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Aldea S, Le Guérinel C. Microsurgical Removal of an Anterior Clinoid Meningioma With Extensive Vascular Encasement: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 27:394-395. [PMID: 38683958 DOI: 10.1227/ons.0000000000001166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/09/2024] [Indexed: 05/02/2024] Open
Affiliation(s)
- Sorin Aldea
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris , France
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Zoia C, Maiorano E, Borromeo S, Mantovani G, Spena G, Pagella F. Endoscopic approaches to the orbit: Transnasal and transorbital, a retrospective case series. BRAIN & SPINE 2024; 4:102770. [PMID: 38510598 PMCID: PMC10951755 DOI: 10.1016/j.bas.2024.102770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/18/2024] [Indexed: 03/22/2024]
Abstract
Introduction Orbital pathologies requiring surgery are traditionally treated by open approach with different techniques depending on the lesion location. Recently, minimally invasive endoscopic approaches, such as the Endoscopic Endonasal Approach (EEA) and the Endoscopic Transorbital Approach (ETA) have been introduced in orbital surgery. Research question The purpose of this study is to report the combined experience of the Neurosurgical and Ear-Nose-Throat (ENT) Units in the endoscopic approach of orbital pathologies. Material and methods We retrospectively retrieved data on patients treated at our Institution between 2016 and 2021 with endoscopic approach for orbital pathologies. The Clavien-Dindo classification and the Scar Cosmesis Assessment and Rating (SCAR) Scale have been used to assess complications and cosmetic outcomes. Results 39 patients met the inclusion criteria. EEA (15 patients) or ETA (20 patients) were chosen to approach the lesions. In three cases we used a combination of endoscopic and anterior orbitotomy and in one patient a combination of EEA + ETA. The type of procedure performed was orbital biopsy (9 cases), orbital decompression (6 cases), subtotal resection of the lesion (STR) (8 cases) and total resection of the lesion (GTR) (16 cases). The more frequent postoperative complications were diplopia (5.1%, with 1 case of permanent diplopia), trigeminal paraesthesia and dysesthesia (5.1%), palpebral edema (17.9%), periorbital ecchymosis (7.7%). Mean follow up time was 21 months (range 2-63 months). Discussion and conclusion Endoscopic approaches to orbital compartments provide minimally invasive access to every orbital compartment with low complications rate and good cosmetic outcome.
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Affiliation(s)
- Cesare Zoia
- Neurosurgery Unit, Moriggia Pelascini Hospital, Gravedona e Uniti, Italy
| | - Eugenia Maiorano
- Department of Surgical Science, University of Pavia, Pavia, Italy
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Sara Borromeo
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Giorgio Mantovani
- Neurosurgery Unit, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Giannantonio Spena
- Neurosurgery Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Fabio Pagella
- Department of Surgical Science, University of Pavia, Pavia, Italy
- Department of Otorhinolaryngology, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
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Devia DA, Graffeo CS, Benner D, Scherschinski L, Thomas G, Koester SW, Srinivasan VM, Lawton MT. Experience and Balance: Long-Term Trends in Preferred Skull Base Approach for a Case Series of Cavernous Malformation Resections. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-00684. [PMID: 37083737 DOI: 10.1227/ons.0000000000000718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 02/16/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Skull base approaches are a foundation of modern cerebrovascular surgery; however, their application over time has varied. OBJECTIVE To assess trends in skull base approach selection for cavernous malformation (CM) resection. METHODS This is a retrospective case series of all first-time CM resections by a single surgeon from 1997 to 2021. Cases were classified by craniotomy and approach. Four sets of common comparator skull base approaches were identified by coauthor consensus: pterional and orbitozygomatic; retrosigmoid, extended retrosigmoid (xRS), and far-lateral; suboccipital and torcular; and trans-cerebellar peduncle (MCP) and transcerebellopontine angle. Counts were binned by 5-year or 10-year clusters for descriptive statistical assessment of temporal trends. RESULTS In total, 372 primary CM resections met the study criteria and were included. Orbitozygomatic approach use increased during the second 5-year period, after which the pterional approach rapidly became and remained the preferred approach. During the first two 5-year periods, the far-lateral approach was preferred to the retrosigmoid and xRS approaches, but the xRS approach grew in popularity and accounted for >50% of operations in this comparator group. Trans-MCP use compared with the transcerebellopontine angle approach closely mirrored the change in xRS use. The midline suboccipital approach accounted for a larger proportion (range, 62%-88%) of cases than the torcular approach (range, 12%-38%) across all periods. CONCLUSION The xRS and trans-MCP approaches have been increasingly used over time, while the orbitozygomatic and far-lateral approaches have become less common. These trends seem to reflect versatility, efficiency, and safety of these techniques.
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Affiliation(s)
- Diego A Devia
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
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Babici D, Johansen PM, Newman SL, Packer E, Snelling B. Ruptured Intracranial Aneurysm Presenting as Isolated Acute Subdural Hemorrhage. Cureus 2022; 14:e28314. [PMID: 36158395 PMCID: PMC9499734 DOI: 10.7759/cureus.28314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/23/2022] [Indexed: 11/22/2022] Open
Abstract
Ruptured intracranial aneurysms are often associated with serious neurologic sequelae, often as a result of subarachnoid or intraparenchymal hemorrhage. Less commonly, ruptured intracranial aneurysms can lead to subdural hemorrhage. However, the characteristic clinical presentation and optimal treatment of associated subdural hemorrhage are unclear due to the paucity of such cases that exist in the current literature. Affected patients may complain of nonspecific symptoms such as headaches, nausea, and confusion. Because of the severity of the disease, rapid diagnosis and intervention is required to lower the high morbidity and mortality rates. Commonly used treatment options include endovascular coiling and microsurgical clipping. Neuroendovascular surgery is often preferred, especially in aneurysms not amenable to surgical clipping, in poor surgical candidates, and cases with endovascularly favorable anatomy. The authors present the case of a patient who came to the hospital with ischemic stroke-like symptoms and was found to have a ruptured posterior communicating artery (PCoA) aneurysm and associated acute subdural hematoma (SDH) without obvious subarachnoid hemorrhage (SAH). Endovascular coiling of the aneurysm was performed successfully the following craniotomy for SDH evacuation, and the patient was discharged to a rehabilitation facility
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Bertani R, Koester S, Batista S, Perret C, Bocanegra-Becerra JE, Maria PS, Gallo BHD, Abi-Aad K, Ferrarez CE, Rabelo NN, Von Zuben D, Do Espirito Santo MP, Figueiredo EG. Minimally invasive craniotomies for lesions of the anterior and middle fossa. Neurosurg Rev 2022; 45:3149-3156. [PMID: 35994128 DOI: 10.1007/s10143-022-01850-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/26/2022] [Accepted: 08/15/2022] [Indexed: 11/24/2022]
Abstract
Minimally invasive craniotomies are the subject of increasing attention over the last two decades in neurosurgery, following the current trend of attempting to increase patient safety by providing surgeries with less tissue disruption, blood loss, and decreased operative time. However, a significant information overlap exists among the various keyhole approaches regarding their indications and differences with more invasive techniques. Therefore, the present study aims to comprehensively review, illustrate, and describe the potential benefits and disadvantages of minimally invasive techniques to access the anterior and middle fossa, including the mini-pterional, mini orbito-zygomatic, supraorbital, lateral supraorbital, and extended lateral supraorbital approaches while comparing them to classic, more invasive approaches.
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Affiliation(s)
- Raphael Bertani
- Department of Neurosurgery, University of São Paulo, São Paulo, Brazil.
| | - Stefan Koester
- School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Sávio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Caio Perret
- Department of Neurosurgery, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
| | | | - Paulo Santa Maria
- Department of Neurosurgery, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
| | | | | | | | | | - Daniela Von Zuben
- Department of Neurosurgery, University of São Paulo, São Paulo, Brazil
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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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Zawy Alsofy S, Sakellaropoulou I, Nakamura M, Ewelt C, Salma A, Lewitz M, Welzel Saravia H, Sarkis HM, Fortmann T, Stroop R. Impact of Virtual Reality in Arterial Anatomy Detection and Surgical Planning in Patients with Unruptured Anterior Communicating Artery Aneurysms. Brain Sci 2020; 10:brainsci10120963. [PMID: 33321880 PMCID: PMC7763342 DOI: 10.3390/brainsci10120963] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 11/30/2020] [Accepted: 12/08/2020] [Indexed: 01/20/2023] Open
Abstract
Anterior-communicating artery (ACoA) aneurysms have diverse configurations and anatomical variations. The evaluation and operative treatment of these aneurysms necessitates a perfect surgical strategy based on review of three-dimensional (3D) angioarchitecture using several radiologic imaging methods. We analyzed the influence of 3D virtual reality (VR) reconstructions versus conventional computed tomography angiography (CTA) scans on the identification of vascular anatomy and on surgical planning in patients with unruptured ACoA aneurysms. Medical files were retrospectively analyzed regarding patient- and disease-related data. Preoperative CTA scans were retrospectively reconstructed to 3D-VR images and visualized via VR software to detect the characteristics of unruptured ACoA aneurysms. A questionnaire was used to evaluate the influence of VR on the identification of aneurysm morphology and relevant arterial anatomy and on surgical strategy. Twenty-six patients were included and 520 answer sheets were evaluated. The 3D-VR modality significantly influenced detection of the aneurysm-related vascular structure (p = 0.0001), the recommended head positioning (p = 0.005), and the surgical approach (p = 0.001) in the planning of microsurgical clipping. Thus, reconstruction of conventional preoperative CTA scans into 3D images and the spatial presentation in VR models enabled greater understanding of the anatomy and pathology, provided realistic haptic feedback for aneurysm surgery, and influenced operation planning and strategy.
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Affiliation(s)
- Samer Zawy Alsofy
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany;
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, 59073 Hamm, Germany; (I.S.); (C.E.); (M.L.); (H.W.S.); (H.M.S.); (T.F.)
- Correspondence:
| | - Ioanna Sakellaropoulou
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, 59073 Hamm, Germany; (I.S.); (C.E.); (M.L.); (H.W.S.); (H.M.S.); (T.F.)
| | - Makoto Nakamura
- Department of Neurosurgery, Academic Hospital Köln-Merheim, Witten/Herdecke University, 51109 Köln, Germany;
| | - Christian Ewelt
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, 59073 Hamm, Germany; (I.S.); (C.E.); (M.L.); (H.W.S.); (H.M.S.); (T.F.)
| | - Asem Salma
- Department of Neurosurgery, St. Rita’s Neuroscience Institute, Lima, OH 45801, USA;
| | - Marc Lewitz
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, 59073 Hamm, Germany; (I.S.); (C.E.); (M.L.); (H.W.S.); (H.M.S.); (T.F.)
| | - Heinz Welzel Saravia
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, 59073 Hamm, Germany; (I.S.); (C.E.); (M.L.); (H.W.S.); (H.M.S.); (T.F.)
| | - Hraq Mourad Sarkis
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, 59073 Hamm, Germany; (I.S.); (C.E.); (M.L.); (H.W.S.); (H.M.S.); (T.F.)
| | - Thomas Fortmann
- Department of Neurosurgery, St. Barbara-Hospital, Academic Hospital of Westfälische Wilhelms-University Münster, 59073 Hamm, Germany; (I.S.); (C.E.); (M.L.); (H.W.S.); (H.M.S.); (T.F.)
| | - Ralf Stroop
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany;
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Cohen-Gadol A. The Orbitozygomatic Craniotomy and Its Judicious Use. Oper Neurosurg (Hagerstown) 2020; 18:559-569. [PMID: 31504829 DOI: 10.1093/ons/opz246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/31/2019] [Indexed: 11/14/2022] Open
Abstract
The concept of maximizing bone removal along the skull base has been advocated to expand the operative space for large, firm, and encasing ventral and ventrolateral skull base tumors. However, indications for the use of such osteotomies have not been well defined. The improved maneuverability and enhanced extent of expansion of the operative corridor via the skull base approaches compared to those of standard craniotomies have been based on cadaveric studies that might not simulate the operative environment realistically. Bony removal alone is not adequate to protect neurovascular structures, and strategic use of dynamic retraction and innovative operative routes are some of the other factors that contribute to successful microsurgery. In this analysis, the more discriminate indications and modified techniques for orbitozygomatic osteotomy are discussed.
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Affiliation(s)
- Aaron Cohen-Gadol
- Goodman Campbell Brain and Spine, Department of Neurosurgery, Indiana University, Indianapolis, Indiana.,The Neurosurgical Atlas, Indianapolis, Indiana
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