Assessment of frontal lobe sagging after endoscopic endonasal transcribriform resection of anterior skull base tumors: Is rigid structural reconstruction of the cranial base defect necessary?

2012 ◽  
Vol 122 (12) ◽  
pp. 2652-2657 ◽  
Author(s):  
Jean Anderson Eloy ◽  
Pratik A. Shukla ◽  
Osamah J. Choudhry ◽  
Rahul Singh ◽  
James K. Liu
Keyword(s):  
Skull Base ◽  
Frontal Lobe ◽  
Cranial Base ◽  
Anterior Skull Base ◽  
Skull Base Tumors ◽  
Endoscopic Endonasal

scholarly journals Tailored Extended Bifrontal Craniotomy for Anterior Skull Base Tumors: Anatomic Description of a Modified Surgical Technique and Case Series

2017 ◽  
Vol 14 (4) ◽  
pp. 386-394 ◽  
Author(s):  
Michael M Safaee ◽  
Michael W McDermott ◽  
Arnau Benet ◽  
Philip V Theodosopoulos
Keyword(s):  
Skull Base ◽  
Frontal Lobe ◽  
Tomographic Reconstruction ◽  
Case Series ◽  
Early Postoperative Period ◽  
Anterior Skull Base ◽  
Skull Base Tumors ◽  
Case Examples ◽  
Computed Tomographic ◽  
Surgical Exposure

Abstract BACKGROUND Open transcranial approaches to the anterior skull base remain an integral component of current skull base practice. Evolution of these and other techniques has resulted in revisions of standard, tried-and-true methods in attempts to improve patient outcomes and cosmesis, while still providing the best combination of surgical exposure and ergonomics. OBJECTIVE To describe a modified approach for midline tumors of the anterior skull base. METHODS We describe the anatomy and techniques of a modified extended bifrontal craniotomy for anterior skull base tumors. Case examples and a postoperative 3-dimensional computed tomographic reconstruction of the craniotomy are provided. RESULTS The technique has been employed with success in 3 tuberculum sellae meningiomas where the anterior limit of the tumor is several centimeters back from the inner table of the frontal bone. The mean distance from the tumor to inner table was 2.8 cm (range 1.3-3.8 cm). Mean tumor dimensions were 3.0 cm (transverse), 3.5 cm (anterior-posterior), and 2.2 cm (craniocaudal). Average operative time was 557 min. No cases had new T2/fluid-attenuated inversion recovery magnetic resonance imaging signal of the inferior frontal lobe to indicate retraction injury. CONCLUSION The tailored extended bifrontal craniotomy for anterior skull base tumors provides adequate access to the anterior cranial fossa and has replaced our standard extended bifrontal approach. Keeping the osteotomy cut lines outside of the orbit reduces orbital swelling and mechanical disruption of conjugate eye movements in the early postoperative period, while allowing for minimal frontal lobe retraction and providing sufficient surgical exposure along the anterior skull base.

scholarly journals Endoscopic-assisted Craniofacial Resection

2011 ◽  
Vol 3 (3) ◽  
pp. 156-160
Author(s):  
Aliasgar Moiyadi ◽  
Deepa Nair ◽  
Prathamesh S Pai
Keyword(s):  
Skull Base ◽  
Tumor Resection ◽  
Additional Treatment ◽  
Anterior Skull Base ◽  
Skull Base Tumors ◽  
Craniofacial Resection ◽  
Endoscopic Endonasal ◽  
The Past ◽  
Select Group ◽  
Sinonasal Tumor

ABSTRACT Management of anterior skull base tumors has progressed steadily since AS Ketcham popularized the craniofacial surgical technique in the seventies with good results. In the past two decades, endoscopic sinonasal tumor resection has been established as an additional treatment option. For tumors that cross the anterior skull base, a cranial access is vital to encompass the tumor all around. For a select group of these transcranial lesions, the sinonasal component is suitable for an endoscopic endonasal oncologically safe resection along with a traditional transcranial access to complete the resection. This article endeavors to describe the endoscopicassisted craniofacial combining the advantages of a transnasal minimal access to reduce facial morbidity and the transcranial access for superior control of tumors with adequate margins.

Extended anterior subcranial approach for skull base tumors: long-term results

1995 ◽  
Vol 82 (6) ◽  
pp. 1002-1010 ◽  
Author(s):  
Joram Raveh ◽  
Jon B. Turk ◽  
Kurt Lädrach ◽  
Rolf Seiler ◽  
Nelson Godoy ◽  
...  
Keyword(s):  
Skull Base ◽  
Frontal Lobe ◽  
Anterior Skull Base ◽  
Long Term Results ◽  
Surgical Approaches ◽  
Skull Base Tumors ◽  
En Bloc ◽  
Content Type ◽  
Anterior Cranial Base ◽  
Anterior Access

✓ The extended anterior subcranial approach differs significantly from more traditional surgical approaches to the skull base in that it allows a broad inferior access to the anterior skull base planes with tumor exposure from below rather than via the transfrontal route. The authors initially used the subcranial approach in 1978 for the treatment of high-velocity skull base trauma and certain craniofacial anomalies. In 1980 they expanded the indications to include the combined neurosurgical—otolaryngological resection of various skull base tumors. Osteotomy of the frontonasoorbital external skeletal frame provides optimum anterior access to the orbital and sphenoethmoidal planes as well as to the nasal and paranasal cavities while avoiding frontal lobe retraction and the external facial incisions characteristic of transcranial and transfacial approaches. The improved visualization of the anterior skull base and clival—sphenoidal region facilitates en bloc tumor removal, optic nerve decompression, exposure of the medial aspect of the cavernous sinus, and watertight realignment of the anterior cranial base dura. In this report the authors present their experience over the past 13 years with 104 patients who underwent operation via the extended subcranial approach. Because extensive frontal lobe manipulation and external facial incisions are avoided with this approach, intensive care unit and overall hospital stay are reduced, related complications are minimized, and postoperative cosmetic appearance is enhanced. The extended anterior subcranial method is therefore an excellent alternative to traditional transfacial-transcranial skull base approaches for the removal of selected skull base tumors.

Expanded Endoscopic Endonasal Approach for Suprasellar and Anterior Skull Base Tumors

2012 ◽  
Vol 73 (S 02) ◽  
Author(s):  
C. Hostalot ◽  
M. Tardáguila ◽  
C. Botella ◽  
C. Pollán ◽  
J. Vergés ◽  
...  
Keyword(s):  
Skull Base ◽  
Anterior Skull Base ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Skull Base Tumors ◽  
Endoscopic Endonasal

Triple-layer reconstruction technique for large cribriform defects after endoscopic endonasal resection of anterior skull base tumors

2012 ◽  
Vol 3 (3) ◽  
pp. 204-211 ◽  
Author(s):  
Jean Anderson Eloy ◽  
Smruti K. Patel ◽  
Pratik A. Shukla ◽  
Mickey L. Smith ◽  
Osamah J. Choudhry ◽  
...  
Keyword(s):  
Skull Base ◽  
Anterior Skull Base ◽  
Reconstruction Technique ◽  
Skull Base Tumors ◽  
Endoscopic Endonasal ◽  
Triple Layer
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