Clinoidectomía anterior extradural en el manejo de meningiomas paraselares: análisis de 13 años de experiencia y revisión de la literatura / Extradural anterior clinoidectomy in the management of parasellar meningiomas: Analysis of 13 years of experience and literature review

Antecedentes y objetivo: La clinoidectomía anterior extradural (CaE) es una técnica microquirúrgica clave que facilita la resección de tumores localizados en la región paraselar. Actualmente, no existe consenso de la ejecución vía extradural o intradural, o evidencia científica que apoye su uso de manera rutinaria. El propósito de este artículo es exponer nuestra experiencia en la realización de la CaE como parte del manejo de los meningiomas paraselares. Materiales y métodos: Se realizó un análisis retrospectivo de las CaE empleadas en las resecciones de meningiomas paraselares realizadas en nuestro centro entre los años 2003 y 2015. Se registraron un total de 53 pacientes. Realizamos un análisis de nuestra serie de casos, enfocándonos en los resultados visuales, las tasas de resección y las complicaciones postoperatorias. A través de una revisión bibliográfica, se discuten las ventajas e inconvenientes de la CaE, consideraciones técnicas, comparación con la clinoidectomía anterior intradural e impacto visual. Resultados: El tipo de tumor más frecuente fueron los meningiomas de clinoides anterior (33,9%). Los síntomas iniciales más frecuentes fueron la disminución de la agudeza visual (45,3%) y la cefalea (22,6%). La resección tumoral total se consiguió en el 67,9% de los casos, siendo subtotal en el restante 32,1%. Con respecto a los déficits visuales, el 67,9% de los pacientes presentaron estabilidad clínica, el 22,6% mejoraron y el 9,4% experimentaron empeoramiento. El grado de resección tumoral no influyó de manera significativa en los resultados visuales posquirúrgicos, ni en la agudeza visual (p=0,71) ni en los déficits campimétricos (p=0,53). El 24,5% de los pacientes experimentaron paresia del iiipar transitoria y el 1,9%, permanente. La tasa de fístula de líquido cefalorraquídeo postoperatoria fue del 3,8%. La mortalidad fue del 0%. El periodo medio de seguimiento fue de 82,3 meses. Conclusiones: En nuestra experiencia, la CaE es una técnica segura que facilita la resección de los meningiomas localizados en la región paraselar, favorece la desvascularización temprana del tumor, reduce la necesidad de retracción del parénquima cerebral y podría ejercer un papel positivo en la preservación de la función visual y en la aparición de recidivas tumorales en la apófisis clinoides anterior (ACa)

Background and aim: The extradural anterior clinoidectomy (EAC) is a key microsurgical technique that facilitates the resection of tumors located in the parasellar region. There is currently no consensus regarding the execution of the procedure via extradural or intradural nor scientific evidence that supports its routine use. The purpose of this article is to expose our experience in performing EAC as part of the management of the parasellar meningiomas. Materials and methods: A retrospective analysis of the EAC for parasellar meningioma resection performed in our center between 2003 and 2015 was done. A total of 53 patients were recorded. We analized our series focusing on visual outcomes, resection rates and complications. Through an extensive bibliographic research, we discussed the advantages and disadvantages of the EAC, technical considerations, comparison with the intradural clinoidectomy and its visual impact. Results: The most frequent tumors were anterior clinoidal meningiomas (33.9%). The most common initial symptoms were decreased visual acuity (45.3%) and headache (22.6%). A gross total resection was achieved in 67.9%, being subtotal in the remaining 32.1%. Regarding the visual deficits 67.9% of the patients presented clinical stability, 22.6% improvement and 9.4% worsening. The degree of tumor resection did not significantly influence post-surgical visual outcomes, either visual acuity (P=.71) or campimetric alterations (P=.53). 24.5% of the patients experienced iiinerve transient paresis and 1.9% permanent. The postoperative cerebrospinal fluid leak rate was 3.8%. Mortality rate was 0%. The mean follow-up was 82.3 months. Conclusions: In our experience, EAC is a safe technique that facilitates the resection of the meningiomas located in the parasellar area, helps to achieve early tumor devascularization, reduces the need for retraction of the cerebral parenchyma and could play a positive role in the preservation of visual function and the appearance of tumor recurrences in the anterior clinoid process (ACP)

Extradural anterior clinoidectomy in the management of parasellar meningiomas: Analysis of 13 years of experience and literature review. / Clinoidectomía anterior extradural en el manejo de meningiomas paraselares: análisis de 13 años de experiencia y revisión de la literatura.

BACKGROUND AND AIM: The extradural anterior clinoidectomy (EAC) is a key microsurgical technique that facilitates the resection of tumors located in the parasellar region. There is currently no consensus regarding the execution of the procedure via extradural or intradural nor scientific evidence that supports its routine use. The purpose of this article is to expose our experience in performing EAC as part of the management of the parasellar meningiomas. MATERIALS AND METHODS: A retrospective analysis of the EAC for parasellar meningioma resection performed in our center between 2003 and 2015 was done. A total of 53 patients were recorded. We analized our series focusing on visual outcomes, resection rates and complications. Through an extensive bibliographic research, we discussed the advantages and disadvantages of the EAC, technical considerations, comparison with the intradural clinoidectomy and its visual impact. RESULTS: The most frequent tumors were anterior clinoidal meningiomas (33.9%). The most common initial symptoms were decreased visual acuity (45.3%) and headache (22.6%). A gross total resection was achieved in 67.9%, being subtotal in the remaining 32.1%. Regarding the visual deficits 67.9% of the patients presented clinical stability, 22.6% improvement and 9.4% worsening. The degree of tumor resection did not significantly influence post-surgical visual outcomes, either visual acuity (P=.71) or campimetric alterations (P=.53). 24.5% of the patients experienced iiinerve transient paresis and 1.9% permanent. The postoperative cerebrospinal fluid leak rate was 3.8%. Mortality rate was 0%. The mean follow-up was 82.3 months. CONCLUSIONS: In our experience, EAC is a safe technique that facilitates the resection of the meningiomas located in the parasellar area, helps to achieve early tumor devascularization, reduces the need for retraction of the cerebral parenchyma and could play a positive role in the preservation of visual function and the appearance of tumor recurrences in the anterior clinoid process (ACP).

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.