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Lee HG, Cho SJ, Park HR, Seo D. Supraorbital Approaches for Anterior Skull Base and Parasellar Lesions: Insights From a Single-Center Experience. Brain Tumor Res Treat 2024; 12:172-180. [PMID: 39109618 PMCID: PMC11306836 DOI: 10.14791/btrt.2024.0026] [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: 07/02/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Modern neurosurgery has undergone significant evolution to include minimally invasive procedures, with the supraorbital approach (SOA) being a prime example. In this study, we aim to explore the surgical techniques and outcomes of this approach in the surgical treatment of frontal lobe, anterior skull base, and parasellar lesions. METHODS This study included 33 patients aged 36-83 years who underwent surgery using the SOA for lesions in the inferior frontal lobe, anterior skull base, and parasellar area between 2015 and 2024. There were 25 cases of meningioma, 2 cases of brain abscess, 2 cases of glioma, and one case each of craniopharyngioma, hemangioma, metastasis, and Rathke's cleft cyst. The medical data and follow-up results were retrospectively analyzed. RESULTS The mean size of lesion was 3.38±3.05 cm. The mean follow-up period was 48.8 months. Gross total resection was achieved in 25 patients (75.8%). There were no perioperative deaths, cases of cerebrospinal fluid rhinorrhea, or infections. Two cases of morbidity were reported as complications: one case of delayed intracerebral hemorrhage and one case of infarction due to vascular injury. All patients exhibited satisfactory cosmetic results. CONCLUSION In comparison to the conventional pterional approach, the SOA represents a safe and effective keyhole method for the removal of both extra-axial and intra-axial skull base tumors. This is particularly beneficial for lesions in the orbitofrontal region and parasellar area, as it allows for minimal disruption of normal brain parenchyma. Moreover, the SOA promotes a swift recovery and short hospital stay. Additionally, the SOA yields superior cosmetic results, including the prevention of temporalis muscle atrophy.
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Affiliation(s)
- Han Gyul Lee
- Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sung Jin Cho
- Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea.
| | - Hye Ran Park
- Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Dongwook Seo
- Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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Ali A, Morris JM, Decker SJ, Huang YH, Wake N, Rybicki FJ, Ballard DH. Clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: neurosurgical and otolaryngologic conditions. 3D Print Med 2023; 9:33. [PMID: 38008795 PMCID: PMC10680204 DOI: 10.1186/s41205-023-00192-w] [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: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Medical three dimensional (3D) printing is performed for neurosurgical and otolaryngologic conditions, but without evidence-based guidance on clinical appropriateness. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides appropriateness recommendations for neurologic 3D printing conditions. METHODS A structured literature search was conducted to identify all relevant articles using 3D printing technology associated with neurologic and otolaryngologic conditions. Each study was vetted by the authors and strength of evidence was assessed according to published guidelines. RESULTS Evidence-based recommendations for when 3D printing is appropriate are provided for diseases of the calvaria and skull base, brain tumors and cerebrovascular disease. Recommendations are provided in accordance with strength of evidence of publications corresponding to each neurologic condition combined with expert opinion from members of the 3D printing SIG. CONCLUSIONS This consensus guidance document, created by the members of the 3D printing SIG, provides a reference for clinical standards of 3D printing for neurologic conditions.
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Affiliation(s)
- Arafat Ali
- Department of Radiology, Henry Ford Health, Detroit, MI, USA
| | | | - Summer J Decker
- Division of Imaging Research and Applied Anatomy, Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Yu-Hui Huang
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Nicole Wake
- Department of Research and Scientific Affairs, GE HealthCare, New York, NY, USA
- Center for Advanced Imaging Innovation and Research, Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA.
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Midline Skull Base Meningiomas: Transcranial and Endonasal Perspectives. Cancers (Basel) 2022; 14:cancers14122878. [PMID: 35740543 PMCID: PMC9220797 DOI: 10.3390/cancers14122878] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/25/2022] [Accepted: 06/03/2022] [Indexed: 12/07/2022] Open
Abstract
Simple Summary Skull base meningiomas have always represented a challenge for neurosurgeons. Despite their histological nature, they may be associated with unfavorable outcomes due to their deep-seated location and the surrounding neurovascular structures. Over time, several corridors have been proposed, each one carrying its own pros and cons. During the last decades, the endoscopic endonasal route has been asserted among the classic routes for a growing number of midline and paramedian lesions. Therefore, the aim of our paper is to present a comprehensive review of the indications and techniques for the management of skull base meningiomas, emphasizing the ambivalent and complementary role of the low and high routes. Abstract Skull base meningiomas have always represented a challenge for neurosurgeons. Despite their histological nature, they may be associated with unfavorable outcomes due to their deep-seated location and the surrounding neurovascular structures. The state of the art of skull base meningiomas accounts for both transcranial, or high, and endonasal, or low, routes. A comprehensive review of the pertinent literature was performed to address the surgical strategies and outcomes of skull base meningioma patients treated through a transcranial approach, an endoscopic endonasal approach (EEA), or both. Three databases (PubMed, Ovid Medline, and Ovid Embase) have been searched. The review of the literature provided 328 papers reporting the surgical, oncological, and clinical results of different approaches for the treatment of skull base meningiomas. The most suitable surgical corridors for olfactory groove, tuberculum sellae, clival and petroclival and cavernous sinus meningiomas have been analyzed. The EEA was proven to be associated with a lower extent of resection rates and better clinical outcomes compared with transcranial corridors, offering the possibility of achieving the so-called maximal safe resection.
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Prem B, Mueller CA. Smell loss as initial symptom of olfactory groove meningioma. BMJ Case Rep 2021; 14:e241013. [PMID: 34426419 PMCID: PMC8383885 DOI: 10.1136/bcr-2020-241013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 11/04/2022] Open
Abstract
Approximately 20% of the general population suffer from olfactory dysfunction (OD). Until today, olfactory function (OF) receives less attention than other human senses despite its significance for quality of life. The main causes of OD are upper respiratory tract infections, traumatic brain injuries and sinonasal diseases. Here, we report the case of a 28-year-old woman, who started to suffer from OD during pregnancy. Smell loss was attributed to pregnancy-induced rhinitis and initiated no further examinations. Nevertheless, OD persisted post partum and undulating headache occurred 1 year later. Only after visual impairment and one more year passing by, diagnosis of olfactory groove meningioma was made using MRI. With this case report, we want to highlight the importance of the symptom of smell loss. Patients reporting OD should undergo thorough anamnesis, endoscopy of the nasal cavity, psychophysical smell testing and radiographic imaging in unclear cases to determine diagnosis.
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Affiliation(s)
- Bernhard Prem
- Department of Otorhinolaryngology, Medical University of Vienna, Wien, Austria
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Bunevicius A, Ahn J, Fribance S, Peker S, Hergunsel B, Sheehan D, Sheehan K, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad RM, Chytka T, Liscak R, Alvarez RM, Moreno NM, Langlois AM, Mathieu D, Lee CC, Yang HC, Tripathi M, Warnick RE, Speckter H, Albert C, Picozzi P, Franzini A, Attuati L, Strickland BA, Zada G, Chang EL, Feliciano Valls CE, Carbini CH, Patel S, Sheehan J. Stereotactic Radiosurgery for Olfactory Groove Meningiomas: An International, Multicenter Study. Neurosurgery 2021; 89:784-791. [PMID: 34383951 DOI: 10.1093/neuros/nyab291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/06/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) is increasingly considered for selected olfactory groove meningiomas (OGMs). OBJECTIVE To investigate the safety and efficacy of SRS for OGMs. METHODS From 20 institutions participating in the International Radiosurgery Research Foundation, we pooled patients who underwent SRS for histologically confirmed or radiologically suspected WHO grade I OGMs and were followed for 6 mo or more after the SRS. RESULTS In total, 278 (median age 57 yr) patients underwent SRS for histologically confirmed (29%) or radiologically suspected (71%) WHO grade I OGMs Median treatment volume was 4.60 cm3 (range: 0.12-27.3 cm3), median prescription dose was 12 Gy, and median dose to the olfactory nerve was 11.20 Gy. During median post-SRS imaging follow-up of 39 mo (range: 6-240 mo), 43% of patients had partial or marginal response, 54% of patients had stable disease, and 3% of patients experienced progression. During median post-SRS clinical follow-up of 51 mo (range: 6-240 mo), 36 (13%) patients experienced clinical and/or radiological adverse radiation events (AREs). Elevated risk of AREs was associated with larger OGM volume (P = .009) and pre-SRS peritumoral T2/fluid-attenuated inversion-recovery signal abnormalities (P < .001). After the SRS, olfaction remained stable, improved, or deteriorated in 90%, 8%, and 2% of patients, respectively. Complete post-SRS anosmia was predicted by partial/complete anosmia before the SRS (odds ratio [OR] = 83.125; 95% CI [24.589-281.01], P < .001) and prior resection of OGM (OR = 3.919; 95% CI [1.713-8.970], P = .001). CONCLUSION SRS is associated with durable local control of the majority of OGM patients with acceptable safety profile. SRS allows preservation or improvement of olfactory function in the majority of OGM patients.
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Affiliation(s)
- Adomas Bunevicius
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Jungeun Ahn
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Sarah Fribance
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Selcuk Peker
- Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
| | - Batu Hergunsel
- Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
| | - Darrah Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Kimball Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Benha University, Qalubya, Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Neurosurgery Department, Ain Shams University, Cairo, Egypt
| | - Reem M Emad
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt.,Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Tomas Chytka
- Department of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Roman Liscak
- Department of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | | | | | - Anne-Marie Langlois
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Canada
| | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Canada
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
| | - Huai-Che Yang
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
| | - Manjul Tripathi
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ronald E Warnick
- Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, Ohio, USA
| | - Herwin Speckter
- Gamma Knife, Radiology Department Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
| | - Camilo Albert
- Gamma Knife, Radiology Department Dominican Gamma Knife Center and CEDIMAT, Santo Domingo, Dominican Republic
| | - Piero Picozzi
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Andrea Franzini
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luca Attuati
- Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Ben A Strickland
- Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
| | - Gabriel Zada
- Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
| | - Eric L Chang
- Department of Radiation Oncology, University of Southern California, Los Angeles, California, USA
| | - Caleb E Feliciano Valls
- Department of Neurosurgery, University of Puerto Rico, School of Medicine, San Juan, Puerto Rico
| | - Carlos H Carbini
- Administración de Servicios Médicos de Puerto Rico, Centro Gamma Knife de Puerto Rico y El Caribe, San Juan, Puerto Rico
| | - Samir Patel
- Division of Radiation Oncology, University of Alberta, Edmonton, Canada
| | - Jason Sheehan
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
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Hong M, Kreykes AJ. Cognitive Changes in a Commercial Pilot Secondary to an Olfactory Meningioma. Aerosp Med Hum Perform 2020; 91:966-969. [PMID: 33243341 DOI: 10.3357/amhp.5679.2020] [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: 11/24/2022]
Abstract
BACKGROUND: Olfactory meningiomas are typically benign, slow-growing intracranial tumors with subtle presentations that result in delayed diagnosis. To date, only a few published reports describe meningiomas in airmen. None specifically mention olfactory meningiomas or detail the associated presence of cognitive impairment.CASE REPORT: This was a 55-yr-old commercial pilot with over 20 yr of flight experience who presented for a fitness-for-duty evaluation due to alarming performance at work and neurocognitive concerns. On examination, the patient had an odd affect and anosmia. Imaging showed a large, frontal, midline intracranial mass consistent with an olfactory meningioma.DISCUSSION: Fitness-for-duty cases are often challenging and even more so when neurocognition is called into question. Symptoms may be subtle and gradual in onset, making recognition and diagnosis difficult. Dementia, alcohol or substance misuse/abuse, and psychiatric diagnoses are often the first conditions considered when evaluating new cognitive impairment in a pilot. This case highlights the importance of keeping a broad differential, including intracranial masses, conducting a thorough neurological examination, and the judicious use of brain imaging.Hong M, Kreykes AJ. Cognitive changes in a commercial pilot secondary to an olfactory meningioma. Aerosp Med Hum Perform. 2020; 91(12):966969.
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Liu J, Rojas R, Lam FC, Mirza FA, Mahadevan A, Kasper EM. Indications, feasibility, safety, and efficacy of CyberKnife radiotherapy for the treatment of olfactory groove meningiomas: a single institutional retrospective series. Radiat Oncol 2020; 15:63. [PMID: 32164781 PMCID: PMC7069021 DOI: 10.1186/s13014-020-01506-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 02/27/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose To assess the safety and efficacy of CyberKnife® radiotherapy (CKRT) for the treatment of olfactory groove meningiomas (OGMs). Methods A retrospective review was performed of 13 patients with OGM treated with CKRT from September 2005 to May 2018 at our institution. Nine patients were treated primarily with CKRT, 3 for residual disease following resection, and 1 for disease recurrence. Results Five patients were treated with stereotactic radiosurgery (SRS), 6 with hypofractionated stereotactic radiotherapy (HSRT), and 2 with fractionated stereotactic radiotherapy (FSRT). The median tumor volume was 8.12 cm3. The median prescribed dose was 14.8 Gy for SRS, 27.3 Gy for HSRT, and 50.2 Gy for FSRT. The median maximal dose delivered was 32.27 Gy. Median post treatment follow-up was 48 months. Twelve of 13 patients yielded a 100% regional control rate with a median tumor volume reduction of 31.7%. Six of the 12 patients had reduced tumor volumes while the other 6 had no changes. The thirteenth patient had significant radiation-induced edema requiring surgical decompression. Twelve patients were alive and neurologically stable at the time of the review. One patient died from pneumonia unrelated to his CKRT treatment. Conclusions CKRT appears to be safe and effective for the treatment of OGMs.
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Affiliation(s)
- Jianmin Liu
- Department of Neurosurgery, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Rafael Rojas
- Department of Radiology, Division of Neuroradiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Fred C Lam
- Division of Neurosurgery, Department of Surgery, Hamilton General Hospital, McMaster University Faculty of Health Sciences, 237 Barton Street East, Hamilton, ON, L2L 8X8, Canada
| | - Farhan A Mirza
- Division of Neurosurgery, Kentucky Neuroscience Institute, University of Kentucky, Lexington, KT, USA
| | - Anand Mahadevan
- Department of Radiation Oncology, Geisinger Medical Group, Danville, PA, USA
| | - Ekkehard M Kasper
- Department of Radiology, Division of Neuroradiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. .,Division of Neurosurgery, Department of Surgery, Hamilton General Hospital, McMaster University Faculty of Health Sciences, 237 Barton Street East, Hamilton, ON, L2L 8X8, Canada.
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Jeon JW, Cho SS, Nag S, Buch L, Pierce J, Su YS, Adappa ND, Palmer JN, Newman JG, Singhal S, Lee JYK. Near-Infrared Optical Contrast of Skull Base Tumors During Endoscopic Endonasal Surgery. Oper Neurosurg (Hagerstown) 2019; 17:32-42. [PMID: 30124919 PMCID: PMC7311828 DOI: 10.1093/ons/opy213] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 08/07/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Near-infrared (NIR) tumor contrast is achieved through the "second-window ICG" technique, which relies on passive accumulation of high doses of indocyanine green (ICG) in neoplasms via the enhanced permeability and retention effect. OBJECTIVE To report early results and potential challenges associated with the application of second-window ICG technique in endonasal endoscopic, ventral skull-base surgery, and to determine potential predictors of NIR signal-to-background ratio (SBR) using endoscopic techniques. METHODS Pituitary adenoma (n = 8), craniopharyngioma (n = 3), and chordoma (n = 4) patients received systemic infusions of ICG (5 mg/kg) approximately 24 h before surgery. Dual-channel endoscopy with visible light and NIR overlay were photodocumented and analyzed post hoc. RESULTS All tumors (adenoma, craniopharyngioma, chordoma) demonstrated NIR positivity and fluoresced with an average SBR of 3.9 ± 0.8, 4.1 ± 1.7, and 2.1 ± 0.6, respectively. Contrast-enhanced T1 signal intensity proved to be the single best predictor of observed SBR (P = .0003). For pituitary adenomas, the sensitivity, specificity, positive predictive value, and negative predictive value of NIR-guided identification of tumor was 100%, 20%, 71%, and 100%, respectively. CONCLUSION In this preliminary study of a small set of patients, we demonstrate that second-window ICG can provide NIR optical tumor contrast in 3 types of ventral skull-base tumors. Chordomas demonstrated the weakest NIR signal, suggesting limited utility in those patients. Both nonfunctional and functional pituitary adenomas appear to accumulate ICG, but utility for margin detection for the adenomas is limited by low specificity. Craniopharyngiomas with third ventricular extension appear to be a particularly promising target given the clean brain parenchyma background and strong SBR.
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Affiliation(s)
- Jun W Jeon
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steve S Cho
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shayoni Nag
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Love Buch
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John Pierce
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - YouRong S Su
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nithin D Adappa
- Department of Otorhinolaryngology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - James N Palmer
- Department of Otorhinolaryngology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason G Newman
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sunil Singhal
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John Y K Lee
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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10
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Bernat AL, Priola SM, Elsawy A, Farrash F, Pasarikovski CR, Almeida JP, Lenck S, De Almeida J, Vescan A, Monteiro E, Zadeh GM, Gentili F. Recurrence of Anterior Skull Base Meningiomas After Endoscopic Endonasal Resection: 10 Years' Experience in a Series of 52 Endoscopic and Transcranial Cases. World Neurosurg 2018; 120:e107-e113. [PMID: 30077030 DOI: 10.1016/j.wneu.2018.07.210] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Although the indication of endoscopic approaches for anterior skull base meningiomas (ASBM) has been progressively refined, there remains a paucity of data on recurrence rates after resection. To analyze and compare recurrence rates of ASBM resected through endoscopic endonasal (EEE) versus transcranial (TCA) approaches. MATERIAL AND METHODS We performed a retrospective analysis of patients submitted to the EEE or TCA approach for ASBM resection from May 2006 to January 2016 in our center. Clinical, radiological, and pathology data were retrieved for analysis. Tumor size, location, surgical technique, extent of resection, and tumor grade were assessed. The 2 groups were compared to identify predictors and differences regarding tumor recurrence. RESULTS Fifty-two patients (17 olfactory groove meningioma [OGM] and 35 tuberculum sellae meningioma [TSM]) were included; 26 (6 OGM and 20 TSM) underwent EEE and 26 (13 OGM and 13 TSM) TCA, with a mean follow-up of 41 months. Gross total resection was achieved in 38 (73%) patients (18 [69%] in EEE and 20 [77%] in TCA). Eight (15%) patients presented with recurrence: 5 (19%) in the EEE group and 3 (11.5%) in the TCA group without a statistical difference (P = 0.69). Among the recurrences, gross total resection had been achieved in 1 case of each group. In the EEE group, 1 patient underwent TCA for a recurrent tumor and another patient was referred for radiosurgery. CONCLUSIONS This study has shown an overall similar recurrence rate of ASBM regardless of the technique used. However, the analysis of larger series with longer follow-up is necessary to clearly define the indications and to fully validate the efficacy of EEE.
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Affiliation(s)
- Anne-Laure Bernat
- Department of Neurosurgery (Neuro-oncology Division), Toronto Western Hospital, Toronto, Ontario, Canada; Department of Neurosurgery, University Paris-Diderot, Lariboisière Hospital, Paris, France.
| | - Stefano Maria Priola
- Department of Neurosurgery (Neuro-oncology Division), Toronto Western Hospital, Toronto, Ontario, Canada; Department of Neurosurgery, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Ahmad Elsawy
- Department of Neurosurgery (Neuro-oncology Division), Toronto Western Hospital, Toronto, Ontario, Canada; Department of Neurosurgery, Ain Shams University, Cairo, Egypt
| | - Faisal Farrash
- Department of Neurosurgery (Neuro-oncology Division), Toronto Western Hospital, Toronto, Ontario, Canada; Department of Neurosurgery, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Christopher R Pasarikovski
- Department of Neurosurgery (Neuro-oncology Division), Toronto Western Hospital, Toronto, Ontario, Canada
| | - Joao Paulo Almeida
- Department of Neurosurgery (Neuro-oncology Division), Toronto Western Hospital, Toronto, Ontario, Canada
| | - Stéphanie Lenck
- Department of Neurosurgery (Neuro-oncology Division), Toronto Western Hospital, Toronto, Ontario, Canada; Department of Interventional Neuroradiology, University Pierre et Marie Curie, La Pitié-Salpêtrière Hospital, Paris, France
| | - John De Almeida
- Department of Otolaryngology, UHN, Toronto, Ontario, Canada; Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Allan Vescan
- Department of Otolaryngology, UHN, Toronto, Ontario, Canada; Department of Otolaryngology, Mount Sinai Hospital, UHN, Toronto, Ontario, Canada; Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology, UHN, Toronto, Ontario, Canada; Department of Otolaryngology, Mount Sinai Hospital, UHN, Toronto, Ontario, Canada; Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gelareh Mohammed Zadeh
- Department of Neurosurgery (Neuro-oncology Division), Toronto Western Hospital, Toronto, Ontario, Canada; Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Fred Gentili
- Department of Neurosurgery (Neuro-oncology Division), Toronto Western Hospital, Toronto, Ontario, Canada; Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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Francies O, Makalanda L, Paraskevopolous D, Adams A. Imaging review of the anterior skull base. Acta Radiol Open 2018; 7:2058460118776487. [PMID: 29872547 PMCID: PMC5977432 DOI: 10.1177/2058460118776487] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 04/17/2018] [Indexed: 12/28/2022] Open
Abstract
The anterior skull base (ASB) is intimately associated with the unique soft tissue subtypes of the nasal cavity, paranasal sinuses, orbits, and intracranial compartment. Pathology involving the ASB is rare but the causes are manifold and can be broadly subdivided into those intrinsic to the skull base and processes extending from below or above. Sinonasal pathology is the most commonly encountered and poses significant management challenges that rely heavily on accurate interpretation of the radiological findings. We illustrate the normal anatomy of the ASB and present a cross-sectional imaging review of the pathological entities that may be encountered, focusing on the specific features that will impact on clinical and surgical management.
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Affiliation(s)
- Olivia Francies
- Department of Radiology, St Bartholomew's and The Royal London Hospitals, Barts Health NHS Trust, London, UK
| | - Levan Makalanda
- Department of Radiology, St Bartholomew's and The Royal London Hospitals, Barts Health NHS Trust, London, UK
| | | | - Ashok Adams
- Department of Radiology, St Bartholomew's and The Royal London Hospitals, Barts Health NHS Trust, London, UK
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Shetty SR, Ruiz-Treviño AS, Omay SB, Almeida JP, Liang B, Chen YN, Singh H, Schwartz TH. Limitations of the endonasal endoscopic approach in treating olfactory groove meningiomas. A systematic review. Acta Neurochir (Wien) 2017; 159:1875-1885. [PMID: 28831590 DOI: 10.1007/s00701-017-3303-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 08/09/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To review current management strategies for olfactory groove meningioma (OGM)s and the recent literature comparing endoscopic endonasal (EEA) with traditional transcranial (TCA) approaches. METHODS A PubMed search of the recent literature (2011-2016) was performed to examine outcomes following EEA and TCA for OGM. The extent of resection, visual outcome, postoperative complications and recurrence rates were analyzed using percentages and proportions, the Fischer exact test and the Student's t-test using Graphpad PRISM 7.0Aa (San Diego, CA) software. RESULTS There were 444 patients in the TCA group with a mean diameter of 4.61 (±1.17) cm and 101 patients in the EEA group with a mean diameter of 3.55 (± 0.58) cm (p = 0.0589). GTR was achieved in 90.9% (404/444) in the TCA group and 70.2% (71/101) in the EEA group (p < 0.0001). Of the patients with preoperative visual disturbances, 80.7% (21/26) of patients in the EEA cohort had an improvement in vision compared to 12.83%(29/226) in the TCA group (p < 0.0001). Olfaction was lost in 61% of TCA and in 100% of EEA patients. CSF leaks and meningitis occurred in 25.7% and 4.95% of EEA patients and 6.3% and 1.12% of TCA patients, respectively (p < 0.0001; p = 0.023). CONCLUSIONS Our updated literature review demonstrates that despite more experience with endoscopic resection and skull base reconstruction, the literature still supports TCA over EEA with respect to the extent of resection and complications. EEA may be an option in selected cases where visual improvement is the main goal of surgery and postoperative anosmia is acceptable to the patient or in medium-sized tumors with existing preoperative anosmia. Nevertheless, based on our results, it seems more prudent at this time to use TCA for the majority of OGMs.
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Liu JK, Hattar E, Eloy JA. Endoscopic Endonasal Approach for Olfactory Groove Meningiomas: Operative Technique and Nuances. Neurosurg Clin N Am 2016; 26:377-88. [PMID: 26141357 DOI: 10.1016/j.nec.2015.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Olfactory groove meningiomas represent approximately 10% of all intracranial meningiomas. Because these tumors originate at the ventral skull base, the endonasal route provides direct access to the tumor blood supply for early devascularization and removal of the underlying hyperostotic bone at the cranial base. In carefully selected patients, these tumors can be totally removed without additional brain retraction or manipulation. In this report, we describe the surgical technique and operative nuances for removal of olfactory groove meningiomas using the endoscopic endonasal approach, and also discuss the indications, limitations, complication avoidance and management, and postoperative care.
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Affiliation(s)
- James K Liu
- Department of Neurological Surgery, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA; Department of Otolaryngology-Head and Neck Surgery, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA.
| | - Ellina Hattar
- Department of Neurological Surgery, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA
| | - Jean Anderson Eloy
- Department of Neurological Surgery, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA; Department of Otolaryngology-Head and Neck Surgery, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, NJ 07103, USA
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Anterior and Posterior Ethmoidal Artery Ligation in Anterior Skull Base Meningiomas: A Review on Microsurgical Approaches. World Neurosurg 2015; 84:1161-5. [PMID: 26072460 DOI: 10.1016/j.wneu.2015.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 06/01/2015] [Accepted: 06/03/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Anterior skull base neoplastic and vascular lesions can receive significant blood supply from the anterior and posterior ethmoidal artery. Although useful in preoperative embolization of middle meningeal artery branches, endovascular techniques for the occlusion of anterior ethmoidal artery expose the parent vessel, the ophthalmic artery, to possible embolic complications, which can cause loss of vision. When dealing with anterior fossa giant meningiomas, moreover, it is not always possible to gain direct intracranial access to anterior ethmoidal arteries because of dimensions and invasiveness of these neoplasms. The aim of this review is to illustrate the anterior and posterior ethmoidal artery anatomy and the microsurgical approaches for extracranial ligation. METHODS We performed a literature review of the relevant microsurgical anatomy of these arteries; particular attention is given to anterior cranial fossa and medial orbital wall anatomy. RESULTS Our research found two surgical sites of arterial occlusion that can be best exposed with five microsurgical approaches. CONCLUSIONS A combination of different surgical and endovascular techniques before resection of hypervascular giant olfactory groove and planum sphenoidale meningiomas should always be considered. Microsurgical extracranial ligation of anterior and sometimes posterior ethmoidal arteries provides a safe and feasible option to limit blood loss during anterior skull base surgery.
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Reconstructive challenges in the extended endoscopic transclival approach. The Journal of Laryngology & Otology 2015; 129:468-72. [PMID: 25827753 DOI: 10.1017/s0022215115000420] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We wanted to present our experience with the extended endoscopic approach to clival pathology, focusing on cerebrospinal fluid leak and reconstruction challenges. METHODS We examined a consecutive series of 37 patients undergoing the extended endoscopic approach for skull base tumours, 9 patients with clival pathology. Patients were examined for the incidence of post-operative cerebrospinal fluid leak in relation to tumour pathology, location, size, reconstruction and lumbar drain. RESULTS The overall incidence of post-operative cerebrospinal fluid leak was 10.8 per cent. Seventy-five per cent of patients who had a post-operative cerebrospinal fluid leak underwent a transclival approach (p < 0.05). All patients with clival pathology who underwent an intradural dissection had a post-operative cerebrospinal fluid leak (p < 0.05). CONCLUSION Post-operative cerebrospinal fluid leak rates after the extended endoscopic approach have improved significantly after advancements including the vascularised nasoseptal flap. Despite this, transclival approaches continue to pose much difficulty. Further investigation is necessary to develop technical improvements that can meet the unique challenges associated with this region.
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Subtle clinical signs of a meningioma in an adult: a case report. Chiropr Man Therap 2014; 22:8. [PMID: 24490991 PMCID: PMC4121950 DOI: 10.1186/2045-709x-22-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 12/17/2013] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Meningiomas are the most common brain tumor in the adult population. This case report describes the epidemiology, the clinical presentation as well as the current treatment options for this condition.
Case presentation
A 49 year-old man attended a chiropractic clinic with non-specific chronic low back pain. Upon the history taking and the systems review, he reported a loss of both smell and taste for which investigations conducted by two different otolaryngologists did not yield a specific diagnosis. The patient was referred to a neurologist who ordered a computer tomography scan that eventually revealed a compression brain tumor.
Brain tumors can produce a large variety of clinical presentations, such as upper motor neuron lesion symptoms, altered consciousness or vital functions which are easy to identify. However, subtle signs, such as those presented in this case, can be neglected.
Conclusion
Clinicians should be aware of uncommon clinical presentations including cranial nerve or neurological dysfunction and refer their patient to a specialist when detected.
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Gamma Knife radiosurgery of olfactory groove meningiomas provides a method to preserve subjective olfactory function. J Neurooncol 2014; 116:577-83. [DOI: 10.1007/s11060-013-1335-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 12/27/2013] [Indexed: 10/25/2022]
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Skorek A, Liczbik W, Stankiewicz C, Kloc W, Plichta Ł. Personal experience in transnasal endoscopic resection of the olfactory groove meningiomas. What can an otolaryngologist offer to a neurosurgeon? Eur Arch Otorhinolaryngol 2013; 271:1037-41. [PMID: 23907369 PMCID: PMC3978380 DOI: 10.1007/s00405-013-2645-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 07/17/2013] [Indexed: 11/10/2022]
Abstract
Olfactory groove meningioma is a demanding therapeutic problem involving two medical specialties, otolaryngology and neurosurgery. The use of transnasal endoscopic (TNE) approach to the tumour has been proved effective in many publications. Three patients with meningiomas localized in olfactory groove were treated in 2011 and 2012 by the otolaryngologist-neurosurgeon team using TNE approach and neuronavigation. The diagnosis was based on MR and CT images. In all patients after tumour removal an endoscopic anterior cranial fossa floor reconstruction was performed using homogeneous cartilage or titanium mesh and Hadad-Bassagasteguy flap. During postoperative period in all patients lumbar drainage was used. There were no cerebrospinal fluid leakage episodes. No recurrence was observed in 22, 12 and 8 months of follow-up, respectively. The authors describe otolaryngological and neurosurgical aspects of TNE approach to anterior cranial fossa with special regard to possible radical resection (according to Simpson) and reconstruction of the bony postoperative defect. TNE is a feasible operative method in olfactory groove meningioma management due to good tumour visibility, lack of brain traction, limited neurovascular structure manipulation and acceptable risk of neurological deficiencies when compared to open approach. Cosmetic aspect and short hospitalization is also of great importance.
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Affiliation(s)
- Andrzej Skorek
- Otolaryngology Department, Medical University in Gdańsk, Gdańsk, Poland,
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Jang WY, Jung S, Jung TY, Moon KS, Kim IY. Preservation of olfaction in surgery of olfactory groove meningiomas. Clin Neurol Neurosurg 2013; 115:1288-92. [DOI: 10.1016/j.clineuro.2012.12.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 11/10/2012] [Accepted: 12/02/2012] [Indexed: 11/16/2022]
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Eloy JA, Shukla PA, Choudhry OJ, Singh R, Liu JK. Challenges and surgical nuances in reconstruction of large planum sphenoidale tuberculum sellae defects after endoscopic endonasal resection of parasellar skull base tumors. Laryngoscope 2013; 123:1353-60. [PMID: 23483459 DOI: 10.1002/lary.23766] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Endoscopic endonasal transplanum transtuberculum (EETT) resection of parasellar skull base (SB) tumors often results in large SB defects with intraoperative high-flow cerebrospinal fluid (CSF) leaks. Reconstruction of these defects can be challenging because of the large defects size, communication with the suprasellar cistern, and close proximity to the optic nerves and chiasm. Recent studies have postulated that transplanum defects may be associated with increased postoperative CSF leakage. We review our experience with reconstruction of transplanum defects after EETT resection of parasellar SB tumors. Challenges encountered during these repairs and our operative nuances for successful reconstruction are discussed. METHODS A retrospective analysis was performed between March 2010 and February 2012 on patients undergoing reconstruction of transplanum defects after EETT resection of parasellar SB tumors. Repair materials, defect sizes, postoperative CSF leakage, postoperative CSF diversion, and demographic data were collected. RESULTS Nineteen patients who underwent 22 repairs with a pedicled nasoseptal flap (PNSF) were identified. The mean age was 47.6 years (range, 12-68 years). Average defect size was 5.6 cm(2) (range, 2.2-10.4 cm(2)). Three failed repairs necessitated a revision procedure. All three revisions were successfully reconstructed with the previously used PNSF. The mean follow-up period was 13.5 months (range, 1-26 months). The overall success rate was 86.4% for transplanum defects alone, as compared to 97.0% for our comprehensive PNSF experience in 99 repairs. CONCLUSION Repair of large transplanum defects after EETT resection of parasellar SB tumors presents a unique challenge. Using a PNSF along with meticulous multilayer closure may help decrease postoperative CSF leaks.
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Affiliation(s)
- Jean Anderson Eloy
- Department of Otolaryngology - Head & Neck Surgery, University of Medicine and Dentistry of New Jersey - New Jersey Medical School, Newark, New Jersey 07103, USA.
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Sanborn MR, Kramarz MJ, Storm PB, Adappa ND, Palmer JN, Lee JYK. Endoscopic, endonasal, transclival resection of a pontine cavernoma: case report. Neurosurgery 2012; 71:198-203. [PMID: 22572676 DOI: 10.1227/neu.0b013e318259e323] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Hemorrhagic, symptomatic cavernous malformations in the brainstem are difficult to access. Conventional approaches such as the transpetrosal approach often require significant brain retraction. We present the successful purely endoscopic, endonasal, transclival resection of a symptomatic cavernoma located in the ventromedial pons. CLINICAL PRESENTATION A 17-year-old male patient presented with acute onset of headache, facial numbness, and tingling. Magnetic resonance imaging demonstrated an enhancing lesion in the pons consistent with a cavernous malformation. Over the course of the next 3 weeks, the patient had 2 additional episodes of acutely worsening neurological deficits that left him with left-sided hemiparesis, a right sixth nerve palsy, and dysphagia. A purely endoscopic, endonasal, transclival approach was used to resect the cavernoma. Postoperatively, he had a transient worsening of his left-side motor function and restricted horizontal gaze, but at the last follow-up, his hemiparesis had improved and his magnetic resonance imaging demonstrated a radiographic cure. He developed a cerebrospinal fluid (CSF) leak despite prophylactic lumbar CSF drainage for 2 days and the use of bilateral vascularized nasoseptal flaps. The CSF leak was repaired with CSF diversion and a second surgical procedure; at the last follow-up, he had no recurrence of the leak. CONCLUSION An endoscopic, endonasal, transclival approach is a novel and effective approach to cavernous malformations presenting to the ventral surface of the pons. Recently developed techniques for closure and repair of the skull base defect have minimized but have not eliminated the risk of CSF leak in these procedures.
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Affiliation(s)
- Matthew R Sanborn
- Department of Neurosurgery, Perelman School of Medicine, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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Bohman LE, Stein SC, Newman JG, Palmer JN, Adappa ND, Khan A, Sitterley TT, Chang D, Lee JYK. Endoscopic versus open resection of tuberculum sellae meningiomas: a decision analysis. ORL J Otorhinolaryngol Relat Spec 2012; 74:255-63. [PMID: 23107968 DOI: 10.1159/000343794] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 08/31/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Tuberculum sellae meningiomas (TSMs) are challenging tumors for surgical resection. Endoscopic endonasal (EE) approaches to these lesions have not been directly compared to open craniotomy in a controlled trial. METHODS We searched Medline and Embase online databases for English-language articles containing key words related to TSMs. Data were pooled, including 5 of our own patients reported here for the first time. Metaregression was used and a decision-analytical model was constructed to compare outcomes between open microsurgery and EE approaches. RESULTS The overall quality of life (QOL) was not significantly different between the approaches (p = 0.410); however, there were large differences in individual complication rates. The Monte Carlo simulation yielded an overall average QOL in craniotomy patients of 0.915 and in endoscopic patients of 0.952. Endoscopy had a higher CSF leak rate (26.8 vs. 3.5%, p < 0.001) but a lower rate of injury to the optic apparatus (1.4 vs. 9.2%, p < 0.001) compared with craniotomy. The 3-year recurrence rates were not statistically different (p = 0.529). CONCLUSION EE resection of TSMs appears to be a comparable alternative to traditional open microsurgical resection with respect to overall QOL based on available publications. A meaningful comparison of recurrence rates will require a longer follow-up.
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Affiliation(s)
- Leif-Erik Bohman
- Department of Neurosurgery, University of Pennsylvania Health System, Philadelphia, PA 19104, USA
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Decker JR, Meen EK, Kern RC, Chandra RK. Cost effectiveness of magnetic resonance imaging in the workup of the dysosmia patient. Int Forum Allergy Rhinol 2012; 3:56-61. [DOI: 10.1002/alr.21066] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 05/07/2012] [Accepted: 05/27/2012] [Indexed: 11/10/2022]
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Adappa ND, Learned KO, Palmer JN, Newman JG, Lee JYK. Radiographic enhancement of the nasoseptal flap does not predict postoperative cerebrospinal fluid leaks in endoscopic skull base reconstruction. Laryngoscope 2012; 122:1226-34. [PMID: 22566127 DOI: 10.1002/lary.23351] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 03/12/2012] [Accepted: 03/15/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Cerebrospinal fluid (CSF) leaks continue to be the most common postoperative complication in expanded endonasal skull base procedures. Currently, a multilayer closure using a vascularized nasoseptal flap is most commonly performed for large ventral skull base defects in an effort to avoid postoperative CSF leaks. We correlated nasoseptal flap enhancement with postoperative CSF leak rates in a group of skull base reconstruction patients. The nasoseptal flap enhancement was determined by immediate postoperative gadolinium-enhanced magnetic resonance imaging (MRI), which allowed for imaging of the flap's vascular pedicle. Our aim was to identify whether nasoseptal flap enhancement contributed to reduction of postoperative CSF leak rates. STUDY DESIGN Retrospective cohort study. METHODS We reviewed 19 patients who underwent expanded endoscopic resections of skull base lesions of advanced complexity. We calculated the incidence of CSF leaks and measured the presence of nasoseptal flap enhancement. RESULTS Of the 19 patients with immediate postoperative MRIs, three developed postoperative CSF leaks. All three CSF leaks were in cases with enhancing vascular pedicles. In contrast, we had three patients without evidence of flap enhancement, none of whom developed a postoperative CSF leak (Fisher exact test, P = 1.0). CSF leak was associated with posterior fossa lesions (P = .25). Nasoseptal flap enhancement was associated with younger age (P = .15). CONCLUSIONS This retrospective cohort study demonstrates that although the vascularized pedicled nasoseptal flap is effective for closure of expanded endonasal skull base procedures, our experience found the actual enhancement of the flap itself does not appear to effect postoperative CSF leak rates.
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Affiliation(s)
- Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
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