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

{"title":"Skull base repair following resection of vestibular schwannoma: a systematic review (Part 1: The Retrosigmoid Approach)","authors":"Joachim Starup-Hansen, Simon Williams, Alexandra Valetopoulou, Danyal Z. Khan, H. Layard Horsfall, Jigishaa Moudgil-Joshi, Oliver Burton, Hala Kanona, Shakeel Saeed, William Muirhead, Hani J. Marcus, Patrick Grover","doi":"10.1055/a-2222-0184","DOIUrl":"https://doi.org/10.1055/a-2222-0184","url":null,"abstract":"Objective: Despite advances in skull-base reconstruction techniques, CSF leaks remain a common complication following retrosigmoid (RS) vestibular schwannoma (VS) surgery. We aimed to review and classify the available strategies used to prevent CSF leaks following RS VS surgery.\u0000\u0000Methods: A systematic review, including studies of adults undergoing RS VS surgery since 2000, was conducted. Repair protocols were synthesised into a narrative summary, and a taxonomic classification of techniques and materials was produced. Additionally, the advantages, disadvantages, and associated CSF leak rates of different repair protocols were described.\u0000\u0000Results: All 42 studies were case series, of which 34 were retrospective, and eight were prospective. Repair strategies included heterogeneous combinations of autografts, xenografts, and synthetic materials. A repair taxonomy was produced considering seven distinct stages to CSF leak prevention, including intraoperative approaches to the dura, internal auditory canal (IAC), air cells, RS bony defect, extra-cranial soft tissue, post-operative dressings, and CSF diversion. Notably, there was significant heterogeneity among institutions, particularly in the dural and IAC stages. The median postoperative incidence of CSF leaks was 6.3% (IQR 1.3%-8.44%).\u0000\u0000Conclusions: The intra-operative strategies used to prevent CSF leaks during RS VS surgery vary significantly between and within institutions. As a result of this heterogeneity and inconsistent reporting of CSF leak predictive factors, a meaningful comparative analysis of repair protocols was not feasible. Instead, we propose the development of a prospective multi-centre service evaluation designed to accurately capture a comprehensive dataset of potential CSF risk factors, including all stages of the operative repair protocol.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"17 23","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138603529","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":"Skull base repair following resection of vestibular schwannoma: a systematic review (Part 2: The Translabyrinthine Approach)","authors":"Joachim Starup-Hansen, Simon Williams, Alexandra Valetopoulou, Danyal Z. Khan, H. Layard Horsfall, Jigishaa Moudgil-Joshi, Oliver Burton, Hala Kanona, Shakeel Saeed, William Muirhead, Hani J. Marcus, Patrick Grover","doi":"10.1055/a-2222-0016","DOIUrl":"https://doi.org/10.1055/a-2222-0016","url":null,"abstract":"Objectives: \u0000Despite advances in skull base reconstruction techniques, cerebrospinal fluid (CSF) leaks remain a relatively common complication after translabyrinthine (TL) vestibular schwannoma (VS) surgery. We conducted a systematic review to synthesise the repair techniques and materials used in TL VS surgery to prevent CSF leaks. \u0000\u0000Design: A systematic review of studies published since 2000 reporting techniques to prevent CSF leaks during adult TL VS surgery was conducted. A narrative synthesis of primary repair protocols was produced, and a taxonomy was established. Additionally, the advantages, disadvantages, and associated CSF leak rates of different repair protocols were extracted.\u0000\u0000Results: All 43 studies were case series, and 39 were retrospective. Repair strategies included heterogeneous combinations of autografts, xenografts, and synthetic materials. A taxonomy was produced, classifying repairs into seven distinct stages, including approaches to the dura, middle ear cleft, air cells, TL bony defect, extra-cranial soft tissue, post-operative dressings and CSF diversion. The median post-operative incidence of CSF leaks was 6% (IQR 0-10%).\u0000\u0000Conclusions: This systematic review reveals substantial inter-institutional heterogeneity in intraoperative strategies to prevent CSF leaks following TL VS surgery. However, comparing these techniques is challenging due to the multiple predictive factors for CSF leaks and their inconsistent reporting. We propose a taxonomy of seven stages to classify operative techniques and materials aimed at preventing CSF leaks. We recommend that future evaluations should adopt a prospective approach encompassing data collection strategies that consider all operative stages described by our taxonomy.\u0000","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"63 9","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138604932","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":"Association of Decreased Enhancement of Nasoseptal Flap on Postoperative Magnetic Resonance Imaging with the Risk of Complication","authors":"Peter M. Wingrove, Keerthi N. Arani, Carl H. Snyderman, Paul A. Gardner, David T. Fernandes Cabral, Georgios A. Zenonos, Eric W. Wang, Joseph Chabot, Juan C. Fernandez-Miranda, Yue-Fang Chang, Marion A. Hughes","doi":"10.1055/s-0043-1776007","DOIUrl":"https://doi.org/10.1055/s-0043-1776007","url":null,"abstract":"<p>\u0000<b>Objectives</b> Our objective was to determine if decreased contrast enhancement on postoperative magnetic resonance imaging (MRI) is associated with an increased risk of complication in patients who have undergone nasoseptal flap (NSF) reconstruction.</p> <p>\u0000<b>Design/Setting</b> This was a single-institution retrospective study of patients who underwent a first-time endoscopic endonasal approach (EEA) with NSF reconstruction.</p> <p>\u0000<b>Participants</b> Patients underwent an EEA to the skull base with NSF reconstruction and received postoperative MRI within 3 weeks of the operation.</p> <p>\u0000<b>Main Outcome Measures</b> MR exams were scored on the degree of contrast enhancement at first postoperative MRI. An enhancement score of 4 indicated ≥75% enhancement of the NSF. A score of 3 indicated enhancement ≥50% and <75% enhancement of the NSF. A score of 2 indicated ≥25% and <50% enhancement of the NSF. Complications (e.g., cerebrospinal fluid [CSF] leak, meningitis, empyema, cerebritis, brain abscess, flap necrosis, and flap migration) were retrieved from our institution's skull base database. Logistic regression was used to determine the effect of the MRI enhancement score on the odds of developing a complication.</p> <p>\u0000<b>Results</b> Out of 99 patients in the study, six had complications. Patients who underwent NSF reconstruction of skull base defects were found to have 19 times higher odds of complication (<i>p</i> = 0.007) if they had had an NSF enhancement score of 2 on their postoperative MRI when compared with patients with complete or near complete NSF enhancement (score 4).</p> <p>\u0000<b>Conclusions</b> Quantifying NSF enhancement with an MRI may help surgeons better predict which of their patients are at an increased risk of complication.</p> ","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"36 5-6","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138509915","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":"Significant Underreporting of Preoperative Hyposmia in Patients Undergoing Endoscopic Skull Base Surgery: Discrepancies Between Subjective and Objective Measurements","authors":"Lindsey F. Jackson, Jennifer K. Mulligan, Jeb M. Justice, Steven N. Roper, Jason E. Blatt, Brian C. Lobo","doi":"10.1055/s-0043-1775851","DOIUrl":"https://doi.org/10.1055/s-0043-1775851","url":null,"abstract":"Abstract Objective The assessment of baseline olfactory function before endoscopic skull base surgery (ESBS) has been relatively limited compared with analysis before functional endoscopic sinus surgery (FESS). Our study addresses this knowledge gap, assessing preoperative olfactory function in ESBS and FESS and elucidating any differences. Study Design We conducted a retrospective review of patients undergoing anterior ESBS or FESS at a single institution between 2021 and 2022. We included 171 patients and compared their reported and measured preoperative olfactory function using the Sino-Nasal Outcome Test questionnaire and the 40-item University of Pennsylvania Smell Identification Test. Results Of the 171 patients included in this study, 30% of patients underwent ESBS and 70% underwent FESS. Of all patients, only 57% correctly reported their objective preoperative olfactory function. Of the 36 ESBS patients with measured preoperative hyposmia, only 31% correctly reported hyposmia, while 69% incorrectly reported normosmia. This distribution significantly differs (p < 0.0001) from the FESS subset (89 patients), with 64% correctly reporting hyposmia and 36% incorrectly reporting normosmia. Conclusions Our analysis demonstrates higher than anticipated underreporting of preoperative hyposmia in patients undergoing ESBS as well as discrepancies between subjective and objective olfactory functions in the FESS population. The results highlight several gaps in knowledge regarding perioperative olfactory function that would be best examined with more thorough pre- and postoperative objective olfactory testing. This analysis demonstrates significant prognostic uncertainty for patients and providers and creates significant medicolegal uncertainty regarding the appropriate attribution of postoperative olfactory loss in cases without objective preoperative testing.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"4 8","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135391520","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":"Analysis of Treatment Modalities for Advanced Stage Squamous Cell Carcinoma of the Maxillary Sinus: A National Cancer Database Study","authors":"Kue Lee, Duncan Kleinbub, Camilo Reyes","doi":"10.1055/a-2201-8466","DOIUrl":"https://doi.org/10.1055/a-2201-8466","url":null,"abstract":"Introduction: Stage cT4a and cT4b SCCa typically require multimodal treatment with adjuvant or neoadjuvant therapy. This study aims to evaluate the impact of different treatment modalities on survival outcomes in patients with stage cT4a-b SCCa exclusively of the maxillary sinus. Methods: A multivariate survival analysis was conducted, evaluating treatment modalities for patients diagnosed between 2004 and 2020 utilizing the National Cancer Data Base (NCDB). Cox hazard regression was performed for variables. Results: The study identified a total of 1788 patients with SCCa of the maxillary sinuses, of which 71.2% were cT4a. Increasing age, Charlson-Deyo score ≥1, and undifferentiated/anaplastic grade were associated with worse rates of survival. Multivariate analysis revealed that neoadjuvant treatment exhibited the lowest hazard ratio (HR 0.574, 95% CI0.370 - 0.892) across the entire cohort (cT4a-b). Neoadjuvant treatment plus surgery, adjuvant treatment plus surgery, and surgery alone demonstrated the highest adjusted 5-year survival for cT4a-b tumors. On the other hand, radiation alone exhibited the highest hazard ratio (1.939, 95% CI 1.555-2.418)) in multivariate analysis and the lowest adjusted 5-year survival. Conclusion: Multimodal treatment of advanced-stage maxillary SCCa has a variable effect on outcomes by tumor stage. Our findings suggest that surgery plus neoadjuvant and surgery plus adjuvant treatment are associated with higher rates of survival. Increasing age, Charlson-Deyo score ≥1, and undifferentiated/anaplastic grade were associated with worse rates of survival. Further randomized controlled trials are required to quantify the therapeutic benefit of these treatments on survival and organ sparing in advanced-stage disease.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"102 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135871761","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":"Outcomes of the endonasal endoscopic approach for the treatment of Clival chordomas: a single-center experience","authors":"Ahmed Alsayed, Abdulaziz Alrasheed, Saif Aljabab, Mohammad Alshareef, Buthaina Jaber Yahya, Abdulmajeed Alharbi, Ahmad Alroqi, Hussain Albaharna, Saud Alromaih, Yasir Alayed, Ashwag Alqurashi, Saad Alsaleh, Abdulrazag Ajlan","doi":"10.1055/a-2198-9169","DOIUrl":"https://doi.org/10.1055/a-2198-9169","url":null,"abstract":"Objective: Chordoma is a low-grade malignant tumor that originates from the remnant tissue of the embryonic notochord. Postoperative or definitive radiotherapy has been used to enhance local control. This study aims to assess the outcomes of the expanded EEA for maximal removal of clival chordomas followed by CyberKnife radiosurgery for visualized residual or tumor recurrence. Methods: A retrospective review was performed on consecutive patients with clival chordoma who underwent endoscopic endonasal resection in the Otorhinolaryngology and Neurosurgery Departments, between 2016 and 2021. We included all patients with pathologically confirmed clival chordoma who were treated using the endoscopic endonasal approach. Patients who underwent combined external and endoscopic approaches or transcranial surgery were excluded. Results: 17 patients were included in this study. Most of them had tumors located in the middle clivus. Regarding radiation therapy (RT), the majority of patients underwent postoperative RT. Almost half of them underwent CyberKnife (CK) RT. None of them had severe toxicities (grade 3 or higher). Three patients died, resulting in a mortality rate of 17.6% none on them related to radiation side effect. The 2-year overall survival was 82.4% (Mean S.E. = 1.765, 95% CI = 1.505–2.024), and the progression-free survival (PFS) was 76.5% (Mean S.E. = 3.403, 95% CI = 2.791–4.016). No distal metastasis was reported in our series. Conclusions: This series illustrates that the expanded EEA to resection of skull-base chordomas followed by CyberKnife radiosurgery is an acceptable alternative to proton therapy. The 2-year overall survival was 82.4% and PFS was 76.5%.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"12 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134907542","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":"Vestibular prehabillitation – a single UK centre experience and literature review","authors":"Lucie Ferguson, Victoria Ruane, Hussein Mansoor, Jenna Quail, KS Manjunath Prasad, Nitin Mukerji, Noweed Ahmad","doi":"10.1055/a-2198-8205","DOIUrl":"https://doi.org/10.1055/a-2198-8205","url":null,"abstract":"Objectives To assess whether vestibular prehab with intratympanic gentamicin is a useful preoperative adjunct in allowing for early mobilisation and short length of stay in patients with vestibular schwannoma Design Retrospective single centre study and literature review Setting Tertiary neurosurgical centre Participants Adult patients undergoing surgery for vestibular schwannoma Main Outcome Measures Our primary outcome measures were evidence of compensation following prehab (defined as saccades becoming more covert and clustered on video Head Impulse Testing – vHIT), length of stay and days until mobilisation. Secondary outcome measures were reduction in gain on vHIT testing following treatment as well as need for anti-emetics post-operatively. Results Ten patients have been treated at our centre and the majority have shown pre-operative reduction in gain and evidence of compensation on video head impulse testing (VHIT). Median time to mobilisation was 1 day and modal length of stay was 6 days. We found the current evidence to be variable, with small sample sizes and significant variation in outcome measures used. Conclusions Overall we have found that the use of vestibular prehab enables early mobilisation, shortened length of stay and appears to be a promising pre-operative adjunct in this population. Further research and assessment with a multi-centre prospective clinical trial is merited.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"32 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135215971","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":"Surgical nuances and predictors of requirement for suprameatal tubercle removal in microvascular decompression for trigeminal neuralgia","authors":"koichi iwasaki, minami uezato, namiko nishida, kazushi kitamura, naoya yoshimoto, Masanori Gomi, hirokuni hashikata, isao sasaki, hiroki toda","doi":"10.1055/a-2198-8279","DOIUrl":"https://doi.org/10.1055/a-2198-8279","url":null,"abstract":"Objective: Suprameatal tubercle (SMT), a bony prominence located above the internal acoustic meatus, is reported to impede the microscopic view during microvascular decompression (MVD) for trigeminal neuralgia (TN). For an enlarged SMT, removal of the SMT may be required in addition to the routine MVD to precisely localize the offending vessels. The objective of this study is to investigate the predictive factors influencing the requirement of SMT removal during trigeminal MVD. Methods: We retrospectively reviewed 197 patients who underwent MVD for TN, and analyzed the correlation of the SMT height and other clinico-surgical data with the necessity to remove the SMT during MVD. The parameters evaluated in the statistical analyses included maximum SMT height, patient clinical characteristics, surgical data including the type and number of offending vessels, and surgical outcomes. Results: SMT removal was required for 20 patients among a total of enrolled 197 patients. In the univariate analysis, maximum SMT height, patient age, and number (≥ 2) of offending vessels were associated with the requirement for SMT removal. Multivariate analysis with binary logistic regression revealed that the maximum SMT height and number (≥ 2) of offending vessels were significant factors influencing the necessity for SMT removal. A receiver operating characteristic curve analysis revealed that an SMT height ≥ 4.8 mm was the optimal cut-off value for predicting the need for SMT removal. Conclusions: Large SMTs and the presence of multiple offending vessels are helpful in predicting the technical difficulty of trigeminal MVD associated with the necessity of SMT removal.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134973485","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":"Idiopathic Intracranial Hypertension is Associated with Recurrent CSF Leak and Reoperation for Spontaneous Temporal Encephalocele","authors":"Sabrina Heman-Ackah, Daksh Chauhan, Alexandra Quimby, Rachel Blue, Michael Ruckenstein, Douglas Bigelow, M. Sean Grady","doi":"10.1055/a-2198-8374","DOIUrl":"https://doi.org/10.1055/a-2198-8374","url":null,"abstract":"Objective: Spontaneous temporal encephaloceles (STEs) are increasingly recognized as sequelae of idiopathic intracranial hypertension (IIH), which in turn may further complicate their management. We endeavored to review the University of Pennsylvania institutional experience on operative management of STEs, with a focus on factors which may influence surgical outcomes, particularly IIH. Design: Retrospective chart review over 9 years from 2013 – 2022. Setting: Single-center, two-hospital, tertiary care, academic setting. Participants: Patients undergoing middle cranial fossa (MCF, 43.9%), transmastoid (TM, 44.9%) or combined (11.2%) approaches for repair of STEs during the study period (n=107). Main Outcome Measures: Post-operative complication rates, recurrence and diagnosis of IIH. Results: The majority of patients were female (64.5%), with a mean BMI of 37 kg/m2 and mean age of 57 years. Twelve patients (9%) represented re-operations after failed primary repairs. Fourteen percent of patients undergoing primary surgical repair of STE were diagnosed with IIH, compared to 42% of patients undergoing re-operations (p = 0.015). In addition, there was a significant difference in the average BMI of patients undergoing primary (36.4 kg/m2) versus revision surgery (40.9 kg/m2, p=0.04). Half of those undergoing re-operation were placed on post-operative acetazolamide compared to 11% of patients undergoing primary operations. No patient experienced recurrent leak after re-operation. Conclusion: Based on our institutional experience, elevated BMI and the presence of IIH are significant predictors of re-operation for STE. In our experience, acetazolamide is a common adjunct management strategy in addition to re-operation for patients with recurrent CSF leak in the setting of STE.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"129 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134973619","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":"Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Bifrontal Transbasal Approach, Surgical Principles, and Illustrative Cases","authors":"Larissa Vilany, Danielle D. Dang, Edoardo Agosti, Pedro Plou, Luciano C. P. C. Leonel, Stephen Graepel, Carlos D. Pinheiro-Neto, Giuseppe Lanzino, Michael J. Link, Maria Peris-Celda","doi":"10.1055/s-0043-1775875","DOIUrl":"https://doi.org/10.1055/s-0043-1775875","url":null,"abstract":"Abstract Introduction The transbasal approach traditionally uses a bicoronal scalp incision with bifrontal craniotomy to establish an extradural midline skull base working corridor. Depending on additional craniofacial osteotomies, this approach can expand its reach to the nasal cavity and paranasal sinuses and may be employed for the resection of particularly complex sinonasal and midline skull base tumors. Given its discrepancy in nomenclature and differences in interoperator technique, we propose a practical, operatively oriented guide for trainees performing this approach. Methods Three formalin-fixed, latex-injected specimens were dissected under microscopic magnification and endoscopic-assisted visualization. Stepwise dissections of the transcranial-transbasal approach with common modifications were performed, documented with three-dimensional photography, and supplemented with representative case applications. Results The traditional transbasal approach via bifrontal craniotomy affords wide extradural access to the anterior cranial fossa and central skull base. The addition of craniofacial osteotomies further expands access into the sinonasal cavities, clivus, and craniocervical junction. Key steps described include patient positioning, bicoronal skin incision, pericranial graft harvest, bifrontal craniotomy, orbital rim osteotomy, sphenoidotomy, bilateral ethmoidectomies, and microsurgical dissection of the sellar region. Basal superior sagittal sinus ligation and durotomy allow for intradural exposure. Reconstruction techniques are also discussed. Conclusion While the transbasal approach is rich with historical descriptions, illustrations, and modifications, its stepwise performance may be relatively unknown and unclear to younger generations of trainees. We present a comprehensive guide to optimize familiarity with the transbasal approach and its indications in the surgical anatomy laboratory, mastery of the relevant microsurgical anatomy, and simultaneous preparation for learning and participation in the operating room.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135045899","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}