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Abdelghani N, Barut C, Ogut E. The investigation of cranial fossae in the intracranial cavity of fixed cadaveric skull bases: associations with sex, laterality, and clinical significance. Surg Radiol Anat 2024; 46:1305-1329. [PMID: 38858315 DOI: 10.1007/s00276-024-03408-8] [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: 03/17/2024] [Accepted: 06/03/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE Our study aims to investigate three parts of the intracranial cavity, their distances to essential anatomical landmarks, and the correlations between these distances with sex, laterality, and surgical significance. METHODS The cranial nerve foraminae and essential surgical landmarks of each fossa were investigated bilaterally in 30 adult formalin-fixed cadaveric heads. Measurements, including lengths, depths, diameters, and horizontal distances to each other, to the midline of the skull, and to the outer lateral margin of the skull, were recorded on both sides. RESULTS The optic canal (OC) depth, internal auditory meatus (IAM) width, CNVII and CNIX diameters, and accessory hypoglossal canal (HC) distance were significantly greater on the left side (p < 0.05). CNVI length, CNV diameter, CNXI length, and the distances of the HC and accessory HC from the skull were significantly greater on the right side (p < 0.05). In males, correlations were found between the length of the left CNVIII and the right IAM diameter (r = 0.864, p = 0.001), right CNVIII length (r = 0.709, p = 0.022), right accessory HC length (r = 0.847, p = 0.016), and right-sided skull distance (r = 0.829, p = 0.042). In females, correlations were noted between IAM depth and length, right IAM location relative to the skull, left CNIX and CNX lengths, left CNXII length, left accessory HC location relative to the skull, and accessory HC length. CONCLUSIONS The findings of the current study indicate inherent asymmetry, sexual dimorphism, and variability in certain cranial nerves among cadaveric heads, which could have implications for surgical procedures, neuroanatomical studies, and clinical assessments. The study revealed side disparities and correlations within cranial fossa formations and essential surgical landmarks in both genders.
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Affiliation(s)
- Noor Abdelghani
- Department of Neuroscience, Institute of Graduate Studies, Bahçeşehir University, Istanbul, Türkiye
| | - Cagatay Barut
- Department of Anatomy, School of Medicine, Istanbul Medeniyet University, Istanbul, Türkiye
| | - Eren Ogut
- Department of Anatomy, School of Medicine, Istanbul Medeniyet University, Istanbul, Türkiye.
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Kraimer K, Geltzeiler M. Skull Base Reconstruction by Subsite after Sinonasal Malignancy Resection. Cancers (Basel) 2024; 16:242. [PMID: 38254733 PMCID: PMC10813932 DOI: 10.3390/cancers16020242] [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: 10/24/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Reconstruction after the resection of sinonasal malignancies is complex and primarily dependent on the defect size and location. While the reconstructive paradigm for sellar mass resection is well delineated, the challenges associated with reconstruction after sinonasal malignancy resection are less well described. This narrative review will address the goals of reconstruction after both endonasal endoscopic and open sinonasal malignancy resection and reconstructive options specific to these subsites. The goals of reconstruction include repairing cerebrospinal fluid leaks, restoring sinonasal function, providing a nasal airway, and optimizing the patient's quality of life. These goals are often complicated by the anatomic nuances of each involved sinus. In this review, we will discuss the methods of reconstruction specific to each sinonasal subsite and describe the factors that guide choosing the optimal reconstructive technique.
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Affiliation(s)
| | - Mathew Geltzeiler
- Department of Otolaryngology—Head and Neck Surgery, Oregon Health & Science University, Portland, OR 97239, USA
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de Andrade EJ, Recinos PF. Exoscopic supraorbital approach for a tuberculum sellae meningioma. Clin Neurol Neurosurg 2023; 231:107830. [PMID: 37356198 DOI: 10.1016/j.clineuro.2023.107830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 05/24/2023] [Accepted: 05/27/2023] [Indexed: 06/27/2023]
Abstract
Tuberculum sellae meningiomas are midline anterior skull base tumors and account for approximately 10-15% of all intracranial meningiomas. Clinical presentation of tuberculum sellae meningiomas is mainly characterized by visual deficits due to optic chiasm compression or optic canal invasion. Treatment options for TSM typically involve surgical resection of the tumor. The relevant microsurgical anatomy of the suprasellar region was discussed. (1,2). Tumor size, anatomical variations can affect the best approach for these tumors, with several approaches been described to access the suprasellar region as pterional, endoscopic endonasal and supraorbital approach that was the choice for this case (3). Besides the surgical corridor, minimally invasive techniques that preserve the surrounding tissue are becoming increasingly popular and are perfectly suited to deep seated lesions. In this article, we present a surgical video of an exoscopic supraorbital approach for resection of a tuberculum sellae meningioma. This is a case of a 42-year-old right-handed female who presented with headaches and progressive vision loss. Patient presented with tumor growth and surgery was indicated. We chose the minimally invasive supraorbital approach and then used the exoscope as magnification tool visualization tool. Gross total resection and decompression of the optic canals was achieved with improvement of visual field deficits.
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Affiliation(s)
- Erion Júnior de Andrade
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA; Section of Skull Base Surgery, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Pablo F Recinos
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA; Section of Skull Base Surgery, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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Potter T, Soni P, Krywyj M, Petitt J, Jarmula J, Obiri-Yeboah D, Oyem P, Momin A, Easley K, Sindwani R, Woodard T, Recinos PF, Kshettry VR. Predictive Factors for Postoperative Opioid Use in Elective Endoscopic Endonasal Skull Base Surgery. Laryngoscope 2023; 133:494-499. [PMID: 35353373 DOI: 10.1002/lary.30116] [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: 01/31/2022] [Revised: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE In 2017, the United States opioid epidemic was declared a public health emergency. Increased efforts have been made to understand and reduce patient opioid use in neurosurgery. However, the factors associated with postoperative opioid use remain understudied in endoscopic endonasal skull base surgery (EESBS). We identified the demographic and surgical factors associated with postoperative opioid use in EESBS. METHODS A retrospective review was conducted of patients who underwent elective EESBS between January 2015 and December 2020. Patient demographics, relevant clinical history, and operative data were collected and analyzed. Total opioid use was calculated 24, 48, and 72 hours postoperatively. Multivariable linear regression analyses were performed to identify factors associated with opioid use. RESULTS There were 454 patients included. A history of anxiety/depression and younger patient age were associated with a significant increase in opioid use at 24 (28.2 MME, p < 0.001), 48 (53.4 MME, p < 0.001), and 72 (89.4 MME, p < 0.001) hours after surgery. Nasoseptal flap use was significantly associated with increased opioid use at 24 (12.8 MME, p < 0.49) and 48 (19.6 MME, p < 0.048) h postoperatively while controlling for intraoperative variables and surgical approach (trans-sellar vs. expanded). No significant association was observed for patient sex, history of migraines, preoperative opioid use, length of surgery, or surgical approach. CONCLUSION In patients undergoing EESBS, patient history of anxiety/depression, younger patient age, and nasoseptal flap use are associated with increased postoperative opioid use. Knowledge of these risk factors may guide perioperative prescribing patterns to both adequately control postoperative pain and reduce opioid use. LEVEL OF EVIDENCE 4 Laryngoscope, 133:494-499, 2023.
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Affiliation(s)
- Tamia Potter
- Section of Skull Base Surgery, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Pranay Soni
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Maria Krywyj
- Section of Skull Base Surgery, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jordan Petitt
- Section of Skull Base Surgery, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Jakub Jarmula
- Section of Skull Base Surgery, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Derrick Obiri-Yeboah
- Section of Skull Base Surgery, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Precious Oyem
- Section of Skull Base Surgery, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Arbaz Momin
- Section of Skull Base Surgery, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Kathryn Easley
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Raj Sindwani
- Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA.,Department of Otolaryngology-Head & Neck Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Troy Woodard
- Department of Otolaryngology-Head & Neck Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Pablo F Recinos
- Section of Skull Base Surgery, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA.,Department of Otolaryngology-Head & Neck Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Varun R Kshettry
- Section of Skull Base Surgery, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Neurological Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
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Salmon MK, Kshirsagar RS, Eide JG. Craniopharyngioma surgery for rhinologists. Curr Opin Otolaryngol Head Neck Surg 2023; 31:45-52. [PMID: 36730658 DOI: 10.1097/moo.0000000000000856] [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: 02/04/2023]
Abstract
PURPOSE OF REVIEW Craniopharyngiomas are rare tumors that that present with loss of pituitary function in most cases. They present in a bimodal age distribution and the most common treatment paradigms include gross total resection or subtotal resection followed by radiation. Endoscopic transnasal access to intradural tumors has become increasingly common due to improvements in equipment, increased familiarity with the surgical corridor and anatomy, and reconstruction techniques. As such, rhinologists play an increasingly important role in the management of craniopharyngiomas. RECENT FINDINGS Recent years have highlighted our growing experience with pediatric endonasal skull base surgery. Prior concerns including sphenoid pneumatization, midfacial growth restrictions, and intercarotid space limitations have been studied more extensively. It has been found that there are no increased complications with lack of sphenoid pneumatization, no changes to midfacial growth with endonasal techniques, and the inter-carotid distance is stable after around age 5. Advances in surgical and skull base reconstruction techniques and intraoperative monitoring have reduced the risks of complications from surgery. SUMMARY Rhinologists play an important role in craniopharyngioma surgery. The approach to and reconstruction after tumor removal are vital portions of the procedure that allow for resection and prevent postsurgical complications.
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Affiliation(s)
- Mandy K Salmon
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Rijul S Kshirsagar
- Department of Head and Neck Surgery, Kaiser Permanente Redwood City Medical Center, Redwood City, California
| | - Jacob G Eide
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, USA
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The Current State of Visualization Techniques in Endoscopic Skull Base Surgery. Brain Sci 2022; 12:brainsci12101337. [PMID: 36291271 PMCID: PMC9599272 DOI: 10.3390/brainsci12101337] [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: 09/08/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022] Open
Abstract
Skull base surgery has undergone significant progress following key technological developments. From early candle-lit devices to the modern endoscope, refinements in visualization techniques have made endoscopic skull base surgery (ESBS) a standard practice for treating a variety of conditions. The endoscope has also been integrated with other technologies to enhance visualization, including fluorescence agents, intraoperative neuronavigation with augmented reality, and the exoscope. Endoscopic approaches have allowed neurosurgeons to reevaluate skull base neuroanatomy from new perspectives. These advances now serve as the foundation for future developments in ESBS. In this narrative review, we discuss the history and development of ESBS, current visualization techniques, and future innovations.
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Yu S, Taghvaei M, Reyes M, Collopy S, Piper K, Karsy M, Prashant GN, Kshettry VR, Rosen MR, Farrell CJ, Evans JJ. Evolution of Surgical Outcomes in Endoscopic Endonasal Resection of Craniopharyngiomas. J Neurol Surg B Skull Base 2022. [DOI: 10.1055/s-0042-1751291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Abstract
Introduction Wide variations exist in the management of craniopharyngiomas, including pituitary stalk preservation/sacrifice. This study examines the practice patterns over 16 years using the endoscopic endonasal approach for the resection of craniopharyngiomas and it examines the effects of stalk preservation.
Methods Retrospective analysis was conducted for 66 patients who underwent endoscopic transsphenoidal surgery for resection of craniopharyngiomas. Patients were stratified into three epochs: 2005 to 2009 (N = 20), 2010 to 2015 (N = 23), and 2016 to 2020 (N = 20), to examine the evolution of surgical outcomes. Subgroup analysis between stalk preservation/stalk sacrifice was conducted for rate of gross total resection, anterior pituitary function preservation, and development of new permanent diabetes insipidus.
Results Gross total resection rates across the first, second, and third epochs were 20, 65, and 52%, respectively (p = 0.042). Stalk preservation across epochs were 100, 5.9, and 52.6% (p = 0.0001). New permanent diabetes insipidus did not significantly change across epochs (37.5, 68.4, 71.4%; p = 0.078). Preservation of normal endocrine function across epochs was 25, 0, and 23.8%; (p = 0.001). Postoperative cerebrospinal fluid (CSF) leaks significantly decreased over time (40, 4.5, and 0%; [p = 0.0001]). Stalk preservation group retained higher normal endocrine function (40.9 vs. 0%; p = 0.001) and less normal-preoperative to postoperative panhypopituitarism (18.4 vs. 56%; p = 0.001). Stalk sacrifice group achieved higher GTR (70.8 vs. 28%, p = 0.005). At last follow-up, there was no difference in recurrence/progression rates between the two groups.
Conclusion There is a continuous evolution in the management of craniopharyngiomas. Gross total resection, higher rates of pituitary stalk and hormonal preservation, and low rates of postoperative CSF leak can be achieved with increased surgical experience.
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Affiliation(s)
- Siyuan Yu
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Mohammad Taghvaei
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Maikerly Reyes
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Sarah Collopy
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Keenan Piper
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Michael Karsy
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Giyarpuram N. Prashant
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Varun R. Kshettry
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States
| | - Marc R. Rosen
- Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Christopher J. Farrell
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - James J. Evans
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
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