels 2, 3, and 4. Level of evidence: NA.

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“…Greater visualization can be achieved with removal of the orbital bar, which reduces the working depth to the ipsilateral anterior clinoid process and results in an increase in the working volume [39,40]. The approach has been described for aneurysms of the ipsilateral anterior cerebral circulation and tumors of the middle cranial base [41,42]. Potential morbidities associated with removal of the orbital bar include injury to the supraorbital nerve and orbital structures, and suboptimal reconstruction of the orbital rim.…”

Section: Supraorbital and Transpalpebral Approaches To The Skull Basementioning

confidence: 99%