Journal of Neurological Surgery Part B: Skull Base最新文献

{"title":"Feasibility and Safety of Cone-Beam Computed Tomography Advanced Navigation to Optimize Intra-arterial Chemotherapy Infusion of Skull Base Tumors","authors":"Francois H. Cornelis, Eric Lis, Viviane Tabar, Andrew Lin","doi":"10.1055/a-2257-5590","DOIUrl":"https://doi.org/10.1055/a-2257-5590","url":null,"abstract":"<p>\u0000<b>Purpose</b> To assess the feasibility and safety of cone-beam computed tomography (CBCT) advanced navigation for optimizing intra-arterial chemotherapy infusion (IACI) in patients with skull base tumors.</p> <p>\u0000<b>Materials and Methods</b> Retrospective review on 10 consecutive IACI procedures performed in five patients (four women, 1 man) over a 1-year period. The median age of the patients was 71 years (interquartile range: 34–74). During the procedures, a CBCT-based navigation software was employed to evaluate tumor perfusion and guide the infusion methods. Catheterization of the primary tumor feeding vessel was performed in seven cases when it originated from the external carotid artery, whereas a temporary balloon-assisted occlusion technique was utilized in the remaining three cases where the tumor was primarily fed by the internal carotid artery. Carboplatin, topotecan, and melphalan were injected over a 10-minute period. Fluoroscopy time, reference dose, and Kerma area product, which estimates effective dose, were analyzed.</p> <p>\u0000<b>Results</b> The technical success rate was 100%, with a median procedure length of 82 minutes (79–90). The median fluoroscopy time was 11.3 minutes (9.4–16.9), reference dose was 93.5 mGy (62–256.5), and Kerma area product was 11.6 Gy.cm² (9.5–25.4). The median effective dose was 3.8 mSv (1.5–5.1). The median follow-up duration was 233.5 days (186.3–432). One severe adverse event was reported, involving a right brachial hematoma and brachiocephalic artery dissection related to catheterization through a type III aortic arch. Three patients exhibited disease progression, but two patients showed stable disease.</p> <p>\u0000<b>Conclusion</b> IACI for skull base tumors guided by CBCT navigation is both feasible and safe.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140017018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilization of Polydioxanone Plate for Endoscopic Anterior Skull Base Repair: Operative Technique and Long-Term Cohort Outcomes","authors":"Jorge A. Gutierrez III, Zachary M. Soler, Thomas Larrew, Nikita Chapurin, Jeffrey E. Wessell, Rodney J. Schlosser, W. Alexander Vandergrift III","doi":"10.1055/a-2262-8050","DOIUrl":"https://doi.org/10.1055/a-2262-8050","url":null,"abstract":"<p>\u0000<b>Objective</b> The purpose of this study is to report the technical procedure and our experience using a polydioxanone suture (PDS) plate with dural substitute as part of a fully resorbable gasket seal technique to repair anterior skull base defects.</p> <p>\u0000<b>Methods</b> A series of patients undergoing anterior skull base reconstruction utilizing our resorbable gasket seal technique from January 2014 to July 2022 was reviewed.</p> <p>\u0000<b>Results</b> A total of 155 patients were included. Nine (5.8%) of the included patients developed postoperative cerebrospinal fluid (CSF) leaks requiring reoperation. There were no cases of intraoperative cranial nerve injury or internal carotid artery injury. A total of 103 (66.5%) patients were observed to have an intraoperative CSF leak, including 57 low-flow leaks and 46 high-flow leaks; 1 of 57 (1.8%) patients with low-flow leaks and 8 of 46 (17.4%) patients with high-flow leaks developed a postoperative CSF leak. During the first 3 years that this technique was utilized at our center for the management of high-flow intraoperative CSF leaks, postoperative CSF leaks were documented in 4 of 12 (33.3%) patients, in comparison to 4 of 34 (11.8%) in the following years.</p> <p>\u0000<b>Conclusion</b> PDS plate reconstruction confers several advantages and can be used in a diverse set of operative scenarios in conjunction with other reconstruction options. There appeared to be an associated learning curve as surgeons at our center gained experience with this new technique. Our findings show that the PDS plate reconstruction is safe and effective in repairing the skull base.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140017076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abducens Nerve Duplication: Novel Intraoperative and Radiographic Observation of a Rare Anatomical Variant","authors":"","doi":"10.1055/s-0044-1779736","DOIUrl":"https://doi.org/10.1055/s-0044-1779736","url":null,"abstract":"Objectives The abducens nerve has a long, serpentine subarachnoid course with complex topographical relationships, rendering abducens nerve palsy the most common ocular motor cranial nerve palsy in adults and second most common in pediatric patients, with anatomical variants reported in the literature. Preoperative awareness of abducens nerve variant anatomy may help prevent inadvertent intraoperative injury. Design This study is a case report with a review of the abducens nerve anatomy and variants. Setting The study setting included outpatient, inpatient, and operating room in the neurosurgery department of a quaternary referral center. Participants The study included a woman in her early 30s with a diagnosis of petrous meningioma. Main Outcome Measures In vivo documentation of a type 3 abducens nerve duplication was carried out. Results A left extended retrosigmoid craniotomy was recommended for the petroclival meningioma resection. Intraoperatively, a complete duplication of the left abducens cisternal segment was encountered and photographed. The left unilateral abducens nerve duplication was confirmed with postoperative volumetric magnetic resonance imaging using the FIESTA (fast imaging employing steady-state acquisition) sequence, revealing the union of the duplicated cisternal abducens nerves into a single trunk from Dorello's canal distally. Conclusions Abducens nerve variants are uncommon, and although reported in the setting of cadaveric dissection, in vivo documentation of them is limited. This case report of an in vivo type 3 abducens nerve duplication with intraoperative photographic and radiographic images highlights the need for clinical awareness to avoid inadvertent intraoperative injury.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140017332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual Outcomes after Suprasellar Meningioma Resection: A Retrospective Cohort Study and a Machine Learning-Based Predictive Model","authors":"","doi":"10.1055/s-0044-1779671","DOIUrl":"https://doi.org/10.1055/s-0044-1779671","url":null,"abstract":"Objectives In this research, the authors provide a retrospective cohort study of 82 patients with suprasellar meningiomas to identify predictors of the visual outcome following surgery. We also conducted a matched retrospective case–control analysis. Methods This retrospective cohort study included all patients who underwent craniotomy for surgical excision of suprasellar meningiomas at our institution between January 2016 and March 2022. We designed a matched case–control study for patients with and without early intradural optic canal decompression (IOCD). We also developed a machine learning model to have the best possible sensitivity for the prediction of visual recovery after surgery. Results The visual acuity score (VAS) improved in 46.3% of our cases and decreased in 7.4% of the 82 included cases postoperatively. The VAS did not change in 46.3% of the patients after surgery. Statistically, visual complaints, optic atrophy, tuberculum sella involvement, and olfactory groove involvement were associated with lower preoperative VAS and visual field index (VFI). Only intracavernous sinus (ICS) extension and intraoperative vascular involvement were significantly associated with lower postoperative mean VAS correction. The outcome analysis revealed that the improvement in VAS and VFI after surgery was not statistically different between the groups with and without early IOCD (p-value = 1). Conclusion ICS extension was the only location-related factor associated with increased tumor recurrence or regrowth, which makes postoperative radiotherapy more valuable in patients with cavernous sinus extension. Our study results did not support the efficacy of early IOCD in increasing postoperative VAS and VFI.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139957048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal CT Evaluation of the Relationships between Basic Anatomical Structures and the Round Window: Importance for the Cochlear Implant Surgery","authors":"Neşe Asal, Nuray Bayar Muluk, Pelin Zeynep Bekin Sarikaya","doi":"10.1055/s-0044-1780521","DOIUrl":"https://doi.org/10.1055/s-0044-1780521","url":null,"abstract":"<p>\u0000<b>Objectives</b> In the present study, we investigated the round window (RW) and neighboring anatomical structures using temporal computed tomography (CT) which are important for cochlear implant (CI) electrodes.</p> <p>\u0000<b>Methods</b> In this retrospective study, the temporal CT images of 112 adult patients (45 males and 67 females) were evaluated. We classified mastoid pneumatization, and measured RW diameter, RW–carotid canal (CC) distance, RW–facial nerve mastoid segment (FNMS) distance, RW–pyramidal eminence distance, RW–jugular bulb (JB) distance, and RW–internal acoustic canal (IAC) distance. Additionally, RW–cochlea angle and RW–facial nerve angle were also measured.</p> <p>\u0000<b>Results</b> RW diameters in males were significantly higher than those in females bilaterally (<i>p</i> < 0.05). RW–CC distance and RW–JB distance were both smaller than 10 mm. RW–IAC distance was 2.54 to 2.68 mm, and RW–FNMS distance was 4.20 to 4.40 mm. RW–cochlea angle ranged from 39.62 to 41.91 degrees and RW–FN angle ranged from 17.28 to 18.40 degrees. Males showed better mastoid pneumatization values (<i>p</i> < 0.05). In higher RW diameters, RW–JB distance decreased, and in pneumatized mastoids, RW–JB distance increased. RW–JB distance and RW–CC distance were detected to increase together (<i>p</i> < 0.05).</p> <p>\u0000<b>Conclusion</b> RW is crucial anatomic structure for CI surgeries. RW diameters are between 1.21 and 1.35 mm and lower in the females. Males exhibited better mastoid pneumatization values than the females, and CC and JB distances from RW were farther in well-pneumatized mastoids. Future studies should include comprehensive clinical and surgical findings.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139911125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of Survival in the Elderly Patients with Glioblastoma using Cumulative Inflammatory Markers Score","authors":"Kun Song, Chunjui Chen, Hao Xu, Lingchao Chen, Hongzhi Xu, Xi Han, Hong Chen, Zhiyong Qin","doi":"10.1055/s-0044-1779050","DOIUrl":"https://doi.org/10.1055/s-0044-1779050","url":null,"abstract":"<p>\u0000<b>Objectives</b> This retrospective study aimed to explore the prognostic effect of cumulative score based on neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and fibrinogen in older adults diagnosed with glioblastoma (GBM).</p> <p>\u0000<b>Design</b> Retrospective study.</p> <p>\u0000<b>Setting</b> Huashan Hospital.</p> <p>\u0000<b>Participants</b> Patients aged over 60 years and diagnosed with GBM between 2010 and 2017.</p> <p>\u0000<b>Main Outcome Measures</b> Results of preoperative routine biochemistry and coagulation blood examinations were reviewed from medical records. Overall survival (OS) was considered a period from first resection surgery until death. Progression-free survival (PFS) was considered a period from initial operation until the date of tumor progression demonstrated in brain magnetic resonance imaging or death from any cause. If no event occurred, the last follow-up appointment was the end of the observation for OS or PFS. The Kaplan–Meier method was used to evaluate survival curves, and prognostic factors were analyzed by the Cox proportional hazards model.</p> <p>\u0000<b>Results</b> A total of 289 patients were included. Patients with higher levels of fibrinogen, NLR, and PLR had significantly shorter median OS (<i>p</i> = 0.001, <i>p</i> = 0.016, and <i>p</i> = 0.002, respectively) and PFS (<i>p</i> = 0.004, <i>p</i> = 0.022, and <i>p</i> = 0.009, respectively) compared with those with lower levels. Multivariate analyses showed a significant association between higher F-NLR-PLR score and reduced OS (adjusted hazard ratios [aHRs]: 1.356, 95% confidence interval [CI] 1.009–1.822 for scores 1–2 compared with 0; 5.974, 95% CI 2.811–12.698 for score 3 compared with 0). Similarly, a significant association between higher F-NLR-PLR score and reduced PFS was observed (aHR: 1.428, 95% CI 1.066–1.912 for scores 1–2 compared with 0; aHR: 2.860, 95% CI 1.315–6.223 for score 3 compared with 0).</p> <p>\u0000<b>Conclusion</b> Higher F-NLR-PLR score is associated with reduced OS and PFS in older adults with GBM, which helps identify patients at high risk and guide the individualized treatment in clinical practice.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139756395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability of Neuronavigation in Localizing the Internal Acoustic Canal during Middle Fossa Approach","authors":"Tufan Agah Kartum, Baris Kucukyuruk, Alperen Kaya, Levent Aydin, Necmettin Tanriover, Galip Zihni zihni Sanus","doi":"10.1055/a-2235-9956","DOIUrl":"https://doi.org/10.1055/a-2235-9956","url":null,"abstract":"Objective The absence of precise landmarks in the middle fossa floor and frequent anatomical variations make it difficult to localize the internal acoustic canal (IAC) during the middle fossa approach (MFA). We aimed to investigate the reliability and utility of the neuronavigation system (NNS) in the MFA and to delineate specific technical considerations regarding NNS during the approach. Method One-millimeter-thin section computed tomography scans were performed on five formalin-fixed human cadavers (10 sides). During the MFA, structures, such as the IAC, vestibule and cochlea hidden in the temporal bone were investigated under NNS guidance. Results All the superficial landmarks, such as the foramen spinosum and ovale were correctly localized by NNS. Deeper landmarks, such as the central part of the IAC lying beneath the surface of the petrous apex could not be localized via NNS. The exact area of bone removal along roof of IAC was determined by using the orientation provided by the probe placed between the basal turn of cochlea and the vestibule. We were able to validate the location of the IAC via a medial to lateral drilling by using the navigation this reference point. Conclusion The NNS can be used effectively during the MFA, and localizing superficial landmarks on the middle fossa floor with a higher accuracy may prove helpful in identifying the IAC from above. By referring to the cochlea–vestibule junctional area, the exact location of the trace of the IAC can be revealed.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139773146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Development of Diabetes Insipidus and Syndrome of Inappropriate Antidiuretic Hormone Secretion after Transsphenoidal Resection of Pituitary Adenoma","authors":"Gabrielle Petito, Alex Hu, Grace Zhang, Susie Min, Siddhant H. Tripathi, Adithya Kumar, Geet Shukla, Sanjit Shah, Katie M. Phillips, Suman Jana, Jonathan A. Forbes, Mario Zuccarello, Norberto O. Andaluz, Ahmad R. Sedaghat","doi":"10.1055/a-2235-7419","DOIUrl":"https://doi.org/10.1055/a-2235-7419","url":null,"abstract":"<p>\u0000<b>Background</b> We aimed to determine the incidence and risk factors for development of diabetes insipidus (DI) and syndrome of inappropriate antidiuretic hormone secretion (SIADH) after transsphenoidal hypophysectomy (TSH) for resection of a pituitary adenoma.</p> <p>\u0000<b>Methods</b> This was a retrospective study of 403 adult patients undergoing TSH for pituitary adenoma. Clinical variables, tumor characteristics, and operative factors were collected. Incidences of DI and SIADH were determined, including timing in the perioperative period. Independent predictors of developing DI and SIADH were identified using multivariable logistic regression.</p> <p>\u0000<b>Results</b> Following TSH, 21.3% of patients developed DI at a mean 2.6 days and 7.4% developed SIADH at a mean 4.7 days. DI was negatively associated with older age (odds ratio [OR] = 0.98, 95% confidence interval [CI]: 0.96–0.99, <i>p</i> = 0.029). DI was positively associated with female sex (OR = 2.26, 95% CI: 1.24–4.11, <i>p</i> = 0.008), increase in anteroposterior tumor size (OR = 1.54, 95% CI: 1.11–2.13, <i>p</i> = 0.010), intraoperative cerebrospinal fluid (CSF) leak (OR = 2.29, 95% CI: 1.25–4.19, <i>p</i> = 0.008), and every 100 mL of estimated blood loss (EBL) (OR = 1.18, 95% CI: 1.01–1.39, <i>p</i> = 0.046). Development of SIADH was positively associated with intraoperative CSF leak (OR = 3.56, 95% CI: 1.24–10.21, <i>p</i> = 0.018) on multivariate analysis.</p> <p>\u0000<b>Conclusion</b> DI and SIADH occur in the minority of patients undergoing TSH, but vigilance for their development must be maintained for days after the surgery. Development of DI after TSH is multifactorial, having possible patient-specific risk factors and risk related to the complexity of surgical dissection, reflected by tumor size, intraoperative CSF leak, and EBL. Development of SIADH could be associated with intraoperative CSF leak occurrence.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139667881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reporting of Participants' Sex, Race, Ethnicity, and Socioeconomic Status in Pituitary Surgery Literature","authors":"Anahita Nourmahnad, Julian A. Purrinos, Renata Grozovsky, Angela M. Richardson, Corinna G. Levine","doi":"10.1055/s-0043-1778646","DOIUrl":"https://doi.org/10.1055/s-0043-1778646","url":null,"abstract":"<p>\u0000<b>Introduction</b> Social determinants of health (SDOH) are associated with differential outcomes after pituitary tumor treatment. However, the specific impact of SDOH is not well characterized. One reason may be the lack of collection and reporting of sociodemographic variables in the literature. This study aims to evaluate the frequency of reporting and distribution of participants' sex, race, ethnicity, income, and education level within pituitary surgery literature. We will compare the reported clinical research population demographics to the 2020 U.S. census.</p> <p>\u0000<b>Methods</b> A systematic review was performed by searching PubMed, Cochrane, and Embase databases for pituitary surgery clinical research published between July 1, 2021 to June 30, 2022. We excluded studies that lacked a comparison group, were not original research (i.e., systematic reviews, meta-analysis), or included national databases and registry data.</p> <p>\u0000<b>Results</b> The final analysis included 92 studies. A total of 99% of studies collected data on subject sex. On average 49% (range: 14–100%) of study populations were male. Only 4% (<i>n</i> = 4) studies included racial demographic data. Two studies included information on participants' ethnicity and two included education background. No studies included income or insurance data. Four U.S. studies included demographic distribution, and the reported race and ethnicity percentages are similar to the U.S. 2020 census distribution.</p> <p>\u0000<b>Conclusions</b> Most clinical pituitary research collects and reports data on participant sex. However, very few studies collect and report data on other sociodemographic variables that can play a role in outcomes. The lack of sociodemographic information in clinical research literature makes it difficult to determine the role of SDOH on pituitary surgery outcomes.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139580851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ipsilateral Nasoseptal Flaps in a Transpterygoid Approach: Technical Pearls and Reconstruction Outcomes","authors":"Michael T. Chang, David Grimm, Karam Asmaro, Michael Yong, Christopher Low, Christine K. Lee, Jayakar V. Nayak, Peter H. Hwang, Juan C. Fernandez-Miranda, Zara M. Patel","doi":"10.1055/s-0043-1778662","DOIUrl":"https://doi.org/10.1055/s-0043-1778662","url":null,"abstract":"<p>\u0000<b>Background</b> Transpterygoid approaches to the skull base require dissection of the sphenopalatine artery, potentially compromising the option to harvest an ipsilateral nasoseptal flap (NSF) for reconstruction. In cases where other reconstructive options are limited, it may be necessary to utilize a NSF ipsilateral to the transpterygoid approach. Here, we describe the technique of NSF pedicle preservation with reconstruction outcomes.</p> <p>\u0000<b>Methods</b> This was a retrospective single-institution review of all expanded endonasal skull base cases utilizing a NSF ipsilateral to a transpterygoid approach. Reconstruction outcomes collected include intraoperative fluorescence with indocyanine green (ICG), postoperative magnetic resonance imaging (MRI) gadolinium enhancement, endoscopic assessment, and reconstruction-related complications.</p> <p>\u0000<b>Results</b> Twenty-one cases were included in this study (mean age 51.0 ± 20.6 years, 61.9% female). Indications for NSF ipsilateral to the transpterygoid approach included: bilateral transpterygoid approach (52.4%), revision reconstruction (23.8%), or significant septal deviation (19.0%). Twelve of 14 (85.7%) flaps demonstrated intraoperative perfusion with ICG, 15 of 15 (100%) enhanced on postoperative MRI, and 21 of 21 (100%) flaps had a healthy, viable appearance on postoperative endoscopy. There were no instances of flap necrosis or postoperative cerebrospinal fluid leaks. Technical keys to optimize mobilization of the pedicle include wide decompression of the sphenopalatine foramen and release of neurovascular tethering points of the pterygopalatine fossa. These steps allow for wide skull base exposure with preservation of the sphenopalatine artery.</p> <p>\u0000<b>Conclusion</b> With this technique, the transpterygoid approach can be performed in a manner that preserves the pedicle for an ipsilateral NSF and achieve an excellent reconstructive outcome.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":null,"pages":null},"PeriodicalIF":0.9,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139556179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}