Integración de la cirugía endoscópica en una unidad de base de cráneo: experiencia en los primeros 72 casos / Endoscopic surgery in the skull base unit: Experience in the first 72 cases

Introducción: La formación de un equipo multidisciplinar es imprescindible para desarrollar y ampliar las indicaciones en la cirugía endonasal endoscópica de la base de cráneo. El objetivo de este trabajo es presentar nuestra experiencia en el grupo de pacientes con afectación de la base de cráneo intervenidos con un abordaje endonasal endoscópico. Métodos: De enero de 2008 a enero de 2012, 72 pacientes con afectación de la base de cráneo fueron diagnosticados y tratados en nuestro centro. Resultados: La edad media de los pacientes en el momento del diagnóstico fue de 53 años. Las diferentes patologías incluyeron 36 adenomas de hipófisis, 10 fístulas de líquido cefalorraquídeo y 5 papilomas invertidos como las más frecuentes. En 45 casos se llevó a cabo un abordaje transesfenoidal transellar, en 4 casos un abordaje transmaxilar transpterigoideo y en 6 casos un abordaje transnasal ampliado. En 12 pacientes se realizó un abordaje a través del etmoides y/o del seno esfenoidal y en 4 casos se utilizó un abordaje frontal tipo Draf IIb/III. En el 61% de los adenomas se consiguió una resección total, en el 22% subtotal y en el 17% parcial. El 86% de las fístulas de líquido cefalorraquídeo se repararon con éxito. No se evidenció ninguna recidiva en los papilomas invertidos intervenidos. En 21 pacientes (29%) ocurrió algún tipo de complicación, apareciendo 6 complicaciones de orden mayor. Conclusiones: Nuestro centro apuesta por la colaboración multidisciplinar en la cirugía endoscópica de la base de cráneo como línea de excelencia (AU)

Introduction: A multidisciplinary team is essential to develop and expand the indications in endonasal endoscopic skull base surgery. The aim of this study was to present our experience in a group of patients with skull base lesions treated using endonasal endoscopic approach. Methods: From January 2008 to January 2012, 72 patients with skull base involvement were diagnosed and treated in our centre. Results: The mean patient age was 53 years. The different pathologies included 36 pituitary adenomas, 10 cerebrospinal fluid leaks and 5 inverted papillomas as the most frequent pathologies. We performed a transsphenoidal transellar approach in 45 cases, a transmaxillary transpterygoid approach in 4 cases and a transnasal expanded approach in 6 cases. We performed an ethmoidal/sphenoidal approach in 12 patients and a Draf IIb/III procedure in four cases. Total resection was achieved in 61% of patients with pituitary adenomas, subtotal in 22% and partial in 17%. Successful repair was achieved in 86% of CSF leaks. No recurrences were observed in patients with inverted papilloma. Complications were observed in 21 patients (29%), 6 being major complications. Conclusions: Our centre stresses the importance of multidisciplinary collaboration in endoscopic endonasal skull base surgery (AU)

Endoscopic surgery in the skull base unit: experience in the first 72 cases.

INTRODUCTION: A multidisciplinary team is essential to develop and expand the indications in endonasal endoscopic skull base surgery. The aim of this study was to present our experience in a group of patients with skull base lesions treated using endonasal endoscopic approach. METHODS: From January 2008 to January 2012, 72 patients with skull base involvement were diagnosed and treated in our centre. RESULTS: The mean patient age was 53 years. The different pathologies included 36 pituitary adenomas, 10 cerebrospinal fluid leaks and 5 inverted papillomas as the most frequent pathologies. We performed a transsphenoidal transellar approach in 45 cases, a transmaxillary transpterygoid approach in 4 cases and a transnasal expanded approach in 6 cases. We performed an ethmoidal/sphenoidal approach in 12 patients and a Draf IIb/III procedure in four cases. Total resection was achieved in 61% of patients with pituitary adenomas, subtotal in 22% and partial in 17%. Successful repair was achieved in 86% of CSF leaks. No recurrences were observed in patients with inverted papilloma. Complications were observed in 21 patients (29%), 6 being major complications. CONCLUSIONS: Our centre stresses the importance of multidisciplinary collaboration in endoscopic endonasal skull base surgery.