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Liao C, Li S, Ouyang H, Zhang W. Optic nerve decompression through pterional and supraorbital approaches in the treatment of severe traumatic optic neuropathy. Neurosurg Rev 2024; 47:306. [PMID: 38977519 DOI: 10.1007/s10143-024-02536-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 06/19/2024] [Accepted: 06/22/2024] [Indexed: 07/10/2024]
Abstract
To investigate the effectiveness of optic nerve decompression (OND) in the treatment of severe traumatic optic neuropathy (TON) through pterional and supraorbital approaches, and to identify the prognostic factor for postoperative visual acuity (VA) following OND. Patients with severe TON treated with OND through either pterional or supraorbital approach in our institute from September 2019 to June 2022 were retrospectively reviewed in this study. Demographic information, trauma factors, the interval between trauma and complete blindness, the interval between trauma and surgery, and the associated craniofacial traumas were recorded. Hospitalization days and the postoperative VA of patients in two groups were compared. There were 54 severe TON patients with NLP included in this study; 21 patients underwent OND through the pterional approach, and the other 33 underwent the supraorbital approach. Respectively, in groups of pterional and supraorbital approaches, the average hospitalization days were 9.8 ± 3.2 and 10.7 ± 2.9 days (p = 0.58), the mean durations of follow-up were 18.9 ± 4.3 and 20.8 ± 3.7 months (p = 0.09), and the average circumference of OND were 53.14 ± 15.89 ◦ (range 220 ◦ -278◦) and 181.70 ± 6.56◦ (range 173 ◦ -193◦) (p<0.001). The overall improvement rates of pterional and supraorbital approaches are 57.1% and 45.5% (p = 0.40), respectively. Optic canal fracture (OCF) was revealed to be significantly associated with postoperative VA in the supraorbital approach (Binary: p = 0.014, CI: 1.573-57.087; Ordinal: p = 0.003, CI: 1.517-5.503), but not in the pterional approach. In the group of supraorbital approach, patients with OFC had a higher rate of a better outcome (78.6%) than those without (21.4%). Patients with severe traumatic TON may benefit from OND through either the pterional or supraorbital approach. OCF is a potential prognostic factor for postoperative VA following OND through the supraorbital approach.
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Affiliation(s)
- Chenlong Liao
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, NO.639 Shanghai Zhizaoju Road, Huangpu District, Shanghai, China
| | - Shuo Li
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, NO.639 Shanghai Zhizaoju Road, Huangpu District, Shanghai, China
| | - Huoniu Ouyang
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, NO.639 Shanghai Zhizaoju Road, Huangpu District, Shanghai, China.
| | - Wenchuan Zhang
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, NO.639 Shanghai Zhizaoju Road, Huangpu District, Shanghai, China.
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Bernardo A, Evins AI, Barbagli G, Kim MG, Kim N, Xia JJ, Nonaka M, Stieg PE. Tailored Surgical Access to the Cavernous Sinus and Parasellar Region: Assessment of Cavernous Sinus Entry Corridors and the Periclinoid and Pericavernous Surgical Maneuvers. World Neurosurg 2023; 171:e253-e275. [PMID: 36503120 DOI: 10.1016/j.wneu.2022.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Lesions involving the cavernous sinus (CS) represent some of the most challenging pathologies of the skull base owing to the dense traversing and surrounding neurovasculature. Extradural exposure and preparation of this region, whether as initial preparation for a combined intra-extradural approach or as the main avenue of surgical exposure, can enlarge surgical corridors and minimize the need for brain retraction in this very confined space. We provide a detailed assessment of the entry corridors to the CS that are available within each approach, the surgical exposure and freedom provided by each of these corridors, and demonstrate how extradural and intradural preparation of these corridors can be used to widen the available working space and facilitate surgery. METHODS Pterional, frontotemporal-orbital, frontotemporal-orbitozygomatic, frontotemporal-zygomatic, perilabyrinthine transtentorial, and endoscopic transnasal transsphenoidal approaches were performed on cadaveric heads to access the perisellar and CS regions. Periclinoid maneuvers (extradural cutting of the meningo-orbital band, anterior clinoidectomy, unroofing of the optic canal, opening of the superior orbital fissure, displacement of the extra-annular structures, opening of the annulus of Zinn, and interdural dissection), pericavernous maneuvers (intradural cutting of the distal dural ring, mobilization of the supraclinoid internal carotid artery, opening of the oculomotor porus, and mobilization of cranial nerve (CN) III), peritrigeminal extensions (extradural mobilization of CN V2 [maxillary] and/or V3 [mandibular]), and other surgical maneuvers were performed and evaluated. The CS was divided into 8 anatomical compartments and 9 entry corridors were described, and exposure and freedom were assessed accordingly. RESULTS Intradurally, the standard unextended pterional, frontotemporal-orbital, and frontotemporal orbitozygomatic transsylvian approaches provided access solely to the parasellar entry corridor into the superior wall of the CS. Expanding these approaches with extradural periclinoid maneuvers allowed for subsequent application of the intradural pericavernous maneuvers and enlargement of the parasellar corridor and exposure of the carotid cave. Extradurally, the frontotemporal-orbital approach could be expanded via application of periclinoid maneuvers, which provided access to the anterior portions of the main lateral wall entry corridors. The frontotemporal-orbitozygomatic approach could also be expanded with periclinoid maneuvers to provide extradural access to all 6 lateral wall entry corridors. The extradural frontotemporal-zygomatic approach only provided exposure following interdural dissection, which allowed for access to the inferolateral entry corridors into the lateral wall. Extradural peritrigeminal extension in the frontotemporal-orbitozygomatic and frontotemporal-zygomatic approaches allows for enlargement of the supramaxillary and pre- and postmandibular corridors. The perilabyrinthine approach to the posterior wall was enlarged with opening of Dorello's canal and the endoscopic transnasal transsphenoidal approach was enlarged with opening of the optic canal. CONCLUSIONS Targeted extradural preparation optimizes exposure and significantly improves access to deep-seated targets by enhancing surgical maneuverability through the unlocking of neurovascular structures and widening of surgical corridors without the need for additional brain retraction.
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Affiliation(s)
- Antonio Bernardo
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA.
| | - Alexander I Evins
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Giovanni Barbagli
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Michael G Kim
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA; Department of Neurological Surgery, University of California, Irvine, Orange, California, USA
| | - NamHee Kim
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jimmy J Xia
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA; Department of Radiology, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Motonobu Nonaka
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Philip E Stieg
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
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Behbahani M, Fernando S, Peng S, Fernandez LG, Hajnas N, Sharma S, Rastatter JC, Alden TD. Endoscopic endonasal optic nerve decompression: treatment of fibrous dysplasia in a pediatric population. J Neurosurg Pediatr 2023; 31:179-185. [PMID: 36401542 DOI: 10.3171/2022.9.peds22313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/22/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Patients with fibrous dysplasia (FD) of the anterior skull base can experience progressive visual loss and impairment. The authors reviewed their experience with endonasal decompression of the optic nerve (ON) in this patient population. Endoscopic ON decompression (EOND) is a feasible surgical approach for children with FD and visual deficit due to structural ON compression. METHODS Electronic medical records of children between 1 and 17 years of age with unilateral FD of the anterior skull base and concomitant ON compression, who required EOND between 2017 and 2022 (n = 4), were reviewed for demographic data, both pre- and postoperative imaging, and evaluations by an otolaryngologist, neurosurgeon, and ophthalmologist in a multidisciplinary fashion. RESULTS EOND was found to be a safe and effective surgery for children with FD. Visual acuity was stable in 80% of the eyes postoperatively. Visual fields improved in 40% of the eyes and remained stable in the rest. CONCLUSIONS EOND is beneficial for progressive optic neuropathy that is unresponsive to steroid therapy and can prevent permanent disability if performed prior to irreversible damage to the nerve. EOND can decompress the edematous ON with proper exposure of the optic canal and orbital apex, without any major complications.
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Affiliation(s)
| | - Shanik Fernando
- 2Otolaryngology, Ann and Robert H. Lurie Children's Hospital
| | | | | | | | | | - Jeffrey C Rastatter
- 2Otolaryngology, Ann and Robert H. Lurie Children's Hospital
- 6Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tord D Alden
- Divisions of1Neurological Surgery and
- Departments of4Neurological Surgery and
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Change in the Location of the Optic Strut Relative to the Anterior Clinoid Process Pneumatization. J Craniofac Surg 2022; 33:1924-1928. [PMID: 35905388 DOI: 10.1097/scs.0000000000008707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study aimed to peruse the alteration of the position of the optic strut (OS) according to the anterior clinoid process (ACP) pneumatization. METHODS This retrospective study conducted on cone-beam computed tomography images of 400 patients with a mean age of 36.49±15.91 years. RESULTS Anterior clinoid process length, width, and angle were measured as 10.56±2.42 mm, 5.46±1.31 mm, and 42.56±14.68 degrees, respectively. The tip of ACP was measured as 6.60±1.50 mm away from the posterior rim of OS. In the 631 sides (78.87%) did not have ACP pneumatization. In the cases with ACP pneumatization, three different configurations were identified as follows: Type 1 in 71 sides (8.87%), Type 2 in 56 sides (7%), and Type 3 in 42 sides (5.23%). Relative to ACP, the location of OS was determined as follows: Type A in 29 sides (3.64%), Type B in 105 sides (13.12%), Type C in 344 sides (43%), Type D in 289 sides (36.12%), and Type E in 33 sides (4.12%). The spread of data related to the attachment site of OS according to the presence or absence of ACP pneumatization showed that the location of OS was affected by ACP pneumatization (P<0.001). In ACPs with pneumatization, the frequency of OS position relative to ACP was found as follows: Type A in none of sides (0%), Type B in 8 sides (7.6%), Type C in 53 sides (15.4%), Type D in 88 sides (30.4%), and Type E in 20 sides (60.6%). CONCLUSIONS The main finding of this study was that the location of OS relative to ACP was affected by ACP pneumatization. In ACPs with pneumatization, OS was located more posteriorly compared with ACPs without pneumatization.
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Kim J, Plitt AR, Vance A, Connors S, Caruso J, Welch B, Garzon-Muvdi T. Endoscopic Endonasal versus Transcranial Optic Canal Decompression: A Morphometric, Cadaveric Study. Skull Base Surg 2022; 83:e395-e400. [DOI: 10.1055/s-0041-1729909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
Abstract
Introduction Decompression of the optic nerve within the optic canal is indicated for compressive visual decline. The two most common approaches utilized for optic canal decompression are a medial approach with an endoscopic endonasal approach and a lateral approach with a craniotomy. Our study is a cadaveric anatomical study comparing the length and circumference of the orbit decompressed via an endoscopic endonasal approach versus a frontotemporal craniotomy.
Methods Five cadaveric specimens were utilized. Predissection computed tomography (CT) scans were performed on each specimen. On each specimen, a standard frontotemporal craniotomy with anterior clinoidectomy and superolateral orbital decompression was performed on one side and an endoscopic endonasal approach with medial wall decompression was performed on the contralateral side. Post-dissection CT scans were performed. An independent radiologist provided measurements of the length (mm) and circumference (degrees) of optic canal decompression bilaterally.
Results The mean length of optic canal decompression for open and endoscopic approach was 13 mm (range 12–15 mm) and 12.4 mm (range 10–16 mm), respectively. The mean circumference of decompression for open and endoscopic approaches was 252.8 degrees (range 205–280 degrees) and 124.6 degrees (range 100–163 degrees), respectively.
Conclusion The endoscopic endonasal and the transcranial approaches provide a similar length of optic canal decompression, but the transcranial approach leads to greater circumferential decompression. The endoscopic endonasal approach has the benefit of being minimally invasive, though. Ultimately, the surgical approach decision should be based on the location of the pathology and the surgeon's comfort.
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Affiliation(s)
- Jun Kim
- Department of Neurological Surgery, Southwestern Medical Center, University of Texas, Dallas, Texas, United States
| | - Aaron R Plitt
- Department of Neurological Surgery, Southwestern Medical Center, University of Texas, Dallas, Texas, United States
| | - Awais Vance
- Department of Neurological Surgery, Southwestern Medical Center, University of Texas, Dallas, Texas, United States
| | - Scott Connors
- Department of Neurological Surgery, Southwestern Medical Center, University of Texas, Dallas, Texas, United States
| | - James Caruso
- Department of Neurological Surgery, Southwestern Medical Center, University of Texas, Dallas, Texas, United States
| | - Babu Welch
- Department of Neurological Surgery, Southwestern Medical Center, University of Texas, Dallas, Texas, United States
| | - Tomas Garzon-Muvdi
- Department of Neurological Surgery, Southwestern Medical Center, University of Texas, Dallas, Texas, United States
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Evaluation of the Cranial Aperture of the Optic Canal on Cone-Beam Computed Tomography Images and its Clinical Implications for the Transcranial Approaches. J Craniofac Surg 2022; 33:1909-1913. [PMID: 35175983 DOI: 10.1097/scs.0000000000008577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/29/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study aimed to investigate morphometric properties of the cranial aperture (CA) of the optic canal. METHODS Cone-beam computed tomography images of 400 individuals (200 males and 200 females) aged 37.32 ± 15.87 years were retrospectively examined to assess the morphometry and morphology of the CA. RESULTS The height and width of CA were found as 4.22 ± 0.74 mm and 7.27 ± 1.15 mm, respectively. The distances between the CA and the midsagittal line, the anterior and lateral boundaries of the anterior skull base were measured as 5.77 ± 1.32 mm, 64.97 ± 6.36 mm, and 41.00 ± 4.05, respectively. The angle of the optic canal in the sagittal plane was measured as 7.57° ± 3.95°, whereas in the horizontal plane as 38.96° ± 4.36°. The aperture shape was defined as the tear-drop (413 foramina, 51.62%), triangular (180 foramina, 22.50%), oval (158 foramina, 19.75%), round (30 foramina, 3.75%), and polygonal (19 foramina, 2.38%). CONCLUSIONS The authors observed that the diameters, and angulations of the CA may change relative to gender and the shape. The anatomic features of CA are important for the positioning of the patient's head, the choice of the appropriate surgical approach or equipment, and the detection of anatomical landmarks during interventions. In this context, our dataset may be beneficial for surgeons helpful as a reference for radiological evaluations.
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Abstract
OBJECTIVE This study was aimed to obtain data on the dimensions of the optic foramen in human fetuses for early childhood surgeries. METHODS Twenty-five formalin-fixed fetuses (16 boys and 9 girls) with average age 21.68 ± 3.12 gestational weeks (range, 16-28 weeks) in the inventory of Anatomy Department, Faculty of Medicine were included in the study. The surface area, width, and height of the optic foramen were bilaterally measured using a digital image analysis software. RESULTS The forms of the optic foramen were described as oval shaped (72%, 36 foramina) and round shaped (28%, 14 foramina). The surface area, width, and height of the optic foramen were found as 2.40 ± 1.02 mm, 1.83 ± 0.59 mm, and 1.58 ± 0.36 mm, respectively. The measurements of the parameters related to the optic foramen were not statistically different in terms of sides and sexes (P > 0.05). Linear functions for the height, width and surface area of the optic foramen were calculated as: y = 0.711 + 0.040 × weeks, y = -0.019 + 0.086 × weeks, and y = -0.400 + 0.129 × weeks, respectively. CONCLUSION The linear functions in this study can be used to estimate the dimensions of the optic foramen. The calculated regression equations, representing the growth dynamic of the optic foramen showed that the surface area, width, and height were increasing according to gestational ages between 16 and 28 weeks. Microanatomical knowledge related to the optic foramen may be beneficial for surgeons to avoid iatrogenic injury in infants and for anatomists to understand the development of the fetal skull base.
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Anatomic features of the cranial aperture of the optic canal in children: a radiologic study. Surg Radiol Anat 2020; 43:187-199. [PMID: 33130955 DOI: 10.1007/s00276-020-02604-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aimed to peruse anatomic features of the cranial aperture of the optic canal (CAOC) for obtaining an extended morphometric dataset in children. METHODS Computed tomography images of 200 children were included in this retrospective work to analyze the shape, location and diameters of the CAOC. RESULTS The CAOC area, width and height were observed as 17.53 ± 2.80 mm2, 6.12 ± 0.84 mm, and 4.35 ± 0.64 mm, respectively. The angle of the optic canal in axial plane was found as 39.28 ± 5.13°, while in sagittal plane as 16.01 ± 6.76°. The distance between the CAOC and the midsagittal line was 7.17 ± 1.48 mm. The CAOC was measured as 54.04 ± 5.23 mm and 42.55 ± 3.28 mm away from the anterior and lateral boundary of the anterior skull base, respectively. The CAOC shape was described as the tear-drop (186 foramina, 46.5%), triangular (156 foramina, 39%), oval (47 foramina, 11.8%), and round (11 foramina, 2.8%). CONCLUSION The depth, angle and diameter measurements belonging to the CAOC were changing according to its shape or demographic data (e.g., sex and age). Therefore, preoperative radiologic evaluation containing the shape, location and size of the CAOC should be considered by multidisciplinary operating teams in terms of surgical interventions such as implant positioning.
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Kutin MA, Kadashev BA, Kalinin PL, Fomichev DV, Sharipov OI, Andreev DN, Cherekaev VA, Lasunin NV, Galkin MV, Serova NK, Tropinskaya OF, Zhadenova IV, Kadasheva AB, Belov AI, Okishev DN, Kuchaev AV, Strunina YV, Mikhailov NI, Abdilatipov AA, Chernov IV, Ismailov DB, Koval KB, Kutin IM. [Transcranial microsurgical decompression of the optic canal in surgical treatment of meningiomas of the sellar region]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2020; 84:61-73. [PMID: 32649815 DOI: 10.17116/neiro20208403161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
RATIONALE When removing the meningiomas of the sellar region, there is always a risk of visual impairment for various reasons, in particular, as a result of traction damage to the optic nerve. Decompression of the optic canal increases nerve mobility during tumor manipulation. In cases of meningioma growing into the canal, its decompression often seems necessary. AIM Evaluation of the effectiveness and risks of performing decompression of the optic canal. MATERIALS AND METHODS The study included patients with meningiomas of the parasellar location, who underwent surgical treatment at the Burdenko Neurosurgical Center for the period from 2001 to 2017. They were divided into two groups - main and control. The main group consisted of 129 patients who underwent decompression of the optic nerve canals when the tumor was removed. The tumor matrix in this group was most often located in the region of the tuberum sellae, supradiaphragmally, in the region of the anterior clinoid process and the optic canal. In 31 cases, decompression was bilateral - during one operation and using one access in 27 patients; in 4 cases, the decompression of the second canal was delayed for 1.5-3 months after the first operation. 160 decompressions were performed by the intradural and 7 - by extradural methods. During intradural decompression, the roof of the optic canal was resected, and during extradural decompression, the lateral wall of the canal was trephined. The control group consisted of 308 patients who did not undergo canal decompression when the tumor was removed. It included meningiomas with a predominant location of the matrix in the area of the tuberclum and diaphragm of the sella. Tumors in both groups were removed according to the same principles (matrix coagulation, mainly the gradual removal of the tumor, the use of ultrasonic aspirator, a situational decision on the radicality of the operation, etc.). The main difference between operations in these two groups was only canal related algorithms (with or without its trepanation), as well as the probable prevalence of significant lateral tumor growth in cases with canal trepanation. Visual functions in the «primary» group were evaluated before and after operations with trepanation of the canal depending on various factors - the initial state of vision and the radicality of the tumor excision, including removal from the canal. The differences in the postoperative dynamics of vision in the main and control groups were studied. The primary data processing was carried out using the program MSExcel. Secondary statistical processing was carried out using the program Statistica. To assess the statistical significance of differences in the results obtained in the compared patient groups, the Chi-square test was used, and in the case of small groups - the exact Fisher test was applied. RESULTS In the main group postoperative vision improvement of varying degrees on the side of trepanation was registered in 36.9% (59 out of 160) cases, no vision changes were found in 36.9% (59 out of 160), and in 26,2% (42 out of 160) the eyesight deteriorated. If preserving vision is attributed to a satisfactory result, then in general the results of these operations should be considered good. A comparative study of the results of removal of meningiomas with trepanation of the canals (main group) or without it (control group) was carried out among patients with the most critical vision situation (visual acuity 0.1 and below, up to only light perception). These groups are comparable in the number of observations - 62 and 73 respectively. The predominance of cases with improved vision in the main group compared with the control group (50.0% versus 38.36%) and a lower incidence of vision impairment (22.58% versus 34.25%) were found. However, the revealed differences are statistically unreliable and make it possible for us to talk only about the trend. The complications associated with trepanation of the canal include mechanical damage to the nerve by the drill. In our series of observations, there was only 1 case of abrasion of the nerve surface with the burr, which did not lead to a significant visual impairment. With the intradural method of trepanation in the area of the medial wall of the canal, the sphenoid sinus may open (in our series, in 34 cases out of 160 trepanations). Immediately closure of these defects was performed by various auto- and allomaterials in various combinations (pericranium, fascia, muscle fragment, hemostatic materials, and fibrin-thrombin glue). A true complication - CSF rhinorrhea liquorrhea developed in only one case, which required transnasal plastic surgery of the CSF fistula using a mucoperiostal flap. CONCLUSIONS 1. Trepanation of the optic canal in cases of meningiomas of parasellar localization is a relatively safe procedure in the hands of a trained neurosurgeon and does not worsen the results of operations compared with the excision of the same tumors without trepanation of the canal. 2. The literature data and the results of our study make it possible to consider the decompression of the optic canal as an optional, but in many cases, useful option that facilitates the transcranial removal of some meningiomas of the sellar region.
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Affiliation(s)
- M A Kutin
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - P L Kalinin
- Burdenko Neurosurgical Center, Moscow, Russia.,Medical Institute of the Peoples' Friendship University of Russia, Moscow, Russia
| | | | | | - D N Andreev
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - N V Lasunin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - M V Galkin
- Burdenko Neurosurgical Center, Moscow, Russia
| | - N K Serova
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | | | | | - A I Belov
- Burdenko Neurosurgical Center, Moscow, Russia
| | - D N Okishev
- Burdenko Neurosurgical Center, Moscow, Russia
| | - A V Kuchaev
- Medical Institute of the Peoples' Friendship University of Russia, Moscow, Russia
| | | | | | | | - I V Chernov
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - K B Koval
- Burdenko Neurosurgical Center, Moscow, Russia
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Beger O, Ten B, Balcı Y, Çakır S, Özalp H, Hamzaoğlu V, Vayisoğlu Y, Dağtekin A, Bağdatoğlu C, Talas DÜ. A Computed Tomography Study of the Prechiasmatic Sulcus Anatomy in Children. World Neurosurg 2020; 141:e118-e132. [PMID: 32413566 DOI: 10.1016/j.wneu.2020.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/30/2020] [Accepted: 05/02/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the characteristics of the prechiasmatic sulcus in children aged between 1-20 years. METHODS Patient files of 200 children admitted to the university hospital on 2019 were analyzed, retrospectively. The computed tomography images of patients were used to obtain anatomical knowledge containing prechiasmatic sulcus types and dimensions. RESULTS The measurements related to the sulcal length (6.94 ± 1.25 mm) and sulcal angle (31.01 ± 18.13°) showed that the sulcal length did not alter in children between 1 and 20 years, whereas the sulcal angle did not vary from infancy to prepubescent period, but it was decreasing in postpubescent period. In 29 patients, the sulcal length was observed to divide into 2 parts with an evident angle. The interoptic distance and planum length were found as follows: 14.70 ± 2.85 mm and 14.84 ± 4.12 mm, respectively. The order of PS types was observed as type 4 (26.5%, 53 cases) > type 2 (26%, 52 cases) > type 1 (24%, 48 cases) > type 3 (23.5%, 47 cases). CONCLUSIONS The sulcal length did not vary in children, whereas the sulcal angle decreased with an irregular pattern. The sulcal angle decreased after prepubescent period, possibly due to the sphenoid sinus pneumatization and spheno-occipital synchondrosis. The sulcal length angle mostly in infants and young children may cause surgical orientation difficult during the resection of tumors using transcranial approaches.
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Affiliation(s)
- Orhan Beger
- Department of Anatomy, Mersin University Faculty of Medicine, Mersin, Turkey; Mersin University Faculty of Medicine, Mersin, Turkey.
| | - Barış Ten
- Department of Radiology Mersin University Faculty of Medicine, Mersin, Turkey; Mersin University Faculty of Medicine, Mersin, Turkey
| | - Yüksel Balcı
- Department of Radiology Mersin University Faculty of Medicine, Mersin, Turkey; Mersin University Faculty of Medicine, Mersin, Turkey
| | - Salim Çakır
- Mersin University Faculty of Medicine, Mersin, Turkey
| | - Hakan Özalp
- Department of Neurosurgery, Mersin University Faculty of Medicine Mersin, Turkey; Mersin University Faculty of Medicine, Mersin, Turkey
| | - Vural Hamzaoğlu
- Department of Neurosurgery, Mersin University Faculty of Medicine Mersin, Turkey; Mersin University Faculty of Medicine, Mersin, Turkey
| | - Yusuf Vayisoğlu
- Department of Otorhinolaryngology, Mersin University Faculty of Medicine, Mersin, Turkey; Mersin University Faculty of Medicine, Mersin, Turkey
| | - Ahmet Dağtekin
- Department of Neurosurgery, Mersin University Faculty of Medicine Mersin, Turkey; Mersin University Faculty of Medicine, Mersin, Turkey
| | - Celal Bağdatoğlu
- Department of Neurosurgery, Mersin University Faculty of Medicine Mersin, Turkey; Mersin University Faculty of Medicine, Mersin, Turkey
| | - Derya Ümit Talas
- Department of Otorhinolaryngology, Mersin University Faculty of Medicine, Mersin, Turkey; Mersin University Faculty of Medicine, Mersin, Turkey
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11
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Lima LR, Beer-Furlan A, Prevedello DM, Carrau RL, Servián-Duarte DA, Galarce MG, Montaser AS, Leal de Vasconcelos V, Giannetti AV. Minimally Invasive Approaches to the Lateral Cavernous Sinus and Meckel's Cave: Comparison of Transorbital and Subtemporal Endoscopic Techniques. World Neurosurg 2020; 141:e86-e96. [PMID: 32371077 DOI: 10.1016/j.wneu.2020.04.180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Transorbital and subtemporal keyhole approaches have recently been proposed to approach lesions in the lateral wall of the cavernous sinus (CS) and Meckel's cave (MC). Our goal was to compare these approaches and suggest indications for each of them. METHODS Five cadaver heads (10 sides, 40 procedures) were used. The lateral transorbital approaches were carried out without and with the removal of the lateral orbital rim, herein referred to as the lateral transorbital approach (LTOA) and the lateral orbital wall approach (LOWA). The subtemporal approaches were performed without and with the removal of the zygomatic arch, referred to as the subtemporal approach (STA) and the subtemporozygomatic approach (STZA). Five targets were chosen and 2 triangles were created representing the lateral wall of the CS and MC. Stereotactic measurements were quantified to calculate angles of attack, surgical freedom, and temporal lobe retraction for each approach. RESULTS LTOA presented the smaller horizontal angles of attack. LOWA increased the angles to the same level of STA and STZA. STA and STZA presented larger vertical angles of attack. The surgical freedom presented gradual increase from LTOA to LOWA, STA, and STZA. STA and STZA needed greater temporal lobe retraction for most targets. CONCLUSIONS LTOA is a good option to biopsy a lesion in the lateral wall of the CS and LOWA increased the surgical corridor to work with microsurgical techniques. STA and STZA could be better options when wide exposure is necessary, but temporal lobe retraction should be taken into consideration.
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Affiliation(s)
- Lucas Ramos Lima
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Department of Surgery, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Andre Beer-Furlan
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Daniel M Prevedello
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
| | - Ricardo L Carrau
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Matias Gomez Galarce
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Alaa S Montaser
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Alexandre Varella Giannetti
- Department of Surgery, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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12
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Beer-Furlan A, Vellutini EDAS, Balsalobre L, Stamm AC. Endoscope-Assisted Middle Fossa Approach: Optimizing the Surgical Corridor for the Resection of Multicompartmental Chordomas. J Neurol Surg B Skull Base 2020; 82:e172-e178. [PMID: 34306933 DOI: 10.1055/s-0040-1702218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/10/2020] [Indexed: 10/24/2022] Open
Abstract
Background Skull base chordomas are a major therapeutic challenge. The surgical management involves selecting an approach that will offer the patient the best chance of largest/complete removal while minimizing morbidity and mortality. Methods Medical records and imaging review of two skull base chordomas involving the middle fossa and posterior fossa that were successfully treated with an endoscope-assisted middle fossa approach. Results The use of angled endoscopes provided better identification of anatomical landmarks and improved tumor resection when compared with the microscopic surgical exposure. The approach selection, anatomical landmarks, and technical aspects of the intraoperative setting of the endoscope-assisted approach are discussed. Conclusion Endoscopic assistance in the middle fossa approach is a safe and valuable tool for maximizing the reach of the surgical corridor when treating skull base chordomas.
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Affiliation(s)
- André Beer-Furlan
- São Paulo Skull Base Center, São Paulo, Brazil.,DFVneuro Neurosurgical Group, São Paulo, Brazil.,Department of Neurological Surgery, Rush University, Chicago, United States
| | | | - Leonardo Balsalobre
- São Paulo Skull Base Center, São Paulo, Brazil.,Department of Otolaryngology, São Paulo ENT Center, Hospital Professor Edmundo Vasconcelos, São Paulo, Brazil
| | - Aldo Cassol Stamm
- São Paulo Skull Base Center, São Paulo, Brazil.,Department of Otolaryngology, São Paulo ENT Center, Hospital Professor Edmundo Vasconcelos, São Paulo, Brazil
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13
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Andrade-Barazarte H, Patel K, Turel MK, Doglietto F, Agur A, Gentili F, Tymianski R, Mendes Pereira V, Tymianski M, Radovanovic I. The endoscopic transpterional port approach: anatomy, technique, and initial clinical experience. J Neurosurg 2020; 132:884-894. [PMID: 30797190 DOI: 10.3171/2018.10.jns171898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 10/24/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The evolution of microsurgical and endoscopic techniques has allowed the development of less invasive transcranial approaches. The authors describe a purely endoscopic transpterional port craniotomy to access lesions involving the cavernous sinus and the anterolateral skull base. METHODS Through single- or dual-port incisions and with direct endoscopic visualization, the authors performed an endoscopic transpterional port approach (ETPA) using a 4-mm straight endoscope in 8 sides of 4 formalin-fixed cadaveric heads injected with colored latex. A main working port incision is made just below the superior temporal line and behind the hairline. An optional 0.5- to 1-cm second skin port incision is made on the lateral supraorbital region, allowing multiangle endoscopic visualization and maneuverability. A 1.5- to 2-cm craniotomy centered over the pterion is done through the main port, which allows an extradural exposure of the cavernous sinus region and extra/intradural exposure of the frontal and temporal cranial fossae. The authors present a pilot surgical series of 17 ETPA procedures and analyze the surgical indications and clinical outcomes retrospectively. RESULTS The initial stage of this work on cadavers provided familiarity with the technique, standardized its steps, and showed its anatomical limits. The clinical ETPA was applied to gain access into the cavernous sinus, as well as for aneurysm clipping and meningioma resection. Overall, perioperative complications occurred in 1 patient (6%), there was no mortality, and at last follow-up all patients had a modified Rankin Scale score of 0 or 1. CONCLUSIONS The ETPA provides a less invasive, focused, and direct route to the cavernous sinus, and to the frontal and temporal cranial fossae, and it is feasible in clinical practice for selected indications with good results.
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Affiliation(s)
- Hugo Andrade-Barazarte
- 1Division of Neurosurgery, Toronto Western Hospital, Krembil Brain Institute, University Health Network, and Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- 5Juha Hernesniemi International Center for Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, China
| | - Krunal Patel
- 1Division of Neurosurgery, Toronto Western Hospital, Krembil Brain Institute, University Health Network, and Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Mazda K Turel
- 1Division of Neurosurgery, Toronto Western Hospital, Krembil Brain Institute, University Health Network, and Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Francesco Doglietto
- 2Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy
| | - Anne Agur
- 3Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Fred Gentili
- 1Division of Neurosurgery, Toronto Western Hospital, Krembil Brain Institute, University Health Network, and Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Tymianski
- 1Division of Neurosurgery, Toronto Western Hospital, Krembil Brain Institute, University Health Network, and Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Vitor Mendes Pereira
- 1Division of Neurosurgery, Toronto Western Hospital, Krembil Brain Institute, University Health Network, and Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- 4Division of Neuroradiology-Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada; and
| | - Michael Tymianski
- 1Division of Neurosurgery, Toronto Western Hospital, Krembil Brain Institute, University Health Network, and Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ivan Radovanovic
- 1Division of Neurosurgery, Toronto Western Hospital, Krembil Brain Institute, University Health Network, and Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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14
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Beger O, Taghipour P, Çakır S, Hamzaoğlu V, Özalp H, Kara E, Vayisoğlu Y, Dağtekin O, Dağtekin A, Bağdatoğlu C, Öztürk AH, Talas DÜ. Fetal Anatomy of the Optic Strut and Prechiasmatic Sulcus with a Clinical Perspective. World Neurosurg 2020; 136:e625-e634. [PMID: 32001393 DOI: 10.1016/j.wneu.2020.01.125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The main objective of the study was to show the morphologic features of optic strut (OS) and prechiasmatic sulcus (PS) in the fetal skull base with a surgical anatomical perspective. METHODS Twenty-three fetal cadavers (9 female, 14 male) with an average age of 21.70 ± 3.12 (range: 16-28) weeks of gestation in the inventory of the Anatomy Department were included in the study. Measurements were made with a digital image analysis software and goniometer. RESULTS The sulcal length, interoptic distance, planum length, and sulcal angle were detected as follows: 3.91 ± 0.74 mm, 6.88 ± 1.04 mm, 6.55 ± 1.51 mm, and 24.52 ± 9.51°, respectively. Considering the location of the posteromedial margin of OS according to PS, OS was identified as the sulcal in 56.5% (13 cases), postsulcal in 30.4% (7 cases), and asymmetric in 13% (3 cases). According to the sulcal length and angle, PS was identified as type 1 in 26.1% (6 cases), type 2 in 21.7% (5 cases), type 3 in 30.4% (7 cases), and type 4 in 21.7% (5 cases). CONCLUSIONS Our findings suggest that the sulcal length and angle reach adult size in utero. Taking into account the fetal and the gathered adult measurements, the high percentage of steep angle compared to flat angle show that after birth, PS become more flat, probably depending on the variations of the sphenoid sinus pneumatization. Thus, more studies conducted on the alterations in PS and OS types relative to the pneumatization are needed in terms of patient positioning, selection of appropriate surgical approach, and intraoperative decision-making.
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Affiliation(s)
- Orhan Beger
- Department of Anatomy, Mersin University Faculty of Medicine, Mersin, Turkey.
| | | | - Salim Çakır
- Mersin University Medical School, Mersin, Turkey
| | - Vural Hamzaoğlu
- Department of Neurosurgery, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Hakan Özalp
- Department of Neurosurgery, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Engin Kara
- Department of Radiology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Yusuf Vayisoğlu
- Department of Otorhinolaryngology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Oykut Dağtekin
- Department of Histology and Embryology, Mersin City Hospital, Mersin, Turkey
| | - Ahmet Dağtekin
- Department of Neurosurgery, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Celal Bağdatoğlu
- Department of Neurosurgery, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Ahmet Hakan Öztürk
- Department of Anatomy, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Derya Ümit Talas
- Department of Otorhinolaryngology, Mersin University Faculty of Medicine, Mersin, Turkey
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15
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Martínez-Pérez R, Albonette-Felicio T, Zachariah MA, Hardesty DA, Carrau RL, Prevedello DM. Quantitative Anatomic Study of the Minipterional Craniotomy in the Paraclinoid Region: Benefits of Extradural Anterior Clinoidectomy. World Neurosurg 2019; 135:e221-e229. [PMID: 31786378 DOI: 10.1016/j.wneu.2019.11.120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Extradural anterior clinoidectomy (eAC) via the minipterional craniotomy (MPT) approach (MPT+eAC) has been recently introduced to the neurosurgical armamentarium to improve access to anterior and middle fossa skull base structures using a minimally invasive approach. However, the effect of extradural clinoidectomy on surgical exposure with the minipterional approach has not been evaluated. Moreover, the effect of eAC on surgical maneuverability has not been established for either traditional pterional or minipterional craniotomy. We sought to illustrate the microsurgical anatomy of the MPT+eAC and to evaluate the effect of eAC on surgical exposure and maneuverability. METHODS The area of exposure, area of surgical freedom, and maneuverability score for the MPT approach and MPT+eAC were compared in 5 cadaveric heads. RESULTS Compared with the MPT approach, the MPT+eAC enlarged the area of exposure approximately twofold (93 cm2 vs. 184 cm2; P < 0.001). All targets considered in the paraclinoid region, including the posterior communicating artery origin, prechiasmatic region, and ophthalmic artery origin, showed an increase in surgical freedom and maneuverability after performing eAC. Targets remote from the clinoid such as the internal carotid bifurcation were not affected. CONCLUSIONS MPT+eAC offers a larger area of exposure and greater surgical freedom and maneuverability at the paraclinoid region using this minimally invasive approach.
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Affiliation(s)
- Rafael Martínez-Pérez
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Thiago Albonette-Felicio
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Marcus A Zachariah
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Douglas A Hardesty
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ricardo L Carrau
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Daniel M Prevedello
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA; Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
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16
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Gogela SL, Zimmer LA, Keller JT, Andaluz N. Refining Operative Strategies for Optic Nerve Decompression: A Morphometric Analysis of Transcranial and Endoscopic Endonasal Techniques Using Clinical Parameters. Oper Neurosurg (Hagerstown) 2019; 14:295-302. [PMID: 29145656 DOI: 10.1093/ons/opx093] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 03/26/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Various approaches can be considered for decompression of the intracanalicular optic nerve. Although clinical experience has been reported, no quantitative study has yet compared the extent of decompression achieved by an endoscopic endonasal versus transcranial approach. OBJECTIVE Toward this aim, our morphometric analysis compared both approaches by quantifying the circumferential degree of optic canal decompression that is possible before any meningeal violation, which would result in cerebrospinal fluid (CSF) leak. METHODS From 10 cadaver heads, 20 optic canals were sequentially decompressed using an endoscopic endonasal approach and pterional craniotomy with extradural clinoidectomy. Dissections ended before violation of the sphenoid sinus during the transcranial approach, and before intracranial transgression from the endonasal corridor. Based on our study criteria, decompressions were not maximal for either approach, but were maximal before violating the other compartment. Decompression achieved from each approach was quantified using CT scans for each stage. RESULTS Greater circumferential bony optic canal decompression was obtained from transcranial (245.2°) than endonasal (114.8°) routes (P < .001). By endonasal perspective, the anatomical point where the optic nerve traverses intracranially was approximated by the medial border of the anterior ascending cavernous internal carotid artery. CONCLUSION Our morphometric analysis comparing optic canal decompression for endonasal and transcranial corridors provides important guidance for this location. Ample visualization and wide exposure can be achieved via a transcranial approach with limited risk of CSF leak. A landmark, where the intracanalicular segment ends and optic nerve traverses intracranially, can mark the extent of decompression safely obtained before risking CSF leak.
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Affiliation(s)
- Steven L Gogela
- Departments of Neurosurgery, Unive-rsity of Cincinnati College of Medicine, Cincinnati, Ohio.,Brain Tumor Center at University of Cincinnati Neuroscience Institute, Cincinnati, Ohio
| | - Lee A Zimmer
- Departments of Neurosurgery, Unive-rsity of Cincinnati College of Medicine, Cincinnati, Ohio.,Departments of Otola-ryngology Head and Neck Surgery, Univ-ersity of Cincinnati College of Medicine, Cincinnati, Ohio.,Brain Tumor Center at University of Cincinnati Neuroscience Institute, Cincinnati, Ohio
| | - Jeffrey T Keller
- Departments of Neurosurgery, Unive-rsity of Cincinnati College of Medicine, Cincinnati, Ohio.,Brain Tumor Center at University of Cincinnati Neuroscience Institute, Cincinnati, Ohio.,Mayfield Clinic, Cincinnati, Ohio
| | - Norberto Andaluz
- Departments of Neurosurgery, Unive-rsity of Cincinnati College of Medicine, Cincinnati, Ohio.,Brain Tumor Center at University of Cincinnati Neuroscience Institute, Cincinnati, Ohio.,Mayfield Clinic, Cincinnati, Ohio
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17
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Endoscopic Optic Nerve Decompression: Indications, Technique, Results. CURRENT OTORHINOLARYNGOLOGY REPORTS 2019. [DOI: 10.1007/s40136-019-00235-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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18
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Cai Q, Guo Q, Zhang W, Ji B, Chen Z, Chen Q. Extradural anterior clinoidectomy and aneurysm clipping using transcranial neuroendoscopic approach: A case report. Medicine (Baltimore) 2019; 98:e15288. [PMID: 31027089 PMCID: PMC6831113 DOI: 10.1097/md.0000000000015288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Anterior clinoidectomy is an important technique for neurovascular and skull base surgery. Until now, extradural anterior clinoidectomies have been performed under a microscope in almost all clinical cases, with only one clinical case performed an extradural pathological anterior clinoid process resection using neuroendoscopy. Additionally, no normal ACP resections have been performed extradurally via neuroendoscopy, especially for aneurysms. We tried to perform extradural anterior clinoidectomies by neuroendoscopy. PATIENT CONCERNS A 63-year-old woman was admitted to hospital presented with sudden onset of headache without any accompanying neurological deficit. A computed tomography (CT) scan of the head revealed a subarachnoid hemorrhage, which was positioned mainly in the left slyvian fissure and interpeduncular and basilar cisterns. DIAGNOSES 1. Left side posterior communicating artery aneurysm; 2. subarachnoid hemorrhage. INTERVENTIONS Extradural anterior clinoidectomy and aneurysm clipping were performed using transcranial neuroendoscopic approaches. OUTCOMES The patient recovered well after the procedure, and the post-operative image view revealed that the ACP had been removed and that the clip was located just at the ACP area. LESSONS This case provided the first evidence that extradural anterior clinoidectomy could be performed by transcranial neuroendoscopic approach.
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19
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Caporlingua A, Prior A, Cavagnaro MJ, Winston G, Oliveira DL, Sadwhani SD, Arias GA, Schwalb JN, Akhbari M, Evins AI, Bernardo A. The Intracranial and Intracanalicular Optic Nerve as Seen Through Different Surgical Windows: Endoscopic Versus Transcranial. World Neurosurg 2019; 124:522-538. [DOI: 10.1016/j.wneu.2019.01.122] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/25/2019] [Indexed: 10/27/2022]
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20
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Skandalakis GP, Koutsarnakis C, Pantazis N, Kalyvas A, Komaitis S, Lani E, Drosos E, Kalamatianos T, Hadjipanayis CG, Natsis K, Stranjalis G, Piagkou M. The carotico-clinoid bar: A systematic review and meta-analysis of its prevalence and potential implications in cerebrovascular and skull base surgery. World Neurosurg 2019; 124:267-276. [PMID: 30677570 DOI: 10.1016/j.wneu.2019.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/31/2018] [Accepted: 01/02/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The caroticoclinoid bar (CCB) is implicated in both transcranial and endonasal surgery. Its morphology reflects differences in the microsurgical anatomy of the parasellar area while its manipulation during an anterior or middle clinoidectomy can result in ICA injury. Although safe surgical access to the paraclinoidal region is related to adjustment of surgical technique according to CCB anatomical variants, a review of the literature indicates the lack of a systematic assortment of published data regarding the prevalence of this variable structure. As such the topic needs further investigation. OBJECTIVE To systematically review and document the prevalence of the CCB and its anatomic variations. METHODS 3 Databases were systematically reviewed according to the PRISMA statement through August of 2018 for the identification of relevant studies. RESULTS A total of 27 articles (7,521 subjects/specimens, 14,449 sides) were included in this meta-analysis. The overall pooled prevalence of the CCB was 32.6% (95% CI 26.6% - 38.8%) when measured over subjects/specimens and 23.6% (95% CI 19.7% - 27.6%) when measured over sides. Overall prevalence of the CCB reported from imaging studies was 23.1% (95% CI 8.9% - 41.4%) when measured over subjects/specimens and 18.7% (95% CI 12.6% - 25.7%) when measured over sides. Moreover, the CCB was slightly more prevalent (p = 0.050), on the right side. CONCLUSION Our results indicate considerable CCB prevalence rates and that imaging studies report lower prevalence rates. Although meticulous preoperative investigation is mandatory, surgeons carrying for patients with parasellar pathologies should always be vigilant about this structure.
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Affiliation(s)
- Georgios P Skandalakis
- Athens Microneurosurgery Laboratory, Athens, Greece; Department of Neurosurgery, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Department of Anatomy and Surgical Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.
| | - Christos Koutsarnakis
- Athens Microneurosurgery Laboratory, Athens, Greece; Department of Neurosurgery, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Department of Anatomy and Surgical Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Aristotelis Kalyvas
- Athens Microneurosurgery Laboratory, Athens, Greece; Department of Neurosurgery, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Department of Anatomy and Surgical Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Spyridon Komaitis
- Athens Microneurosurgery Laboratory, Athens, Greece; Department of Neurosurgery, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Department of Anatomy and Surgical Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Evgenia Lani
- Athens Microneurosurgery Laboratory, Athens, Greece; Department of Neurosurgery, National and Kapodistrian University of Athens School of Medicine, Athens, Greece; Department of Anatomy and Surgical Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Evangelos Drosos
- Athens Microneurosurgery Laboratory, Athens, Greece; Department of Neurosurgery, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | | | - Constantinos G Hadjipanayis
- Department of Neurosurgery, Icahn School of Medicine, Mount Sinai Health System, New York, NY; Department of Neurosurgery, Icahn School of Medicine Mount Sinai Beth Israel, Mount Sinai Health System, New York, New York
| | - Konstantinos Natsis
- Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Stranjalis
- Athens Microneurosurgery Laboratory, Athens, Greece; Department of Neurosurgery, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Maria Piagkou
- Athens Microneurosurgery Laboratory, Athens, Greece; Department of Anatomy and Surgical Anatomy, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
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21
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Bartoli A, Fasel JH, Schaller K, Jägersberg M. Endoscopic Transcranial Duraplasty for Rhinoliquorrhea: A Cadaveric Study. Oper Neurosurg (Hagerstown) 2018; 14:188-193. [PMID: 29351678 DOI: 10.1093/ons/opx084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 03/22/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Repair of the anterior skull base for cerebrospinal fluid leak requires either endoscopic endonasal approach or open transcranial approach. OBJECTIVE To present a less invasive surgical procedure for sealing of the entire anterior fossa floor for traumatic rhinoliquorrhea. METHODS Cadaver study in 3 head specimens. Endoscopic placement of a furled bovine pericardial patch bilaterally along the sphenoid ridge and planum in guidewire technique. Unfurling and spreading of the patch under endoscope assistance. RESULTS Patch placement was feasible in all 3 specimens without visible injuries to the frontal lobes. Dissection and preservation of the olfactory tracts was only possible for 50% of olfactory tracts. CONCLUSION Endoscopic transcranial keyhole duraplasty is a promising concept for traumatic rhinoliquorrhea.
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Affiliation(s)
- Andrea Bartoli
- Department of Neurosurgery, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland
| | - Jean H Fasel
- Clinical Anatomy Research Group, Department of Cellular Physiology and Metabolism, University Medical Center, Geneva, Switzerland
| | - Karl Schaller
- Department of Neurosurgery, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland
| | - Max Jägersberg
- Department of Neurosurgery, Geneva University Hospitals, Faculty of Medicine, Geneva, Switzerland
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22
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Jin H, Gong S, Han K, Wang J, Lv L, Dong Y, Zhang D, Hou L. Clinical management of traumatic superior orbital fissure and orbital apex syndromes. Clin Neurol Neurosurg 2018; 165:50-54. [DOI: 10.1016/j.clineuro.2017.12.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/25/2017] [Accepted: 12/26/2017] [Indexed: 12/20/2022]
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de Notaris M, Laleva L, Spiriev T, Dallan I, Di Nuzzo G, Pineda J, Prats-Galino A, Catapano G. Frontolateral Approach Combined with Endoscopic Endonasal Extradural Posterior Clinoidectomy to the Upper Clival Region: Anatomic and Feasibility Study. World Neurosurg 2017; 111:86-93. [PMID: 29269065 DOI: 10.1016/j.wneu.2017.12.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/04/2017] [Accepted: 12/08/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Surgical management of lesions located in the upper clival region is challenging. Complex open transcranial approaches have been used to reach surgical targets in these areas. The frontotemporozygomatic approach combined with an intradural posterior clinoidectomy has been proposed as the most reliable route to manage such lesions. We investigated combining a minimally invasive endoscopic endonasal extradural posterior clinoidectomy (EPC) with a standard frontolateral approach to expand the working area within the upper clival region. METHODS Investigators dissected 10 human cadaveric heads at the Laboratory of Surgical NeuroAnatomy of the University of Barcelona. The heads were positioned to simulate a supine position, enabling the simultaneous use of both endonasal and frontolateral routes. The dissections were divided into 3 steps-standard frontolateral approach, EPC, and re-evaluation of the frontolateral route-aiming to compare the surgical exposure before and after EPC. RESULTS After EPC, through the frontolateral pathway it was possible to improve visualization and working angles to the interpeduncular fossa and retrosellar and upper clival regions. Increase in extension of the carotid-oculomotor window was 7 mm and 10 mm before and after the posterior clinoidectomy, respectively. CONCLUSIONS EPC provided extra working space for the frontolateral approach to the upper clival area with 42.8% expansion of the carotid-oculomotor triangle. Surgical series are needed to demonstrate clinical advantages and disadvantages of this novel combined approach.
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Affiliation(s)
- Matteo de Notaris
- Department of Neuroscience, "G. Rummo" Hospital, Neurosurgery Operative Unit, Benevento, Italy.
| | - Lili Laleva
- Unit of Otorhinolaryngology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Toma Spiriev
- Unit of Otorhinolaryngology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Iacopo Dallan
- Department of Neurosurgery, Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Giuseppe Di Nuzzo
- Department of Neuroscience, "G. Rummo" Hospital, Neurosurgery Operative Unit, Benevento, Italy
| | - Jose Pineda
- Laboratory of Surgical NeuroAnatomy, Human Anatomy and Embryology Unit, University of Barcelona Faculty of Medicine, Barcelona, Spain
| | - Alberto Prats-Galino
- Laboratory of Surgical NeuroAnatomy, Human Anatomy and Embryology Unit, University of Barcelona Faculty of Medicine, Barcelona, Spain
| | - Giuseppe Catapano
- Department of Neuroscience, "G. Rummo" Hospital, Neurosurgery Operative Unit, Benevento, Italy
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Bernardo A, Evins AI, Mattogno PP, Quiroga M, Zacharia BE. The Orbit as Seen Through Different Surgical Windows: Extensive Anatomosurgical Study. World Neurosurg 2017; 106:1030-1046. [DOI: 10.1016/j.wneu.2017.06.158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Beer-Furlan A, Balsalobre L, Vellutini EDAS, Stamm AC, Pahl FH, Gentil AF. Endoscopic endonasal management of cerebrospinal fluid rhinorrhea after anterior clinoidectomy for aneurysm surgery: changing the paradigm of complication management. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 74:580-6. [PMID: 27487379 DOI: 10.1590/0004-282x20160087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 05/09/2016] [Indexed: 11/22/2022]
Abstract
Resection of the anterior clinoid process results in the creation of the clinoid space, an important surgical step in the exposure and clipping of clinoidal and supraclinoidal internal carotid artery aneurysms. Cerebrospinal fluid rhinorrhea is an undesired and potentially serious complication. Conservative measures may be unsuccesful, and there is no consensus on the most appropriate surgical treatment. Two patients with persistent transclinoidal CSF rhinorrhea after aneurysm surgery were successfully treated with a combined endoscopic transnasal/transeptal binostril approach using a fat graft and ipsilateral mucosal nasal septal flap. Anatomical considerations and details of the surgical technique employed are discussed, and a management plan is proposed.
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Affiliation(s)
- Andre Beer-Furlan
- Centro de Base de Crânio de São Paulo, São Paulo SP, Brasil;,DFVneuro, São Paulo SP, Brasil
| | - Leonardo Balsalobre
- Centro de Base de Crânio de São Paulo, São Paulo SP, Brasil;,DFVneuro, São Paulo SP, Brasil;,Hospital Professor Edmundo Vasconcelos, Centro de Otorrino e Fonoaudiologia, São Paulo SP, Brasil
| | | | - Aldo Cassol Stamm
- Centro de Base de Crânio de São Paulo, São Paulo SP, Brasil;,DFVneuro, São Paulo SP, Brasil;,Hospital Professor Edmundo Vasconcelos, Centro de Otorrino e Fonoaudiologia, São Paulo SP, Brasil
| | - Felix Hendrik Pahl
- Centro de Base de Crânio de São Paulo, São Paulo SP, Brasil;,DFVneuro, São Paulo SP, Brasil
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Kühnel TS, Reichert TE. Trauma of the midface. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2015; 14:Doc06. [PMID: 26770280 PMCID: PMC4702055 DOI: 10.3205/cto000121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Fractures of the midface pose a serious medical problem as for their complexity, frequency and their socio-economic impact. Interdisciplinary approaches and up-to-date diagnostic and surgical techniques provide favorable results in the majority of cases though. Traffic accidents are the leading cause and male adults in their thirties are affected most often. Treatment algorithms for nasal bone fractures, maxillary and zygomatic fractures are widely agreed upon whereas trauma to the frontal sinus and the orbital apex are matter of current debate. Advances in endoscopic surgery and limitations of evidence based gain of knowledge are matters that are focused on in the corresponding chapter. As for the fractures of the frontal sinus a strong tendency towards minimized approaches can be seen. Obliteration and cranialization seem to decrease in numbers. Some critical remarks in terms of high dose methylprednisolone therapy for traumatic optic nerve injury seem to be appropriate. Intraoperative cone beam radiographs and preshaped titanium mesh implants for orbital reconstruction are new techniques and essential aspects in midface traumatology. Fractures of the anterior skull base with cerebrospinal fluid leaks show very promising results in endonasal endoscopic repair.
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Affiliation(s)
- Thomas S Kühnel
- Department of Otolaryngology, Head & Neck Surgery, University of Regensburg, Germany
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Beer-Furlan A, Gomes MQT, Santo MPE, Dias PSC, Casarolli C, Teixeira MJ. The evolution of endoscopic approaches to the lateral cavernous sinus. J Neurol Surg B Skull Base 2015; 76:163-4. [PMID: 25844301 DOI: 10.1055/s-0034-1390399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 07/23/2014] [Indexed: 10/24/2022] Open
Affiliation(s)
- André Beer-Furlan
- Department of Neurosurgery, University of São Paulo Medical School (FMUSP), São Paulo, Brazil
| | - Marcos Q T Gomes
- Department of Neurosurgery, University of São Paulo Medical School (FMUSP), São Paulo, Brazil
| | | | - Paulo S C Dias
- Department of Neurosurgery, University of São Paulo Medical School (FMUSP), São Paulo, Brazil
| | - César Casarolli
- Department of Neurosurgery, University of São Paulo Medical School (FMUSP), São Paulo, Brazil
| | - Manoel J Teixeira
- Department of Neurosurgery, University of São Paulo Medical School (FMUSP), São Paulo, Brazil
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Rigante L, Evins AI, Berra LV, Beer-Furlan A, Stieg PE, Bernardo A. Optic Nerve Decompression through a Supraorbital Approach. J Neurol Surg B Skull Base 2015. [PMID: 26225308 DOI: 10.1055/s-0034-1543964] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Objective We propose a stepwise decompression of the optic nerve (ON) through a supraorbital minicraniotomy and describe the surgical anatomy of the ON as seen through this approach. We also discuss the clinical applications of this approach. Methods Supraorbital approaches were performed on 10 preserved cadaveric heads (20 sides). First, 3.5-cm skin incisions were made along the supraciliary arch from the medial third of the orbit and extended laterally. A 2 × 3-cm bone flap was fashioned and extradural dissections were completed. A 180-degree unroofing of the ON was achieved, and the length and width of the proximal and distal portions of the optic canal (OC) were measured. Results The supraorbital minicraniotomy allowed for identification of the anterior clinoid process and other surgical landmarks and adequate drilling of the roof of the OC with a comfortable working angle. A 25-degree contralateral head rotation facilitated visualization of the ON. Conclusion The supraorbital approach is a minimally invasive and cosmetically favorable alternative to more extended approaches with longer operative times used for the management of ON decompression in posttraumatic or compressive optic neuropathy from skull base pathologies extending into the OC. The relative ease of this approach provides a relatively short learning curve for developing neurosurgeons.
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Affiliation(s)
- Luigi Rigante
- Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, United States ; Neurosurgery Institute, Catholic University School of Medicine, Rome, Italy
| | - Alexander I Evins
- Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, United States
| | - Luigi V Berra
- Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, United States ; Department of Neurosurgery, San Carlo Borromeo Hospital, Milan, Italy
| | - André Beer-Furlan
- Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, United States ; Department of Neurosurgery, University of São Paulo Medical School (FMUSP), São Paulo, Brazil
| | - Philip E Stieg
- Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, United States
| | - Antonio Bernardo
- Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, United States
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Beer-Furlan A, Evins AI, Rigante L, Anichini G, Stieg PE, Bernardo A. The Pterional Port in Dual-Port Endoscopy: A 2D and 3D Cadaveric Study. J Neurol Surg B Skull Base 2014; 76:80-6. [PMID: 25685654 DOI: 10.1055/s-0034-1390398] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 07/21/2014] [Indexed: 10/24/2022] Open
Abstract
Objective We propose a novel dual-port endonasal and pterional endoscopic approach targeting midline lesions of the anterior cranial fossa with lateral extension beyond the optic nerve. Methods Ten dual-port approaches were performed on five cadaveric heads. All specimens underwent an endoscopic transtuberculum/transplanum approach followed by placement of a pterional port. The endonasal port was combined with an endoscopic extradural pterional keyhole craniectomy. The pterional port was placed at the intersection of the sphenoparietal and coronal sutures. The extradural space was explored using two-dimensional and three-dimensional endoscopes. Results The superolateral access provided by the pterional port may improve the ability to achieve a gross total resection of tumors with lateral extensions. The complete opening of the optic canal achieved through the dual-port approach may enable resection of the intracanalicular portion of a tumor, a crucial step in improvement of visual function and reduction of tumor recurrence. Conclusion The pterional port may enhance control of midline anterior skull base lesions with lateral extension beyond the optic nerve and optic canal. Dual-port endoscopy maintains minimally invasiveness and dramatically increases the working limits and control of anatomical structures well beyond what is attainable through single-port neuroendoscopy.
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Affiliation(s)
- André Beer-Furlan
- Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, United States ; Department of Neurosurgery, University of São Paulo Medical School (FMUSP), São Paulo, Brazil
| | - Alexander I Evins
- Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, United States
| | - Luigi Rigante
- Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, United States
| | - Giulio Anichini
- Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, United States
| | - Philip E Stieg
- Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, United States
| | - Antonio Bernardo
- Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, United States
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