Transsphenoethmoid Approach to the Sphenoid Sinus and Clivus

Lalwani, Anil K.; Kaplan, Mehmet; Gutin, Philip H.; Habal, Mutaz B.

doi:10.1097/00001665-199307000-00016

Cited by 19 publications

(22 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The extended transsphenoidal 3 -or transsphenoethmoidal approach incorporating an osteotomy of the frontal process of the maxilla ipsilateral to the lesion-can be used for tumors involving the upper clivus, sella turtica area, or the medial part of the cavernous sinus. 3,25,26 The transoral approach is only suitable for extradural tumors at the ventral CCJ with minimal lateral extension. In our series, only partial or subtotal removal could be achieved using the transoral approach.…”

Section: Neurosurgical Focus / Volume 10 / March 2001mentioning

confidence: 99%

Surgical approaches and strategies for skull base chordomas

Tamaki

Nagashima²,

Ehara³

et al. 2001

FOC

View full text Add to dashboard Cite

Object The management of chordomas involving the skull base continues to present a number of treatment-related problems. Recently, both radical resection and charged-particle irradiation or stereotactic radiosurgery have reportedly been found effective for tumor control and for promoting a better quality of life in patients. In this article the authors analyzed the outcomes in 17 patients with skull base chordomas who were surgically treated at Kobe University Hospital between 1972 and 2000. Methods Preoperative radiological examinations included magnetic resonance imaging, computerized tomography, angiography, and balloon occlusion test of the internal carotid artery. Among the various surgical approaches used to remove the tumor were the frontoorbitozygomatic, transmaxillary, transcondylar, transsphenoidal, and the transbasal. Total removal was achieved in two (12%), near-total removal in three (18%), subtotal removal in nine (52%), and partial removal in three patients (18%). Since 1990, chordomas have been radically resected via various skull base approaches; the combined total or near-total removal rate has been 80% in this period. Radical removal of the tumors has not led to an increased risk. At the final follow-up review (mean 59.5 month), 75% of the patients were still alive, and 25% had died of chordoma recurrence. The overall recurrence-free survival rate was 82% at 3 years and 51% at 5 years. The 5-year recurrence-free survival rate in the five patients who underwent the operation during the past decade was 77% (mean follow up of 5.2 years). In two patients with recurrent tumors who underwent radiosurgery, no evidence of tumor regrowth was demonstrated at 3 years posttreatment. Conclusions The authors suggest that for the treatment of skull base chordomas radical resection is a key factor for longer survival and improved quality of life. Patients with sufficiently small tumors, which show a favorable configuration and location, can be suitable candidates for stereotactic radiosurgery.

show abstract

Section: Neurosurgical Focus / Volume 10 / March 2001mentioning

confidence: 99%

Surgical approaches and strategies for skull base chordomas

Tamaki

Nagashima²,

Ehara³

et al. 2001

FOC

View full text Add to dashboard Cite

show abstract

“…12,13,16,19,25,31,34,35,[37][38][39][40]45,46,50,58,65 In contrast to traditional cranial base surgical approaches, the endonasal technique offers a direct and minimally invasive approach that allows excellent midline access to and visibility of the suprasellar, retrosellar, and retroclival spaces, while obviating brain retraction. 10,13,14,29,42,45,48,50,54,63,66 Such approaches have recently been integrated and expanded with the use of the endoscope. In fact, this tool has boosted the use of the Object.…”

mentioning

confidence: 99%

Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations

Cavallo

Messina²,

Cappabianca³

et al. 2005

FOC

166

190

View full text Add to dashboard Cite

Object The midline skull base is an anatomical area that extends from the anterior limit of the cranial fossa down to the anterior border of the foramen magnum. Resection of lesions involving this area requires a variety of innovative skull base approaches. These include anterior, anterolateral, and posterolateral routes, performed either alone or in combination, and resection via these routes often requires extensive neurovascular manipulation. The goals in this study were to define the application of the endoscopic endonasal approach and to become more familiar with the views and skills associated with the technique by using cadaveric specimens. Methods To assess the feasibility of the endonasal route for the surgical management of lesions in the midline skull base, five fresh cadaver heads injected with colored latex were dissected using a modified endoscopic endonasal approach. Full access to the skull base and the cisternal space around it is possible with this route. From the crista galli to the spinomedullary junction, with incision of the dura mater, a complete visualization of the carotid and vertebrobasilar arterial systems and of all 12 of the cranial nerves is obtainable. Conclusions The major potential advantage of the endoscopic endonasal approach to the skull base is that it provides a direct anatomical route to the lesion without traversing any major neurovascular structures, obviating brain retraction. Many tumors grow in a medial-to-lateral direction, displacing structures laterally as they expand, creating natural corridors for their resection via an anteromedial approach. Potential disadvantages of this procedure include the relatively restricted working space and the danger of an inadequate dural repair with cerebrospinal fluid (CSF) leakage and potential for meningitis resulting. These approaches often require a large opening of the dura mater over the tuberculum sellae and posterior planum sphenoidale, or retroclival space. In addition, they typically involve large intraoperative CSF leaks, which necessitate precise and effective dural closure.

show abstract

“…A detailed analysis of the advantages and disadvantages of each approach proposed for resection of skull base chordomas is beyond the scope of this article, and excellent reports have already been published on this topic. 1,11,17,23,26,27,33,36,37,45,47,51,55,57,58,76,[86][87][88][89]94 Careful study of the preoperative neuroradiological studies is essential when planning the surgical approach to these challenging lesions. In recent years, continuous refinements of frameless stereotactic systems have come to provide the surgeon with intraoperative feedback regarding surgical orientation.…”

mentioning

confidence: 99%

Skull base chordomas: overview of disease, management options, and outcome

Lanzino¹,

As²,

Mb³

et al. 2001

FOC

104

View full text Add to dashboard Cite

Cranial base chordomas are locally invasive tumors that, from a midline, clival location, extend in different directions and display various patterns of skull base invasion. Although histologically benign, their invasive nature makes true “oncological” resection virtually impossible to achieve in most cases, despite modern skull base surgical techniques. Moreover, because of the tumor's location and proximity to critical neural and vascular structures, surgery-related morbidity can be significant when an aggressive resection is undertaken. Cytoreductive surgery assumes a critical role in the management of these lesions. The choice of surgical approach and the extent of resection are dependent on several factors: location and extension of the tumor, the surgeon's philosophy and familiarity with a specific approach, and the patient's preexisting clinical status. Proton-beam radiotherapy seems to be effective as an adjunct to surgery in achieving local tumor control. The timing of radiation therapy, however, remains controversial. Gamma knife surgery has been proposed as an adjunctive therapy, but the limited experience and short follow-up periods do not permit formulation of meaningful conclusions at this time. Recurrences are common, although in a subset of patients prolonged disease-free survival is demonstrated.

show abstract

Transsphenoethmoid Approach to the Sphenoid Sinus and Clivus

Cited by 19 publications

References 0 publications

Surgical approaches and strategies for skull base chordomas

Surgical approaches and strategies for skull base chordomas

Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations

Skull base chordomas: overview of disease, management options, and outcome

Contact Info

Product

Resources

About