scholarly journals Endoscopic endonasal approach for craniovertebral junction pathology: a review of the literature

2015 ◽  
Vol 38 (4) ◽  
pp. E15 ◽  
Author(s):  
Saul F. Morales-Valero ◽  
Elena Serchi ◽  
Matteo Zoli ◽  
Diego Mazzatenta ◽  
Jamie J. Van Gompel
Keyword(s):  
Cerebrospinal Fluid Leak ◽  
Craniovertebral Junction ◽  
Transoral Approach ◽  
Oral Feeding ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Respiratory Complications ◽  
Related Factors ◽  
Endoscopic Endonasal ◽  
Indications For Treatment

OBJECT The transoral approach is the gold standard for ventral decompression of the brainstem caused by craniovertebral junction (CVJ) pathology. This approach is often associated with significant morbidity, related to swallowing and respiratory complications. The endoscopic endonasal approach was introduced to reduce the rate of these complications. However, the exact role of this approach in the treatment of CVJ pathology is not well defined. METHODS A comprehensive literature search was performed to identify series of patients with pathology of the CVJ treated via the endoscopie endonasal approach. Data on patient characteristics, indications for treatment, complications, and outcome were obtained and analyzed. RESULTS Twelve studies involving 72 patients were included. The most common indications for treatment were rheumatoid pannus (38.9%) and basilar invagination (29.2%). Cerebrospinal fluid leak was found in 18% of cases intraoperatively and 4.2% of cases postoperatively. One case of meningitis complicated by sepsis and death represents the procedure-related mortality of 1.4%. Of the patients without preoperative swallowing impairment, 95% returned to oral feeding on the 3rd postoperative day. Ninety-three percent of patients experienced improvement in neurological symptoms after the procedure. CONCLUSIONS The endonasal endoscopie approach is effective for the treatment of neural compression caused by CVJ pathology. It offers advantages such as lower rates of postoperative dysphagia and respiratory complications when compared with the more traditional transoral approach. However, these 2 approaches should be seen as complementary rather than alternatives. Patient-related factors as well as the surgeon’s expertise must be considered when making treatment decisions.

Endoscopic Endonasal Approaches to the Clivus with No Violation of the Nasopharynx: Surgical Anatomy and Clinical Illustration

2021 ◽  
Author(s):  
Carlos D. Pinheiro-Neto ◽  
Laura Salgado-Lopez ◽  
Luciano C.P.C. Leonel ◽  
Serdar O. Aydin ◽  
Maria Peris-Celda
Keyword(s):  
Posterior Fossa ◽  
Cerebrospinal Fluid Leak ◽  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Surgical Anatomy ◽  
Csf Leak ◽  
Surgical Approaches ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

Abstract Background Despite the use of vascularized intranasal flaps, endoscopic endonasal posterior fossa defects remain surgically challenging with high rates of postoperative cerebrospinal fluid leak. Objective The aim of the study is to describe a novel surgical technique that allows complete drilling of the clivus and exposure of the craniovertebral junction with preservation of the nasopharynx. Methods Two formalin-fixed latex-injected anatomical specimens were used to confirm feasibility of the technique. Two surgical approaches were used: sole endoscopic endonasal approach and transnasion approach. The sole endonasal approach was used in a patient with a petroclival meningioma. Results In both anatomical dissections, the inferior clivectomy with exposure of the foramen magnum was achieved with a sole endoscopic endonasal approach. The addition of the transnasion approach helped to complete drilling of the inferior border of the foramen magnum and exposure of the arch of C1. Conclusion This study shows the anatomical feasibility of total clivectomy and exposure of the craniovertebral junction with preservation of the nasopharynx. A more favorable anatomical posterior fossa defect for the reconstruction is achieved with this technique. Further clinical studies are needed to assess if this change would impact the postoperative CSF leak rate.

The endoscopic endonasal approach for cerebrospinal fluid leak repair in the elderly

2015 ◽  
Vol 132 ◽  
pp. 21-25 ◽  
Author(s):  
Enzo Emanuelli ◽  
Laura Milanese ◽  
Marta Rossetto ◽  
Diego Cazzador ◽  
Elena d’Avella ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebrospinal Fluid Leak ◽  
The Elderly ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Fluid Leak

Endoscopic Endonasal Approach for Craniovertebral Junction Pathologic Conditions: Myth and Truth in Clinical Series and Personal Experience

2017 ◽  
Vol 101 ◽  
pp. 122-129 ◽  
Author(s):  
Massimiliano Visocchi ◽  
Francesco Signorelli ◽  
Chenlong Liao ◽  
Mario Rigante ◽  
Gaetano Paludetti ◽  
...  
Keyword(s):  
Personal Experience ◽  
Craniovertebral Junction ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Clinical Series

scholarly journals The Tough Fibrous Tissue of The Supracondylar Groove As A Useful Landmark Via The Endoscopic Endonasal Approach To The Lower Clivus

2021 ◽  
Author(s):  
Changchen Hu ◽  
Liyuan Zhou ◽  
Hongming Ji ◽  
Gangli Zhang ◽  
Shengli Chen ◽  
...  
Keyword(s):  
Connective Tissue ◽  
Fibrous Tissue ◽  
Craniovertebral Junction ◽  
Fibrous Connective Tissue ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
External Orifice ◽  
Surgical Corridor ◽  
Lower Clivus

Abstract Background: The hypoglossal canal (HGC) is the most important structural landmark for the endoscopic endonasal approach to access the lower clivus (LC). We explored the feasibility of using the tough fibrous tissue covering the supracondylar groove (SCG) as a useful landmark to identify the location of the HGC. Methods: Four cadaveric specimens were dissected and analyzed. The craniovertebral junction (CVJ) region was accessed utilizing 4-mm endoscope with either 0° or 30° lenses. CVJ exposure and the surgical corridor areas were measured. The relationship between the tough fibrous tissue covering the SCG and the HGC was analyzed.Results: Tough fibrous connective tissue was tightly attached the SCG and ran superomedially to inferolaterally. The angle between the horizontal plane and the long axis of the SCG was 30°. Separating the tough tissue inferolaterally, we could locate the external orifice (EO) of the HGC to further accurately isolate the hypoglossal nerve. Conclusion: The tough fibrous connective tissue covered the SCG to the upper part of the HGC EO. The course of the tough fibrous connective tissue was superomedial to inferolateral. Using the tough fibrous connective tissue covering the SCG as a landmark, it was possible to accurately locate the HGC EO via the endoscopic endonasal approach to access the LC.

Modified endoscopic endonasal approach with a minimally invasive transoral approach-an adjunct to infrapetrous approaches

2018 ◽  
Vol 129 (2) ◽  
pp. 339-343 ◽  
Author(s):  
Guillermo Maza ◽  
Ali M. Moustafa Omar ◽  
Somasundram Subramaniam ◽  
Bradley A. Otto ◽  
Daniel M. Prevedello ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Transoral Approach ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

Endoscopic Endonasal Approach for Resection of Cranial Base Chordomas

Neurosurgery ◽  
2012 ◽  
Vol 71 (3) ◽  
pp. 614-625 ◽  
Author(s):  
Maria Koutourousiou ◽  
Paul A. Gardner ◽  
Matthew J. Tormenti ◽  
Stephanie L. Henry ◽  
Susan T. Stefko ◽  
...  
Keyword(s):  
Cerebrospinal Fluid Leak ◽  
Neurological Complications ◽  
Tumor Location ◽  
Cranial Base ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Success Rates ◽  
Endoscopic Endonasal ◽  
Previously Treated Patients ◽  
Previously Treated

Abstract BACKGROUND: Gross total resection (GTR) of cranial base chordomas represents a surgical challenge because of the location, invasiveness, and tumor extension. In the past decade, the endoscopic endonasal approach (EEA) has been used with notable outcomes. OBJECTIVE: To present the endoscopic endonasal experience in the treatment of cranial base chordomas at our institution. METHODS: From April 2003 to March 2011, 60 patients underwent an EEA for primary (n = 35) or previously treated (n = 25) cranial base chordomas. We evaluated the degree of GTR and complications. We studied the factors that influenced outcomes and compared our surgical results in the early and late years of our experience. RESULTS: The overall rate of GTR of cranial base chordomas was 66.7% (82.9% in primary and 44% in previously treated patients). The most important limitations for GTR were tumor volume greater than 20 cm3 (P = .042), tumor location in the lower clivus with lateral extension (P = .022), and previously treated disease (P = .002). The learning curve had a significant impact on GTR, increasing the success rate to 88.9% (92.6% in primary patients and 63.6% in previously treated patients) during recent years (P < .0001). The most frequent complication was cerebrospinal fluid leak (20%) resulting in meningitis in 3.3%. Carotid injuries occurred in 2 patients without any resulting deficit. Neurological complications included new cranial neuropathies (6.7%) and long tract deficits (1.7%). There was no operative mortality in our series. CONCLUSION: For the treatment of cranial base chordomas, the EEA is a competitive alternative to transcranial approaches with minimal morbidity and high success rates of GTR when performed by experienced cranial base surgeons.

scholarly journals Endoscopic endonasal repair of sphenoid cerebrospinal fluid leak, review and institutional experience

2019 ◽  
Vol 5 (2) ◽  
pp. 241
Author(s):  
Isra Al-Jazeeri ◽  
Hassan Al-Jazeeri ◽  
Ali Al-Momen
Keyword(s):  
Demographic Data ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Uncommon Presentation ◽  
Pubmed Database ◽  
Intracranial Complications ◽  
Csf Leaks

<p class="abstract"><strong>Background:</strong> Rhinogenic CSF leaks are not an uncommon presentation. Considering the possibility of drastic intracranial complications if left untreated, makes the management of such cases of outmost importance. Most of the non-traumatic CSF leaks will need a surgical repair. And since the introduction of the endoscopic nasal surgeries, these repairs are done almost always through the endoscopic endonasal approach.</p><p class="abstract"><strong>Methods:</strong> Retrospective review of cases with endoscopic repair of sphenoid CSF leak, who presented to King Fahad Specialist Hospital in Dammam (KFSH-D), from November 2003 to December 2017. And the U.S. National Library of Medicine (Pubmed) database was searched for “Sphenoid CSF Leak”.  </p><p class="abstract"><strong>Results:</strong> We had a total of 12 cases. The demographic data, diagnostic investigations and operative data were retrieved and reviewed.</p><p class="abstract"><strong>Conclusions:</strong> We advise using high resolution CT and intra-operative fluroscein for a reliable localization. And we found no complications with use of correct concentration of fluroscein. Endoscopic endonasal approach for repair of sphenoid CSF leak was found to be both effective and safe.</p>

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