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

{"title":"The Role of the Transeptal Window in Endoscopic Endonasal Access to the Contralateral Orbit","authors":"Juan M. Revuelta-Barbero, Alejandra Rodas, Edoardo Porto, Jackson R. Vuncannon, Youssef M. Zohdy, Justin Maldonado, C. Arturo Solares, Oswaldo Henriquez, Gustavo Pradilla","doi":"10.1055/s-0043-1775755","DOIUrl":"https://doi.org/10.1055/s-0043-1775755","url":null,"abstract":"Abstract Objective This study aimed to objectively compare maneuverability at the contralateral medial orbit when approached through the traditional endoscopic endonasal approach (EEA) and EEA with transeptal window (TW). Study Design Anatomic dissections were performed bilaterally on three latex-injected cadaveric heads. Approaches were performed sequentially; initially, an EEA was fashioned. Binostril access was achieved through a 2-cm posterior septectomy. The second stage pertained to the TW dissection. Area of exposure (AoE), surgical freedom (SF), and angles of attack (AoA) were measured along the contralateral medial orbital wall and compared for each approach. Additionally, the study presents an illustrative case describing the application of the EEA + TW for resection of an intraorbital schwannoma. Results Compared with EEA, EEA + TW yielded a significantly greater AoE along the contralateral medial orbital wall (39.45 vs. 48.45 cm2, respectively; p = 0.002). SF was statistically different between the EEA and EEA + TW (1153.25 vs. 2256.33 cm2, respectively; p = 0.002). AoA in the horizontal plane were significantly broader with the EEA + TW (6.36 vs. 4.9 degrees by EEA; p = 0.015). A 50-year-old male with a right medial extraconal orbital tumor was successfully treated through an EEA using the transeptal corridor to access the medial orbital region. No long-term complications were encountered after 31 months of follow-up. Conclusions EEA + TW is a minimally invasive technique that maximizes exposure and maneuverability within the medial orbital wall, allowing resection of lesions that extend anteriorly. EEA + TW limits disruption of the nasal septum and overcomes the obstacle that intranasal anatomy represents for instrumentation.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135534540","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":"Clinical Study of Symptomatic Nonacute Intracranial Large Arterial Occlusion with Endovascular Recanalization","authors":"Bitang Dan, Bifeng Zhu, Wei Zeng, Tao Peng, Jing Liu, Xin Li, Junjian Zhang","doi":"10.1055/s-0043-1774791","DOIUrl":"https://doi.org/10.1055/s-0043-1774791","url":null,"abstract":"Abstract Objectives This study reported a single-center clinical trial of endovascular treatment for symptomatic nonacute occlusion of the intracranial large artery (NA-ILAO). The aim of this study was to evaluate the safety, feasibility, and clinical effect of simple balloon dilatation and stent implantation. Methods The patients diagnosed with symptomatic NA-ILAO were enrolled. A total of 40 cases were included in this study. While recanalization failed in 4 patients, it was successful in 36 patients, who were then divided into two groups for further analysis: balloon dilatation group (n = 24) and stent implantation group (n = 12). The perioperative complications, clinical outcome, and follow-up results were analyzed. Results Perioperative complications in the stent implantation group were significantly higher than those in the simple balloon dilatation group (p < 0.05). There were 21 and 10 cases of 90-day good clinical outcome (modified Rankin scale [mRS] ≤ 2) in the balloon and stent groups, respectively (p = 0.518). All patients with successful recanalization underwent digital subtraction angiography (DSA) or CT angiography (CTA) during an average follow-up of 14 months. There were two cases of restenosis in the balloon dilatation group and one in the stent implantation group (p = 1.000). There were two cases of re-occlusion in the stent group and none in the balloon dilatation group (p < 0.001). Stroke recurred in two cases in the stent group and in one case in the simple balloon dilatation group (p = 0.013). Conclusion Endovascular recanalization is safe and feasible for patients with symptomatic NA-ILAO. Compared with stent implantation, simple balloon dilation may be a better recanalization method, but larger randomized controlled trials are needed to confirm it.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135534981","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":"Assessing the Quality of Recruitment Information on Skull Base Surgical Fellowship Program Websites","authors":"Hana Sung, Emily Ton, Nolan Brown, Zach Pennington, Sachiv Chakravarti, Dontre Douse, Julian L. Gendreau, Siviero Agazzi, Matthew L Carlson, Michael J Link, Jamie J Van Gompel","doi":"10.1055/a-2181-6813","DOIUrl":"https://doi.org/10.1055/a-2181-6813","url":null,"abstract":"Abstract Introduction The American Association of Neurological Surgeons (AANS), North American Skull Base Society (NASBS), American Rhinologic Society (ARS), and American Neurotology Society (ANS) fellowship directories are important information repositories for skull base surgical fellowship programs. However, there is limited research on the amount and depth of information available through these resources. The objective of the present study is to assess Web site accessibility and information availability for individual fellowship programs listed within the AANS, NASBS, ARS, and ANS fellowship directories. Methods Lists of all accredited skull base surgical programs were obtained from the AANS and NASBS fellowship directories. Duplications in listed programs were removed, and systematic queries via an online search engine were conducted to identify fellowship Web sites. From each available Web site, information pertaining to 24 different variables was collected and organized into two categories—recruitment and education. Differences in the availability of information on recruitment and education were then compared across Web sites and contextualized relative to other surgical specialties. Results After excluding duplicates, 113 fellowship programs were identified, of which 99 (87.6%) had accessible Web sites. Of the 48 listed by the NASBS, direct Web site links were available for 33 (68.8%), email contacts were accessible for 32 (66.7%), and phone numbers were listed for 6 (12.5%). Of the 39 programs listed by the AANS, none included Web site links, 38 (97.4%) provided an email contact, and 39 (100%) listed a departmental contact telephone number. All 28 (100%) programs listed by the ANS provided a phone and email contact in addition to a Web site link to each institutional Web site. Of the 33 programs listed by the ARS, 29 (88%) had a departmental contact telephone number, 31 (94%) had an email contact available, and 4 (12%) had a program Web site link directly available from the database Web site. Of the 99 total programs, fellowship Web sites displayed an average of 5.46 (42.0%) of the 13 recruitment features and 4.80 (42.6%) of the 11 education features. Programs in the geographic Northeast were significantly less likely to present information pertaining to recruitment (p = 0.023). Furthermore, programs in geographic Northeast and West were significantly less likely to present information focused on surgical training and/or education (p = 0.006). Conclusion Although many skull base fellowship programs have maintained comprehensive program Web sites, certain critical aspects remain deficient, and some programs provide little to no information. Providing more detailed information about programs can prove mutually beneficial for fellowship program directors and candidates.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134885133","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":"Endoscopic endonasal approach for clival chordomas in elderly patients: clinical characteristics, patients outcome and recurrence rate.","authors":"Matteo ZOLI, Alessandro Carretta, Arianna Rustici, Federica Guaraldi, Davide Gori, Riccardo Cavicchi, Giacomo Sollini, Sofia Asioli, Marco Faustini-Fustini, Ernesto Pasquini, Diego Mazzatenta","doi":"10.1055/a-2181-2787","DOIUrl":"https://doi.org/10.1055/a-2181-2787","url":null,"abstract":"Abstract Introduction The endoscopic endonasal route has demonstrated to be the approach of choice for a large majority of clival chordomas (CCs). However, its results in elderly patients are under-evaluated in the literature. The aim of this study is to assess the surgical outcome for these patients, determining the factors associated with a larger tumor resection in this population. Materials and Methods Our institutional database of CC has been retrospectively reviewed, to identify all cases over 65 years old, operated through an endoscopic endonasal approach (EEA). Preoperative clinical and radiological features were considered, as well as surgical results, morbidity, and patients' outcome at follow-up. Results Out of our series of 143 endoscopic surgical procedures for CC, 34 (23.8%) were in patients older than 65 and 10 in older than 75 (7.0%). Gross tumor removal was achieved in 22 cases (64.7%). Complications consisted of 2 (5.9%) postoperative cerebrospinal leaks, 1 (2.9%) meningitis, 1 (2.9%) permanent cranial nerve VI palsy, 1 (2.9%) pneumonia, and 2 (5.9%) urinary infections. In 39.1% of cases, the preoperative ophthalmoplegia improved or resolved. Twenty-seven patients (79.4%) underwent radiation therapy. At follow-up (37.7 ± 44.9 months), 13 patients (38.2%) showed a recurrence/progression and 13 (38.3%) deceased. Conclusion EEA can be a useful approach in elderlies, balancing the large tumor removal with an acceptable morbidity rate, even if higher than that for general CC population. However, patient selection remains crucial. A multidisciplinary evaluation is important to assess not only their medical conditions, but also their social and familiar conditions.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135769910","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":"Induction Chemotherapy for Sinonasal Tumors in Patients Presenting with Brain Invasion and/or Neurological Deficits","authors":"Bledi C. Brahimaj, Kevin J. Contrera, Franco Rubino, Romulo Andrade de Almeida, Renata Ferrarotto, Jack Phan, Shirley Y. Su, Ehab Y. Hanna, Franco DeMonte, Shaan M. Raza","doi":"10.1055/s-0043-1774792","DOIUrl":"https://doi.org/10.1055/s-0043-1774792","url":null,"abstract":"Abstract Objective The aim of this study was to investigate the safety of induction chemotherapy (IC) for patients with sinonasal malignancies with brain invasion or a neurological deficit. Methods We conducted a retrospective analysis of patients who underwent IC for sinonasal malignancies with intracranial invasion or a neurological deficit at a single tertiary cancer center from 1992 to 2020. Results In total, 460 patients with sinonasal malignancies were included in the study. Of the patients reviewed, 341 underwent IC and within this group 40 had brain invasion (BI) and 31 had a neurological deficit (ND) at presentation. The most prevalent malignancy was sinonasal undifferentiated carcinoma (BI 40%, ND 41.9%), followed by esthesioneuroblastoma (BI 27.5%, ND 9.7%). All tumors were stage T4 with the majority lacking nodal metastases (BI N0: 72.5%, ND N0: 77.5%). All patients completed at least two cycles of IC. Partial or complete response to IC was seen in 80% of BI and 71% of ND patients. No patients had cessation of treatment due to neurologic decline and none required urgent surgery. Five patients (12.5%) with BI and 2 (6.5%) with ND had interruption of IC for reasons other than neurological decline. In patients with ND, IC led to improvement of 54.5% NDs. Conclusion In patients with sinonasal malignancies with BI or ND who underwent IC, no patients had cessation of treatment due to neurologic decline. In contrast, most patients had improvement of neurologic symptoms with IC. IC was safely administered without interruption due to neurological decline or symptom progression.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"225 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135770964","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":"Epidural Interlay Graft for Pituitary Surgery: A 4-Year Institutional Experience","authors":"Rita Snyder, Sungho Lee, Prazwal Athukuri, Emmeline Monique Ngo, Meha Fox, Samer Fakhri, Mas Takashima, Bahar Force, Susan Samson, K. Kelly Gallagher, Daniel Yoshor, Ali Jalali","doi":"10.1055/a-2175-8181","DOIUrl":"https://doi.org/10.1055/a-2175-8181","url":null,"abstract":"Abstract Objective Sellar repair techniques with varying complexity and effectiveness have been employed to reduce the incidence of postoperative cerebrospinal fluid (CSF) leaks following endoscopic transsphenoidal pituitary surgery. This study describes our institutional experience with a minimalistic, highly effective approach to sellar repair. Methods The authors performed a retrospective review of consecutive cases of transsphenoidal pituitary surgery performed at our institution. All included subjects underwent sellar repair with an epidural interlay graft. Relationships between patient and tumor characteristics, incidence of CSF leak, adjunct repair techniques, and endocrine outcomes were examined. Results Three hundred and thirty-four (334) cases were included. Intraoperative CSF leak was encountered in 116 cases (34.7%), and postoperative CSF leak occurred only once (0.3%) early in the series. Seventy intraoperative CSF leaks were successfully repaired with an epidural interlay alone, including 13 high-flow leaks. Our rate of fat graft use (1.2%), nasoseptal flap (3.0%), and lumbar drain placement (6.6%) in the second half of the series showed a significant decline compared with the first half, indicating increased reliance on the interlay graft over time. Our 65% functional macroadenoma remission rate compares favorably with large historical series. Conclusions Simple sellar repair using an epidural interlay graft is highly effective in preventing postoperative CSF leaks, including cases of high-flow intraoperative leaks. More complex repair techniques are reserved for select high-risk cases or those with inadequate sellar bony ledges. With this technique, there has been no postoperative CSF leak at our institution in over 300 consecutive transsphenoidal pituitary surgeries.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135552865","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: lateral supraorbital approach with expanded indications","authors":"Xiaochun Zhao, Kiana Yang Prather, Andrew Bauer, Ian Dunn, Christopher Salvatore Graffeo","doi":"10.1055/a-2175-8105","DOIUrl":"https://doi.org/10.1055/a-2175-8105","url":null,"abstract":"Abstract Objectives The lateral supraorbital (LSO) approach is a less-invasive alternative to the pterional craniotomy that provides rapid transsylvian access. Establishing familiarity with the LSO technique and its features as compared with other anterolateral approaches is an important component of advanced skull base training. We present a step-by-step demonstration of the LSO approach using cadaveric dissection in a manner that is digestible for trainees at various levels. Design This is anatomic step-by-step dissection and representative case series. Setting This study was carried out in the cadaveric dissection laboratory. Participants A formalin-fixed, latex-injected cadaveric head specimen was dissected under microscopic magnification by a neurosurgery resident under faculty supervision. Following dissection, representative case applications were reviewed. Main Outcome Measures Dissection and case illustration were the main outcome measures. Results A single-layer myocutaneous flap is developed, and a single-burr-hole technique is used, followed by extensive drilling of the sphenoid wing. The dura is opened in a C-shaped fashion centered on the Sylvian fissure, exposing the inferior frontal and superior temporal lobes. Labeled photographs of dissections with pertinent anatomical structures are presented. Three case examples illustrating the versatility of the LSO approach, including the resection of a large pituitary adenoma, an inferior frontal melanoma metastasis presenting to the Sylvian surface, and a frontoinsular low-grade glioma, are reviewed. Conclusions As compared with the pterional craniotomy, the LSO approach involves a shorter incision, smaller craniotomy, and faster exposure; it can be conveniently tailored to various indications. Understanding the step-by-step dissection and indications of the LSO approach is of paramount importance to neurosurgery trainees.","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135551944","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 Parameters and Growth of the Pediatric Skull Base: Endonasal Access Implications.","authors":"Joshua Chen,&nbsp;Christopher Pool,&nbsp;Einat Slonimsky,&nbsp;Tonya S King,&nbsp;Sandeep Pradhan,&nbsp;Meghan N Wilson","doi":"10.1055/a-1862-0321","DOIUrl":"https://doi.org/10.1055/a-1862-0321","url":null,"abstract":"<p><p><b>Objectives</b>  Endoscopic endonasal anterior skull base surgery has expanding use in the pediatric population, but the anatomy of pediatric patients can lead to limitations. This study aims to characterize the important anatomical implications of the pediatric skull base using computed tomography (CT) scans. <b>Design</b>  This study is designed as retrospective analysis. <b>Setting</b>  The study setting comprises of tertiary academic medical center. <b>Participants</b>  In total, 506 patients aged 0 to 18 who had undergone maxillofacial and or head CTs between 2009 to 2016 were involved. <b>Methods</b>  Measurements included piriform aperture width, nare to sella distance (NSD), sphenoid pneumatization, olfactory fossa depth, lateral lamella cribriform plate angles, and intercarotid distances (ICD) at the superior clivus and cavernous sinus. These patients were then subdivided into three age groups adjusting for sex. Analysis of covariance (ANCOVA) models were fit comparing between all age groups and by sex. <b>Results</b>  Piriform aperture width, NSD, sphenoid sinus pneumatization as measured using lateral aeration and anterior sellar wall thickness, olfactory fossa depth, and ICD at the cavernous sinus were significantly different among all age groups ( <i>p</i> <0.0001). Our results show that mean piriform aperture width increased with each age group. The mean olfactory fossa depth also had consistent age dependent growth. In addition, ICD at the cavernous sinus showed age dependent changes. When comparing by sexes, females consistently showed smaller measurements. <b>Conclusion</b>  The process of skull base development is age and sex dependent. During preoperative evaluation of pediatric patients for skull base surgery piriform aperture width, sphenoid pneumatization in both the anterior posterior and lateral directions, and ICD at the cavernous sinus should be carefully reviewed.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"84 4","pages":"336-348"},"PeriodicalIF":0.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10317570/pdf/10-1055-a-1862-0321.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10161622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phenotypical Variability of the Internal Acoustic Canal in the Middle Cranial Fossa Surgery.","authors":"Maryna Al-Fauri Kornieieva,&nbsp;Paul Kelly,&nbsp;Daniel Lee,&nbsp;Azmy Hadidy","doi":"10.1055/a-1786-9026","DOIUrl":"https://doi.org/10.1055/a-1786-9026","url":null,"abstract":"<p><p><b>Introduction</b>  The wide range of anatomical variability of the structures of the middle cranial fossa (MCF) and the lack of reliable surgical landmarks contribute to a high level of complications in the surgical treatment of vestibular schwannomas. We hypothesized that the cranial phenotype influences the shape of the MCF, the orientation of the pyramid of the temporal bone, and the relative topography of the internal acoustic canal (IAC). <b>Methods</b>  The skull base structures were studied on 54 embalmed cadavers and 60 magnetic resonance images of the head and neck by photo modeling, dissection, and three-dimensional analysis techniques. By the value of the cranial index, all specimens were subdivided into dolichocephalic, mesocephalic, and brachycephalic groups for comparison of variables. <b>Results</b>  The length of the superior border of the temporal pyramid (SB), the apex to squama distance, and the width of the MCF all peaked in the brachycephalic group. The value of the angle between the SB and the axis of the acoustic canal varied from 33 to 58 degrees; it peaked in the dolichocephalic group and showed its smaller value in the brachycephalic one. The pyramid to squama angle had reversed distribution and dominated in the brachycephalic group. <b>Conclusion</b>  The cranial phenotype influences the shape of the MCF, temporal pyramid, and IAC. Presented in this article data help specialists operating on the vestibular schwannoma to localize the IAC based on the individual shape of a skull.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"84 4","pages":"384-394"},"PeriodicalIF":0.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ab/a0/10-1055-a-1786-9026.PMC10317566.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9805968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Endoscopic-Assisted Supraorbital Approach for Resection of Anterior Skull Base Meningiomas: A Large Single-Center Retrospective Surgical Study.","authors":"Lucas Serrano Sponton,&nbsp;Florian Oehlschlaegel,&nbsp;Amr Nimer,&nbsp;Eike Schwandt,&nbsp;Martin Glaser,&nbsp;Eleftherios Archavlis,&nbsp;Jens Conrad,&nbsp;Sven Kantelhardt,&nbsp;Ali Ayyad","doi":"10.1055/s-0042-1751000","DOIUrl":"https://doi.org/10.1055/s-0042-1751000","url":null,"abstract":"<p><p><b>Objective</b>  The endoscopic-assisted supraorbital approach (eSOA) constitutes a minimally invasive strategy for removing anterior skull base meningiomas (ASBM). We present the largest retrospective single-institution and long-term follow-up study of eSOA for ASBM resection, providing further insight regarding indication, surgical considerations, complications, and outcome. <b>Methods</b>  We evaluated data of 176 patients operated on ASBM via the eSOA over 22 years. <b>Results</b>  Sixty-five tuberculum sellae (TS), 36 anterior clinoid (AC), 28 olfactory groove (OG), 27 planum sphenoidale, 11 lesser sphenoid wing, seven optic sheath, and two lateral orbitary roof meningiomas were assessed. Median surgery duration was 3.35 ± 1.42 hours, being significantly longer for OG and AC meningiomas ( <i>p</i> <0.05). Complete resection was achieved in 91%. Complications included hyposmia (7.4%), supraorbital hypoesthesia (5.1%), cerebrospinal fluid fistula (5%), orbicularis oculi paresis (2.8%), visual disturbances (2.2%), meningitis (1.7%) and hematoma and wound infection (1.1%). One patient died due to intraoperative carotid injury, other due to pulmonary embolism. Median follow-up was 4.8 years with a tumor recurrence rate of 10.8%. Second surgery was chosen in 12 cases (10 via the previous SOA and two via pterional approach), whereas two patients received radiotherapy and in five patients a wait-and-see strategy was adopted. <b>Conclusion</b>  The eSOA represents an effective option for ASBM resection, enabling high complete resection rates and long-term disease control. Neuroendoscopy is fundamental for improving tumor resection while reducing brain and optic nerve retraction. Potential limitations and prolonged surgical duration may arise from the small craniotomy and reduced maneuverability, especially for large or strongly adherent lesions.</p>","PeriodicalId":16513,"journal":{"name":"Journal of Neurological Surgery Part B: Skull Base","volume":"84 4","pages":"349-360"},"PeriodicalIF":0.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10317572/pdf/10-1055-s-0042-1751000.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9805963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}