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Nizzola M, Leonel LCPC, Peris-Celda M. Neurosurgery for the rhinologist. Curr Opin Otolaryngol Head Neck Surg 2024; 32:40-49. [PMID: 38193519 DOI: 10.1097/moo.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide a comprehensive anatomical appraisal of the neurosurgical anatomy exposed through the endonasal and paranasal sinuses routes, focusing on the most common expanded endonasal approaches (EEAs) as well as recent advances in this surgical field. RECENT FINDINGS The EEAs are redefining the management of skull base pathology. Neurovascular structures previously considered a limitation, can be now approached through these surgical corridors. Advances in this field include the development of new surgical techniques and routes that allow better visualization and access to pathologies located in the ventral skull base. Understanding the surgical anatomy related to EEAs is essential not only for neurosurgeons but also for rhinologists. SUMMARY Knowledge of the surgical anatomy of the most common EEAs that utilize paranasal sinuses as a surgical corridor enables more effective management of complex skull base pathologies. Comprehensive anatomical knowledge of these corridors and the surrounding neurovascular structures is crucial to maximize benefits of EEAs and improve outcomes.
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Affiliation(s)
- Mariagrazia Nizzola
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery and Gamma Knife radiosurgery, Vita-Salute San Raffaele University and IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Luciano C P C Leonel
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Maria Peris-Celda
- Mayo Clinic Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Chen W, Zhang H, Zhang W, Su M, Xie R, Li K, Xia X, Zou C. Development of a contouring guide for three different types of optic chiasm: A practical approach. J Med Imaging Radiat Oncol 2019; 63:657-664. [PMID: 31173469 DOI: 10.1111/1754-9485.12903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 04/23/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Sparing of the organs at risk (OARs) is a crucial task in daily radiotherapy practice. Irradiation of the optic chiasm (OC) results in radiation-induced optic neuropathy (RION). The structure of the OC is complex, and OC morphology can vary in axial images. Therefore, a standard atlas can result in inaccurate descriptions of OC morphology in different patients. The aim of our study was to provide a guide based on computed tomography (CT) for the delineation of different types of OC. METHODS Thirty-six patients were selected to participate in our study. These patients underwent CT analysis of the brain, head and neck regions in a supine position. Axial images 3 mm in thickness were obtained at 3-mm intervals. A magnetic resonance imaging (MRI) study was also performed using the same set-up. The OC was then delineated. The contours were revised by three neuroradiologists and nine radiation oncologists with > 5 years of expertise. RESULTS Three types of OC were distinguished by magnetic resonance (MR). The location and boundaries of normal, prefixed and postfixed chiasms were developed with a CT-based atlas. Discrepancies were observed in the delineation of the prefixed and postfixed OC. CONCLUSIONS Our guide allows improved definitions of the anatomical boundaries for different types of OC. Our experience could provide useful information for radiation oncologists in daily practice.
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Affiliation(s)
- Wenhao Chen
- Department of Chemoradiotherapy Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hui Zhang
- Department of Chemoradiotherapy Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenyi Zhang
- Department of Chemoradiotherapy Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Meng Su
- Department of Chemoradiotherapy Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Raoying Xie
- Department of Chemoradiotherapy Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kejie Li
- Department of Chemoradiotherapy Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaofang Xia
- Department of Chemoradiotherapy Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Changlin Zou
- Department of Chemoradiotherapy Oncology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Zoli M, Manzoli L, Bonfatti R, Ruggeri A, Mariani GA, Bacci A, Sturiale C, Pasquini E, Billi AM, Frank G, Cocco L, Mazzatenta D. Endoscopic endonasal anatomy of the ophthalmic artery in the optic canal. Acta Neurochir (Wien) 2016; 158:1343-50. [PMID: 27117907 DOI: 10.1007/s00701-016-2797-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 03/27/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND The endoscopic endonasal opening of the optic canal has been recently proposed for tumors with medial invasion of this canal, such as tuberculum sellae meningiomas. Injury of the ophthalmic artery represents a dramatic risk during this maneuver. Therefore, the aim of this study was to analyze the endoscopic endonasal anatomy of the precanalicular and canalicular portion of this vessel, discussing its clinical implication. METHODS The course of the ophthalmic artery was analyzed through five endoscopic endonasal dissections, and 40 nonpathological consecutive MRAs were reviewed. RESULTS The ophthalmic artery arises from the intradural portion of the supraclinoid internal carotid artery, in 93 % of cases about 1.9 mm (range: 1-3) posterior to the falciform ligament. At the entrance into the optic canal, the ophthalmic artery is located infero-medially to the optic nerve in 13 % of cases. In 50 % of these cases the artery moves infero-laterally along its course, remaining in a medial position in the others. In cases with an non medial entrance of the ophthalmic artery, it runs infero-lateral to the optic nerve for its entire canalicular portion, with just one exception. CONCLUSION The endoscopic endonasal approach gives a direct, extensive and panoramic view of the course of the precanalicular and canalicular portion of the ophthalmic artery. Dedicated high-field neuroimaging studies are of paramount importance in preoperative planning to evaluate the anatomy of the ophthalmic artery, reducing the risk of jeopardizing the vessel, particularly for those uncommon cases with an infero-medial course of the artery.
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Affiliation(s)
- Matteo Zoli
- Center of Surgery for Pituitary Tumors and Endoscopic Skull Base Surgery, Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy.
| | - Lucia Manzoli
- Institute of Anatomy, DIBINEM, University of Bologna, Bologna, Italy
| | - Rocco Bonfatti
- Center of Surgery for Pituitary Tumors and Endoscopic Skull Base Surgery, Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | | | | | - Antonella Bacci
- Department of Neuroradiology, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Carmelo Sturiale
- Center of Surgery for Pituitary Tumors and Endoscopic Skull Base Surgery, Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | | | - Anna Maria Billi
- Institute of Anatomy, DIBINEM, University of Bologna, Bologna, Italy
| | - Giorgio Frank
- Center of Surgery for Pituitary Tumors and Endoscopic Skull Base Surgery, Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Lucio Cocco
- Institute of Anatomy, DIBINEM, University of Bologna, Bologna, Italy
| | - Diego Mazzatenta
- Center of Surgery for Pituitary Tumors and Endoscopic Skull Base Surgery, Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
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Singh H, Vogel RW, Lober RM, Doan AT, Matsumoto CI, Kenning TJ, Evans JJ. Intraoperative Neurophysiological Monitoring for Endoscopic Endonasal Approaches to the Skull Base: A Technical Guide. SCIENTIFICA 2016; 2016:1751245. [PMID: 27293965 PMCID: PMC4886091 DOI: 10.1155/2016/1751245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 04/04/2016] [Accepted: 04/11/2016] [Indexed: 06/06/2023]
Abstract
Intraoperative neurophysiological monitoring during endoscopic, endonasal approaches to the skull base is both feasible and safe. Numerous reports have recently emerged from the literature evaluating the efficacy of different neuromonitoring tests during endonasal procedures, making them relatively well-studied. The authors report on a comprehensive, multimodality approach to monitoring the functional integrity of at risk nervous system structures, including the cerebral cortex, brainstem, cranial nerves, corticospinal tract, corticobulbar tract, and the thalamocortical somatosensory system during endonasal surgery of the skull base. The modalities employed include electroencephalography, somatosensory evoked potentials, free-running and electrically triggered electromyography, transcranial electric motor evoked potentials, and auditory evoked potentials. Methodological considerations as well as benefits and limitations are discussed. The authors argue that, while individual modalities have their limitations, multimodality neuromonitoring provides a real-time, comprehensive assessment of nervous system function and allows for safer, more aggressive management of skull base tumors via the endonasal route.
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Affiliation(s)
- Harminder Singh
- Stanford Hospitals and Clinics, Department of Neurosurgery, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Richard W. Vogel
- Safe Passage Neuromonitoring, 915 Broadway, Suite 1200, New York, NY 10010, USA
| | - Robert M. Lober
- Stanford Hospitals and Clinics, Department of Neurosurgery, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Adam T. Doan
- Safe Passage Neuromonitoring, 915 Broadway, Suite 1200, New York, NY 10010, USA
| | - Craig I. Matsumoto
- Sentient Medical Systems, 11011 McCormick Road, Suite 200, Hunt Valley, MD 21031, USA
| | - Tyler J. Kenning
- Department of Neurosurgery, Albany Medical Center, Physicians Pavilion, First Floor, 47 New Scotland Avenue, MC 10, Albany, NY 12208, USA
| | - James J. Evans
- Thomas Jefferson University Hospital, Department of Neurosurgery, 909 Walnut Street, Third Floor, Philadelphia, PA 19107, USA
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Zoli M, Mazzatenta D, Valluzzi A, Marucci G, Acciarri N, Pasquini E, Frank G. Expanding indications for the extended endoscopic endonasal approach to hypothalamic gliomas: preliminary report. Neurosurg Focus 2015; 37:E11. [PMID: 25270130 DOI: 10.3171/2014.7.focus14317] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object In the last decade the indications for the endoscopic endonasal approach have been progressively expanded to include lesions that have not been traditionally considered amenable to resection through the transsphenoidal route. In this study, the authors analyze their experience with hypothalamic gliomas treated via the endoscopic endonasal approach. Methods Consecutive cases of hypothalamic gliomas treated since 2007 via an endoscopic endonasal approach were reviewed. Preoperative and postoperative neuroimaging as well as endocrinological, neurological, and visual symptoms were analyzed to assess the surgical outcome. Signs and symptoms of hypothalamic dysfunction including body mass index (BMI), memory, sleep-wake rhythm, and polyphagia were prospectively collected pre- and postoperatively to assess hypothalamic function. Quality of life was evaluated using the Katz scale. Results In the initial phase the endoscopic endonasal approach was adopted in 3 cases with a palliative intent, to obtain a biopsy sample or for debulking of the mass followed by radio- or chemotherapy. In 2 later cases it was successfully adopted to achieve gross-total tumor resection. Complications consisted of 2 postoperative CSF leaks, which required an endoscopic endonasal reintervention. Visual deficit improved in 3 cases and normalized in the other 2. Four patients developed diabetes insipidus, and 3 an anterior panhypopituitarism. All patients had a moderate increase in BMI. No patients presented with any other signs of hypothalamic damage, and their quality of life at follow-up is normal. Conclusions Despite the limitations of a short follow-up and small sample, the authors' early experience with the endoscopic endonasal approach has revealed it to be a direct, straightforward, and safe approach to third ventricle astrocytomas. It allowed the authors to perform tumor resection with the same microsurgical technique: dissecting the tumor with 2 hands, performing a central debulking, and controlling the bleeding with bipolar coagulation. The main limitations were represented by some anatomical conditions, such as the position of the chiasm and the anterior communicating artery complex and, finally, by the challenge of watertight plastic repair. To definitively evaluate the role of this approach in hypothalamic gliomas, a comparison with transcranial series would be necessary, but due to the rarity of these cases such a study is still lacking. The authors observed that more aggressive surgery is associated with a worse endocrinological outcome; thus they consider it to be an open question (in particular in prepubertal patients) whether radical removal is an advisable goal for hypothalamic gliomas.
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Affiliation(s)
- Matteo Zoli
- Department of Neurosurgery, Center of Surgery for Pituitary Tumors and Endoscopic Skull Base Surgery, IRCCS Istituto delle Scienze Neurologiche, Bellaria Hospital, Bologna
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Kahilogullari G, Beton S, Al-Beyati ESM, Kantarcioglu O, Bozkurt M, Kantarcioglu E, Comert A, Unlu MA, Meco C. Olfactory functions after transsphenoidal pituitary surgery: Endoscopic versus microscopic approach. Laryngoscope 2013; 123:2112-9. [DOI: 10.1002/lary.24037] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 01/02/2013] [Accepted: 01/14/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Gokmen Kahilogullari
- Department of Neurosurgery, Faculty of Medicine; Ankara University; Ankara; Turkey
| | - Suha Beton
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine; Ankara University; Ankara; Turkey
| | | | - Ozlem Kantarcioglu
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine; Ankara University; Ankara; Turkey
| | - Melih Bozkurt
- Department of Anatomy, Faculty of Medicine; Ankara University; Ankara; Turkey
| | - Emrah Kantarcioglu
- Department of Anatomy, Faculty of Medicine; Ankara University; Ankara; Turkey
| | - Ayhan Comert
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine; Ankara University; Ankara; Turkey
| | - M. Agahan Unlu
- Department of Anatomy, Faculty of Medicine; Ankara University; Ankara; Turkey
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