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1.
No Shinkei Geka ; 52(4): 762-771, 2024 Jul.
Article in Japanese | MEDLINE | ID: mdl-39034514

ABSTRACT

Recent advancements in endoscopic transnasal surgery(ETS)have expanded the application of this technique to meningiomas in the central skull base area, offering a less invasive alternative with a potentially lower physical burden on patients than conventional microscopic skull base surgery. Notably, while ETS allows surgeons to reach tumors without traversing the brain and nerves, thus theoretically reducing the risk of cranial nerve damage, it requires a high level of proficiency to avoid inadequate resection and tumor recurrence. In this article, we discuss the various surgical considerations, including preoperative imaging, surgical setting, nasal cavity expansion, skull base opening, tumor removal, and skull base reconstruction, as general procedures for specific meningiomas. We further describe the concept and details of our multi-layer fascial closure technique for dural repair in ETS, underlining the importance of skilled dural reconstruction in preventing postoperative complications. In conclusion, while ETS for skull base meningiomas presents a promising and less invasive treatment option, its success relies heavily on the surgeon's experience and understanding of the skull base anatomy, stressing the need for careful approach selection.


Subject(s)
Meningeal Neoplasms , Meningioma , Skull Base Neoplasms , Humans , Meningioma/surgery , Meningioma/diagnostic imaging , Skull Base Neoplasms/surgery , Meningeal Neoplasms/surgery , Meningeal Neoplasms/diagnostic imaging , Skull Base/surgery , Skull Base/diagnostic imaging , Endoscopy/methods , Neurosurgical Procedures/methods
2.
Neurosurg Rev ; 47(1): 334, 2024 Jul 16.
Article in English | MEDLINE | ID: mdl-39009883

ABSTRACT

PURPOSE: The past two decades have witnessed the rise of keyhole microscopic minimally invasive surgeries, including the transciliary supraorbital approach (TCA) and transpalpebral approach (TPA), commonly known as the transorbital approach. This study aims to elucidate the nuances, specific indications, and advantages of each approach. METHODS: A series of dissections were conducted on five formalin-fixed, alcohol-preserved cadaver heads. The TCA was performed on one side, and the TPA on the other. Virtual measurements of working angles for both approaches were recorded. Additionally, three clinical cases were presented to illustrate the practical application of the techniques. RESULTS: For TCA, the craniotomy dimensions were 1.7 cm x 2.5 cm (Cranial-Caudal (CC) x Lateral-Lateral (LL)), while for TPA, they measured 2.1 cm x 2.9 cm (CC x LL). The measurements of anterior clinoid processes (ACP) were obtained and compared between approaches. In the TCA, the mean ipsilateral ACP measurement was 62 mm (Range: 61 -63 mm), and the mean contralateral ACP measurement was 71.2 mm (Range: 70 -72 mm). In TPA, these measurements were 47.8 mm (Range: 47 -49 mm) and 62.8 mm (Range: 62 -64 mm), respectively. TCA exhibited an average cranial-caudal angle of 14.9°, while TPA demonstrated an average of 8.3°. CONCLUSION: The anterior cranial fossa was better exposed by a TCA, which also featured shorter operative times, enhanced midline visualization, and a quicker learning curve. Conversely, the middle fossa was better exposed by a TPA, making it an excellent option for middle fossa pathologies, including those in the anterior temporal lobe. After sphenoid bone wing drilling, the TPA offers superior visualization from the lateral to the medial aspect and enhances the CC angle. Additionally, the TPA reduces the risk of postoperative frontalis palsy based on anatomic landmarks. However, the TPA requires a greater cranial osteotomy, and due to unfamiliarity with eyelid anatomy, the learning curve for most neurosurgeons is lengthier for this procedure.


Subject(s)
Cadaver , Craniotomy , Skull Base , Humans , Craniotomy/methods , Skull Base/surgery , Skull Base/anatomy & histology , Male , Female , Minimally Invasive Surgical Procedures/methods , Middle Aged , Orbit/anatomy & histology , Orbit/surgery , Neurosurgical Procedures/methods , Aged , Adult , Microsurgery/methods
3.
Adv Tech Stand Neurosurg ; 52: 29-61, 2024.
Article in English | MEDLINE | ID: mdl-39017785

ABSTRACT

Presently, endoscopic skull base surgery has undergone significant advancements since its inception over two decades ago. Nevertheless, it is imperative to underscore that the fundamental basis of all surgical procedures lies in the meticulous understanding of anatomy, with particular emphasis on the ventral anatomy. This facet has recently garnered increased attention.Following the advancements in endoscopic skull base surgery techniques, this chapter will concentrate on the pertinent anatomical considerations that serve as key foundations for successful procedures. These considerations are categorized into two planes: the sagittal plane and the coronal plane.The sagittal plane is further subdivided into five distinct approaches, namely,(1) the transcribriform approach, (2) the transplanum approach, (3) the transsellar approach, (4) the transclival approach, and (5) the transodontoid approach.On the other hand, the coronal plane is delineated into seven specific zones to facilitate comprehension and potential applications: (1) the petrous apex approach, (2) the intrapetrous approach, (3) the suprapetrous approach, (4) the cavernous sinus approach, (5) the infratemporal approach, (6) the medial condyle approach, and (7) the jugular foramen approach.By organizing the anatomical aspects in this systematic manner, the information provided becomes more accessible, fostering a comprehensive understanding of the subject matter for potential future application.


Subject(s)
Skull Base , Humans , Skull Base/anatomy & histology , Skull Base/surgery , Neuroendoscopy/methods , Endoscopy/methods , Neurosurgical Procedures/methods
4.
Adv Tech Stand Neurosurg ; 52: 183-205, 2024.
Article in English | MEDLINE | ID: mdl-39017795

ABSTRACT

The endoscopic superior eyelid transorbital approach has emerged as a notable and increasingly utilized surgical technique in recent years. This chapter presents an overview of the approach, tracing its historical development and highlighting its growing acceptance within the skull base community.Beginning with an introduction and historical perspective, the chapter outlines the evolution of the transorbital approach, shedding light on its origins and the factors driving its adoption. Subsequently, a comprehensive exploration of the anatomic bone pillars and intracranial spaces accessible via this approach is provided. Hence, five bone pillars of the transorbital approach were identified, namely the lesser sphenoid wing, the anterior clinoid, the sagittal crest, the middle cranial fossa, and the petrous apex. A detailed correlation of those bone targets with respective intracranial areas has been reported.Furthermore, the chapter delves into the practical application of the technique through a case example, offering insights into its clinical utility, indications, and limitations.


Subject(s)
Orbit , Skull Base , Humans , Orbit/surgery , Orbit/anatomy & histology , Skull Base/surgery , Skull Base/anatomy & histology , Neuroendoscopy/methods , History, 20th Century
5.
Acta Neurochir (Wien) ; 166(1): 302, 2024 Jul 22.
Article in English | MEDLINE | ID: mdl-39037618

ABSTRACT

PURPOSE: Sinus thrombosis is a common post-operative finding after posterior fossa surgery performed in the vicinity of the dural venous sinuses. The SARS-CoV-2 virus has been shown to confer an increased risk of venous thromboembolic events owing to eliciting a hyper-inflammatory and pro-thrombotic state. In this study, we examine the incidence of post-operative venous sinus thrombosis in patients undergoing peri-sigmoid posterior fossa surgery in the pre- and post-COVID era and investigate whether COVID infection confers an increased risk of sinus thrombosis. METHODS: A retrospective review of a single institution case series of patients underwent peri-sigmoid surgery (retrosigmoid, translabyrinthine, or far lateral) approach. Relevant clinical variables were investigated that may confer an increased risk of sinus thrombosis. RESULTS: A total of 311 patients (178 in the pre-COVID era, and 133 operated on after the pandemic began in March 2020) are included in the study. The composite incidence of sinus thrombosis seen on post-operative imaging was 7.8%. The incidence of sinus thrombosis in the pre-COVID cohort was N = 12 patients (6.7%) versus N = 12 (9%) in the post-COVID cohort (p = 0.46). A history of COVID infection was not shown to confer an increased risk of post-operative sinus thrombosis (OR: 0.61; 95% CI: 0.08-4.79, p = 0.64). Only a small number of patients (N = 7, 2.3%) required either medical or surgical intervention for post-operative sinus thrombosis. CONCLUSION: The overall incidence of post-operative sinus thrombosis is similar in the pre- and post-COVID era. The findings of this study suggest that COVID infection is not associated with a higher risk of venous sinus thrombosis.


Subject(s)
COVID-19 , Postoperative Complications , Sinus Thrombosis, Intracranial , Humans , COVID-19/epidemiology , COVID-19/complications , Male , Female , Middle Aged , Incidence , Retrospective Studies , Sinus Thrombosis, Intracranial/epidemiology , Sinus Thrombosis, Intracranial/etiology , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Aged , Adult , Skull Base/surgery , Neurosurgical Procedures/adverse effects , Risk Factors
6.
Neurol India ; 72(3): 626-628, 2024 May 01.
Article in English | MEDLINE | ID: mdl-39041984

ABSTRACT

Bone wax is an important hemostatic agent used in neurosurgical practice from more than a century. It acts by mechanical tamponade effect to stop the oozing from cancellous bone. Bone wax application over the skull surface over the vertex is easy and can be applied with fingers. In deeper areas, one uses dissector to apply the bone wax; however, it becomes difficult at times to apply in transnasal surgery using the same dissectors. Author designed a cost-effective 20-cm-long different angled bone wax applicator for skull base transnasal surgery. This applicator is cost-effective and not described previously in English literature.


Subject(s)
Palmitates , Skull Base , Waxes , Humans , Skull Base/surgery , Palmitates/economics , Cost-Benefit Analysis , Neurosurgical Procedures/methods , Neurosurgical Procedures/instrumentation , Neurosurgical Procedures/economics
7.
World Neurosurg ; 187: 288-293, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38970199

ABSTRACT

Cerebrospinal fluid (CSF) leaks may occur at the skull base or along the spinal column and can cause a variety of debilitating neurological symptoms for patients. Recognizing the potential presence of a CSF leak and then identifying its source are necessary for accurate diagnosis and definitive treatment. A standardized workflow can be followed for successful leak localization, which often requires several diagnostic studies, and for definitive leak treatment, which can range from minimally invasive, needle-based approaches to a variety of surgical corrections. This review paper provides an overview of epidemiology, pathophysiology, and diagnostic workup for CSF leaks and introduces available treatment options. An illustrative case of a skull base CSF leak demonstrating diagnosis and surgical correction is provided.


Subject(s)
Cerebrospinal Fluid Leak , Humans , Cerebrospinal Fluid Leak/therapy , Cerebrospinal Fluid Leak/surgery , Cerebrospinal Fluid Leak/diagnosis , Cerebrospinal Fluid Leak/diagnostic imaging , Skull Base/surgery , Skull Base/diagnostic imaging , Neurosurgical Procedures/methods
8.
Acta Neurochir (Wien) ; 166(1): 311, 2024 Jul 31.
Article in English | MEDLINE | ID: mdl-39085521

ABSTRACT

BACKGROUND: For a minimally invasive treatment approach to the anteromedial part of the anterior cranial fossa (ACF), a small incision and craniotomy of the posterolateral part of the ACF are preferable. METHOD: We described the concept and technique of suprapterional keyhole approach (SPKA), which uses an exoscope and endoscope to treat ACF lesions. CONCLUSION: The SPKA enables ACF observation from the lateral direction; the endoscope's extended viewing angles enable the observation of the anteromedial part of the ACF, including the bilateral olfactory groove. Facial skin and large scalp incisions are avoided, making this approach efficient for ACF lesions.


Subject(s)
Cranial Fossa, Anterior , Craniotomy , Skull Base Neoplasms , Humans , Skull Base Neoplasms/surgery , Skull Base Neoplasms/diagnostic imaging , Craniotomy/methods , Cranial Fossa, Anterior/surgery , Skull Base/surgery , Skull Base/diagnostic imaging , Minimally Invasive Surgical Procedures/methods , Neurosurgical Procedures/methods , Male , Female , Middle Aged
9.
Front Endocrinol (Lausanne) ; 15: 1353494, 2024.
Article in English | MEDLINE | ID: mdl-38899009

ABSTRACT

Aims: Post-operative CSF leak is the major source of morbidity following transsphenoidal approaches (TSA) and expanded endonasal approaches (EEA) to lesions of the sella turcica and the ventral skull base. There are conflicting reports in the literature as to whether obesity (BMI ≥30) is a risk factor for this complication. We aimed to evaluate data collected as part of prospective multi-centre cohort study to address this question. Methods: The CRANIAL (CSF Rhinorrhoea After Endonasal Intervention to the Skull Base) study database was reviewed and patients were divided into obese and non-obese cohorts. Data on patient demographics, underlying pathology, intra-operative findings and skull base repair techniques were analysed. Results: TSA were performed on 726 patients, of whom 210 were obese and 516 were non-obese. The rate of post-operative CSF leak in the obese cohort was 11/210 (5%), compared to 17/516 (3%) in the non-obese cohort, which was not statistically significant (χ2 = 1.520, p=0.217). EEA were performed on 140 patients, of whom 28 were obese and 112 were non-obese. The rate of post-operative CSF leak in the obese cohort was 2/28 (7%), which was identical to the rate observed in the non-obese cohort 8/112 (7%) Fisher's Exact Test, p=1.000). These results persisted following adjustment for inter-institutional variation and baseline risk of post-operative CSF leak. Conclusion: CSF leak rates following TSA and EEA, in association with modern skull base repair techniques, were found to be low in both obese and non-obese patients. However, due to the low rate of post-operative CSF leak, we were unable to fully exclude a small contributory effect of obesity to the risk of this complication.


Subject(s)
Cerebrospinal Fluid Leak , Obesity , Postoperative Complications , Skull Base , Humans , Obesity/complications , Female , Male , Skull Base/surgery , Cerebrospinal Fluid Leak/etiology , Cerebrospinal Fluid Leak/epidemiology , Middle Aged , Prospective Studies , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Adult , Aged , Endoscopy/adverse effects , Cerebrospinal Fluid Rhinorrhea/etiology , Cerebrospinal Fluid Rhinorrhea/epidemiology , Risk Factors , Cohort Studies , Young Adult
10.
Article in Chinese | MEDLINE | ID: mdl-38858108

ABSTRACT

Endoscopic skull base surgery presents significant technical challenges and high surgical risks, requiring collaboration among multiple disciplines such as otolaryngology, neurosurgery, ophthalmology, and oral maxillofacial surgery. In recent years, there has been rapid development in endoscopic skull base surgery, characterized by flourishing anatomical research and an expanding range of surgical indications. The future brings both opportunities and challenges, and endoscopic skull base surgery must grasp new directions in medical development, actively providing patients with safer and more effective treatment options.


Subject(s)
Endoscopy , Skull Base , Humans , Skull Base/surgery , Endoscopy/methods , Endoscopy/trends , Skull Base Neoplasms/surgery
11.
Article in Chinese | MEDLINE | ID: mdl-38858114

ABSTRACT

Objective:To explore the methods of resection, dura and skull base repair and reconstruction of cranionasal communication tumor. Methods:Data of 31 patients with cranionasal communication tumor who underwent dura and skull base reconstruction after tumor resection from 2018 to 2022 were collected. Follow-up lasted for 3 to 41 months. Results:A total of 31 patients were enrolled, including 20 males and 11 females. The ages ranged from 19 to 74 years, with a median age of 57 years old. There were 17 benign lesions(one case of hemangioma, one case of Rathke cyst, one case of squamous papilloma, one case of craniopharyngioma, two cases of meningocele, two cases of varus papilloma, two cases of meningioma of grade Ⅰ, three cases of schwannoma, four cases of pituitary tumor) and 14 malignant lesions(one case of osteosarcoma, one case of poorly differentiated carcinoma, two cases of varus papilloma malignancy, two cases of olfactory neuroblastoma, two cases of adenocarcinoma, two cases of adenoid cystic carcinoma, four cases of squamous cell carcinoma) . Sixteen cases underwent nasal endoscopy combined with craniofacial incision and 15 cases underwent nasal endoscopy surgery alone. Complete resection of the mass and dura and skull base reconstruction were performed in all 31 patients, and free graft repair was performed in 8 cases(fascia lata in 5 cases and nasal mucosa in 3 cases). Twenty-three cases were repaired with pedicled flaps(septal mucosal flap alone in 11 cases, septal mucosal flap combined with free graft in 6 cases, and cap aponeurosis combined with free graft in 6 cases). Eight out of 31 patients underwent skull base bone repair. Postoperative cerebral hemorrhage occurred in 1 case, cerebrospinal fluid leakage in 1 case, intracranial infection in 2 cases. All patients were successfully treated without severe sequelae. Cerebrospinal fluid leakage and intracranial infection occurred in one patient after radiotherapy, who recovered after conservative treatment. All 17 patients with benign lesions survived. Thirteen out of 14 patients with malignant lesions received radiotherapy after surgery, nine survived without recurrence, five cases recurred, of which 2 survived with tumor, one underwent reoperation and 2 died. Conclusion:Cranionasal communication tumors are high-risk diseases of anterior and middle skull base, and various surgical repair methods could be selected after complete resection of the tumor. Successful reconstruction and multidisciplinary cooperation are crucial for treatment outcome.


Subject(s)
Plastic Surgery Procedures , Skull Base , Humans , Male , Middle Aged , Female , Adult , Plastic Surgery Procedures/methods , Aged , Skull Base/surgery , Young Adult , Dura Mater/surgery , Skull Base Neoplasms/surgery
13.
Acta Neurochir (Wien) ; 166(1): 256, 2024 Jun 08.
Article in English | MEDLINE | ID: mdl-38850489

ABSTRACT

BACKGROUND: Cerebrospinal fluid leak after endoscopic skull base surgery remains a significant complication. Several investigators have suggested Hydroset cranioplasty to reduce leak rates. We investigated our early experience with Hydroset and compared the rate of nasal complications and CSF leak rates with case-controlled historic controls. METHODS: We queried a prospective database of patients undergoing first time endoscopic, endonasal resection of suprasellar meningiomas and craniopharyngiomas from 2015 to 2023. We compared cases closed with a gasket seal, Hydroset, and a nasoseptal flap with those closed with only a gasket seal and nasoseptal flap. Demographics, technical considerations and postoperative outcomes (SNOT-22) were compared. RESULTS: Seventy patients met inclusion criteria, twenty patients in the Hydroset group (meningioma n = 12; craniopharyngioma n = 8) and 50 control patients (meningioma n = 25; craniopharyngioma n = 25). CSF diversion was used in fewer Hydroset patients (75%, 15/20) compared with control group (94%, 47/50; p = 0.02). CSF leak was less frequent in the Hydroset than the control group (5% versus 12%, p = 0.38). One Hydroset patient required delayed nasal debridement. SNOT-22 responses demonstrated no significant difference in sinonasal complaints between groups (Hydroset average SNOT-22 score 22.45, control average SNOT-22 score 25.90; p = 0.58). CONCLUSIONS: We demonstrate that hydroxyapatite reconstruction leads to improved CSF leak control above that provided by the gasket-seal and nasoseptal flap, without significant associated morbidity as long as the cement is fully covered with vascularized tissue.


Subject(s)
Cerebrospinal Fluid Leak , Craniopharyngioma , Meningioma , Skull Base , Surgical Flaps , Humans , Male , Female , Middle Aged , Cerebrospinal Fluid Leak/prevention & control , Cerebrospinal Fluid Leak/etiology , Cerebrospinal Fluid Leak/surgery , Case-Control Studies , Skull Base/surgery , Craniopharyngioma/surgery , Aged , Meningioma/surgery , Adult , Pituitary Neoplasms/surgery , Postoperative Complications/prevention & control , Postoperative Complications/etiology , Treatment Outcome , Skull Base Neoplasms/surgery , Plastic Surgery Procedures/methods , Meningeal Neoplasms/surgery , Nasal Septum/surgery
14.
World Neurosurg ; 188: e613-e617, 2024 Aug.
Article in English | MEDLINE | ID: mdl-38843965

ABSTRACT

BACKGROUND: Tension pneumocephalus (PMC) is a rare and feared complication following the endonasal endoscopic approach (EEA) to skull base procedures. This is a neurosurgical emergency that requires urgent decompression to avoid catastrophic neurologic damage or death. An avoidable cause is the application of positive pressure ventilation (PPV) in EEA patients for postoperative hypoxia. Our institution implemented a hospital-wide protocol in response to this to identify and manage at-risk patients; this paper aims to identify if this protocol was effective in lowering the rates of tension PMC secondary to PPV. RESULTS: In the 3 years following the implementation of the protocol, 110 patients underwent EEAs, from which 1 case of tension PMC (found to be not secondary to PPV) was identified. This is compared with 2 cases of tension PMC secondary to PPV over the preceding 5 years, out of 406 EEA patients. This constitutes a quantifiable reduction in PPV-related tension PMC in both standard and extended approach EEAs, signifying the effective uptake of the protocol. CONCLUSIONS: We found no cases of tension PMC after PPV following EEA skull base surgery in our institution since the implementation of an institution-wide guideline. This underscores the utility of our simple and cost-effective preventative protocol in reducing the overall rates of tension PMC following the inadvertent postoperative application of PPV. Further research is needed to study the comparative risks and benefits of PPV in the post-EEA patient and thus inform future iterations of the protocol.


Subject(s)
Pneumocephalus , Positive-Pressure Respiration , Postoperative Complications , Skull Base , Humans , Pneumocephalus/etiology , Pneumocephalus/prevention & control , Pneumocephalus/diagnostic imaging , Skull Base/surgery , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Follow-Up Studies , Female , Positive-Pressure Respiration/methods , Male , Middle Aged , Neuroendoscopy/methods , Clinical Protocols , Aged , Skull Base Neoplasms/surgery , Adult , Neurosurgical Procedures/methods , Neurosurgical Procedures/adverse effects
15.
Sci Rep ; 14(1): 14886, 2024 06 27.
Article in English | MEDLINE | ID: mdl-38937569

ABSTRACT

To explore the techniques, safety, and feasibility of minimally invasive neurosurgery through the supraorbital eyebrow arch keyhole approach by neuroendoscopy. Retrospective analysis of clinical data of patients with various cranial diseases treated by transcranial neuroendoscopic supraorbital eyebrow keyhole approach in our hospital from March 2021 to October 2023. A total of 39 complete cases were collected, including 21 cases of intracranial aneurysms, 9 cases of intracranial space occupying lesions, 5 cases of brain trauma, 3 cases of cerebrospinal fluid rhinorrhea, and 1 case of cerebral hemorrhage. All patients' surgeries were successful. The good prognosis rate of intracranial aneurysms was 17/21 (81%), and the symptom improvement rate of intracranial space occupying lesions was 8/9 (88.9%). Among them, the initial symptoms of one patient with no improvement were not related to space occupying, while the total effective rate of the other three types of patients was 9/9 (100%). The average length of the craniotomy bone window of the supraorbital eyebrow arch keyhole is 3.77 ± 0.31 cm, and the average width is 2.53 ± 0.23 cm. The average postoperative hospital stay was 14.77 ± 6.59 days. The average clearance rate of hematoma by neuroendoscopy is 95.00% ± 1.51%. Our results indicate that endoscopic surgery through the supraorbital eyebrow arch keyhole approach is safe and effective for the treatment of anterior skull base lesions and cerebral hemorrhage. However, this retrospective study is a single center, small sample study, and the good surgical results do not exclude the subjective screening of suitable patients by clinical surgeons, which may have some bias. Although the clinical characteristics such as indications and contraindications of this surgical method still require further prospective and multicenter clinical research validation, our study still provides a new approach and choice for minimally invasive surgical treatment of anterior skull base lesions.


Subject(s)
Intracranial Aneurysm , Minimally Invasive Surgical Procedures , Neuroendoscopy , Skull Base , Humans , Male , Female , Middle Aged , Adult , Neuroendoscopy/methods , Minimally Invasive Surgical Procedures/methods , Retrospective Studies , Aged , Intracranial Aneurysm/surgery , Intracranial Aneurysm/diagnostic imaging , Skull Base/surgery , Craniotomy/methods , Treatment Outcome , Young Adult , Neurosurgical Procedures/methods , Cerebral Hemorrhage/surgery
16.
Laryngorhinootologie ; 103(S 01): S28-S42, 2024 May.
Article in English, German | MEDLINE | ID: mdl-38697142

ABSTRACT

OBJECTIVE: Endoscopic endonasal skull base surgery has gained acceptance worldwide. Comparative analysis has demonstrated that endoscopic skull base surgery may have advantages for many pathologies of the anterior skull base, e. g., sinonasal malignant tumors; pathologies of the central skull base, e. g., pituitary adenomas, craniopharyngiomas; well-selected cases of planum sphenoidale and tuberculum sellae meningiomas; or for clival lesions, e. g., chordomas, chondrosarcomas, or selected meningiomas. Over the past three decades, interdisciplinary surgical teams, consisting of otolaryngologists and neurosurgeons, have provided detailed anatomical knowledge, suggested new approaches or modifications of established surgical techniques, and offered continued surgical education. METHOD: A review of pertinent literature was conducted with an emphasis on interdisciplinary endoscopic surgery of skull base lesions. RESULTS: Based on the authors̓ surgical experience in two different interdisciplinary endoscopic skull base centers, the authors classify approaches for endoscopic endonasal skull base surgery, describe indications, and key anatomic landmarks for common pathologies, and highlight surgical techniques to avoid complications. CONCLUSION: Interdisciplinary endonasal endoscopic surgery combines surgical expertise, improves resection rates for many pathologies, and minimizes morbidity by reducing the incidence of surgical complications.


Subject(s)
Skull Base Neoplasms , Skull Base Neoplasms/surgery , Skull Base Neoplasms/pathology , Humans , Endoscopy , Patient Care Team , Skull Base/surgery , Natural Orifice Endoscopic Surgery/methods , Interdisciplinary Communication
17.
J Clin Neurosci ; 125: 38-42, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38744121

ABSTRACT

The nasal skull base is located into the deep position of nasal cavity and closely related to important nerves and vessels. The complete removal of tumors in this area poses a complex surgical challenge.In order to investigate the clinical efficacy of utilizing free middle turbinate mucosa (FMT), fascia lata, and pedicled nasal septum flap (known as the Hadad-Bassagasteguy flap, HBF) for the treatment of cerebrospinal fluid (CSF) rhinorrhea, a retrospective analysis was conducted on clinical data from 65 patients who underwent skull base reconstruction following endoscopic resection of nasal-skull base tumors. The selection of the repair material was based on the size and location of the defect. For defects less than 1.5 cm (n = 24), FMT was chosen, while for defects greater than or equal to 1.5 cm (n = 16), HBF was preferred. In cases where HBF was not available or not suitable (specifically, when the defect was located on the posterior wall of the frontal sinus), fascia lata was selected (n = 25). The repair outcomes of all 65 patients were summarized, and subsequently, a comparison was made between the use of fascia lata and HBF. The overall success rate for one-time repairs was 93.8 %. Specifically, the success rates for repairs using FMT, fascia lata, and HBF were 91.7 %, 96.0 %, and 93.8 %, respectively. Throughout the follow-up period, there were 2 cases of postoperative CSF leakage out of 24 patients who underwent FMT reconstruction, 1 case out of 25 patients who underwent fascia lata reconstruction, and 1 case out of 16 patients who underwent HBF reconstruction. The occurrence of postoperative complications, such as intracranial infection, lung infection, and epistaxis, was observed in both the fascia lata group and the HBF group. However, there were no statistically significant differences between the two groups. The transnasal endoscopic reconstruction of skull base defect using HBF, fascia lata, and FMT demonstrated satisfactory repair effects in managing CSF rhinorrhea. Generally, FMT has been found to be a dependable repair material for small defects measuring less than 1.5 cm, while in the case of larger defects equal to or exceeding 1.5 cm, both HBF and fascia lata can be utilized with comparable repair outcomes. The selection of fascia lata becomes a viable option when HBF is unavailable or not suitable.


Subject(s)
Cerebrospinal Fluid Rhinorrhea , Plastic Surgery Procedures , Surgical Flaps , Humans , Cerebrospinal Fluid Rhinorrhea/surgery , Female , Male , Middle Aged , Retrospective Studies , Adult , Plastic Surgery Procedures/methods , Aged , Skull Base/surgery , Fascia Lata/transplantation , Fascia Lata/surgery , Young Adult , Skull Base Neoplasms/surgery , Treatment Outcome , Adolescent , Endoscopy/methods , Nasal Cavity/surgery
18.
Am J Otolaryngol ; 45(4): 104343, 2024.
Article in English | MEDLINE | ID: mdl-38729013

ABSTRACT

OBJECTIVE: Landmark arteries during endoscopic sinus surgery are currently identified on the basis of anatomy, CT imaging and navigation, and Doppler flowmetry. However, the advantage of intraoperative fluorescence imaging during endoscopic sinus surgery has not been demonstrated. This study aimed to investigate whether Indocyanine Green (ICG) is useful for visualizing landmark arteries during endoscopic sinus and skull base surgery. METHODS: Eight patients who underwent endoscopic sinus and pituitary surgeries and consented to study participation were included. After planned procedures were performed as usual, landmark arteries were examined by ICG endoscope. Recorded video and preoperative CT images were analyzed for identification of five landmark arteries: anterior ethmoidal artery (AEA), posterior ethmoidal artery (PEA), internal carotid artery (ICA), sphenopalatine artery (SPA), and postnasal artery (PNA). Identification of arteries was evaluated three grades: identifiable, locatable, unrecognizable. RESULTS: Eight patients and eleven sides were evaluated. The ICG dose was 2.5 mg/body and a single shot was sufficient for evaluation. 100 % of AEA was identified (9/9 sides), 86 % of PNA (6/7 sides), 56 % of ICA (5/9 sides), and 25 % of PEA and SPA (2/8 sides). CONCLUSION: ICG could visualize landmark arteries, even thin arteries like AEA, during endoscopic sinus and skull base surgeries. Visualization was affected by thickness of bone or soft tissue above arteries, blood clots, sensitivity setting, and angle and distance of near-infrared light irradiation. ICG visualization of landmark arteries may help avoid vascular injuries during endoscopic sinus and skull base surgeries, particularly of AEA, PNA and ICA.


Subject(s)
Endoscopy , Indocyanine Green , Paranasal Sinuses , Skull Base , Humans , Endoscopy/methods , Skull Base/surgery , Skull Base/diagnostic imaging , Skull Base/blood supply , Female , Male , Middle Aged , Adult , Aged , Paranasal Sinuses/surgery , Paranasal Sinuses/diagnostic imaging , Paranasal Sinuses/blood supply , Arteries/diagnostic imaging , Anatomic Landmarks , Coloring Agents/administration & dosage , Tomography, X-Ray Computed/methods , Fluorescence , Optical Imaging/methods
19.
J Craniofac Surg ; 35(5): e474-e476, 2024.
Article in English | MEDLINE | ID: mdl-38814095

ABSTRACT

The foramen spinosum, one of the important openings at the base of the cranium, is the opening through which the middle meningeal artery enters the cranium. The variations of the foramen spinosum should be well known to be an important landmark in middle fossa surgeries and to understand better the clinical conditions related to the middle meningeal artery passing through it. A total of 35 bones (32 cranial base and 3 separate sphenoid bones) of individuals of unknown age, sex, and ethnicity in the Laboratory of the Department of Anatomy, Gaziantep University, Faculty of Medicine were examined bilaterally in this study. One of the 35 bones was found to have a duplicated foramen spinosum on the left side and an absence foramen spinosum on the right side. Foramen spinosum variations should be considered in middle fossa approaches and procedures involving the middle meningeal artery.


Subject(s)
Anatomic Variation , Meningeal Arteries , Skull Base , Sphenoid Bone , Humans , Meningeal Arteries/abnormalities , Meningeal Arteries/diagnostic imaging , Skull Base/surgery , Cranial Fossa, Middle/surgery , Anatomic Landmarks
20.
Int J Comput Assist Radiol Surg ; 19(7): 1273-1280, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38816649

ABSTRACT

PURPOSE: Skullbase surgery demands exceptional precision when removing bone in the lateral skull base. Robotic assistance can alleviate the effect of human sensory-motor limitations. However, the stiffness and inertia of the robot can significantly impact the surgeon's perception and control of the tool-to-tissue interaction forces. METHODS: We present a situational-aware, force control technique aimed at regulating interaction forces during robot-assisted skullbase drilling. The contextual interaction information derived from the digital twin environment is used to enhance sensory perception and suppress undesired high forces. RESULTS: To validate our approach, we conducted initial feasibility experiments involving a medical and two engineering students. The experiment focused on further drilling around critical structures following cortical mastoidectomy. The experiment results demonstrate that robotic assistance coupled with our proposed control scheme effectively limited undesired interaction forces when compared to robotic assistance without the proposed force control. CONCLUSIONS: The proposed force control techniques show promise in significantly reducing undesired interaction forces during robot-assisted skullbase surgery. These findings contribute to the ongoing efforts to enhance surgical precision and safety in complex procedures involving the lateral skull base.


Subject(s)
Robotic Surgical Procedures , Skull Base , Humans , Skull Base/surgery , Robotic Surgical Procedures/methods , Feasibility Studies , Mastoidectomy/methods
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