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Skull Base 2011; 21(1): 013-022
DOI: 10.1055/s-0030-1261265
ORIGINAL ARTICLE

© Thieme Medical Publishers

Endoscopic Transcranial and Intracranial Resection: Case Series and Design of a Perioperative Management Protocol

Evan R. Ransom1 , John Lee1 , 3 , John Y.K Lee2 , James N. Palmer1 , Alexander G. Chiu1
  • 1Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
  • 2Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
  • 3Department of Otolaryngology, Head and Neck Surgery, St. Michael's Hospital, University of Toronto Hospital System, Toronto, Ontario, Canada
Further Information

Publication History

Publication Date:
21 June 2010 (online)

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ABSTRACT

Purely endoscopic resections of transcranial/intracranial pathology represent an exciting minimally invasive option for some patients. There is an abundance of literature on surgical techniques, though very little deals with perioperative management, which is critical for good outcomes. We present a detailed case review and a perioperative management protocol with specific reference to skull base and neuroanatomy. We performed a retrospective chart review and analysis of outcomes and complications by approach and design and prospective employment of a perioperative management protocol in a major tertiary care referral hospital. We included patients undergoing endoscopic skull base approaches by the two senior surgeons from September 2005 to April 2009, selecting of transcranial/intracranial cases for detailed review. Our main outcome measures included perioperative morbidity, mortality, and complications; degree of resection; recurrence rate; and survival. Fifteen patients met study criteria. No perioperative mortality occurred. There were two major and four minor complications. Mean follow-up was 15 months; 11/13 patients with malignancies had no evidence of disease. A perioperative management protocol was designed from these data and has resulted in decreased lumbar drainage and increased fluid/electrolyte monitoring. Endoscopic transcranial/intracranial anterior skull base surgery is both safe and effective when a complete understanding of the surgery and perioperative management is achieved.

KEYWORDS

Extended endonasal approach - endoscopic - anterior skull base - skull base neoplasm

REFERENCES

  • 1 Poetker D M, Toohill R J, Loehrl T A, Smith T L. Endoscopic management of sinonasal tumors: a preliminary report.  Am J Rhinol. 2005;  19 307-315
    PubMedGoogle Scholar
  • 2 Stankiewicz J A, Girgis S J. Endoscopic surgical treatment of nasal and paranasal sinus inverted papilloma.  Otolaryngol Head Neck Surg. 1993;  109 988-995
    PubMedGoogle Scholar
  • 3 Tomenzoli D, Castelnuovo P, Pagella F et al.. Different endoscopic surgical strategies in the management of inverted papilloma of the sinonasal tract: experience with 47 patients.  Laryngoscope. 2004;  114 193-200
    CrossrefPubMedGoogle Scholar
  • 4 Waitz G, Wigand M E. Results of endoscopic sinus surgery for the treatment of inverted papillomas.  Laryngoscope. 1992;  102 917-922
    CrossrefPubMedGoogle Scholar
  • 5 Chen M K. Minimally invasive endoscopic resection of sinonasal malignancies and skull base surgery.  Acta Otolaryngol. 2006;  126 981-986
    CrossrefPubMedGoogle Scholar
  • 6 Lund V, Howard D J, Wei W I. Endoscopic resection of malignant tumors of the nose and sinuses.  Am J Rhinol. 2007;  21 89-94
    CrossrefPubMedGoogle Scholar
  • 7 Podboj J, Smid L. Endoscopic surgery with curative intent for malignant tumors of the nose and paranasal sinuses.  Eur J Surg Oncol. 2007;  33 1081-1086
    CrossrefPubMedGoogle Scholar
  • 8 Snyderman C H, Carrau R L, Kassam A B et al.. Endoscopic skull base surgery: principles of endonasal oncological surgery.  J Surg Oncol. 2008;  97 658-664
    CrossrefPubMedGoogle Scholar
  • 9 Greene F L, Page D L, Fleming I D et al.. Nasal cavity and paranasal sinuses. In: American Joint Committee on Cancer. AJCC Cancer Staging Manual, 6th ed. New York: Springer-Verlag; 2000: 73-80
    Google Scholar
  • 10 Kadish S, Goodman M, Wang C C. Olfactory neuroblastoma. A clinical analysis of 17 cases.  Cancer. 1976;  37 1571-1576
    CrossrefPubMedGoogle Scholar
  • 11 Castelnuovo P, Pistochini A, Locatelli D. Different surgical approaches to the sellar region: focusing on the “two nostrils four hands technique”.  Rhinology. 2006;  44 2-7
    PubMedGoogle Scholar
  • 12 Hadad G, Bassagasteguy L, Carrau R L et al.. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap.  Laryngoscope. 2006;  116 1882-1886
    CrossrefPubMedGoogle Scholar
  • 13 de Divitiis E, Cavallo L M, Esposito F, Stella L, Messina A. Extended endoscopic transsphenoidal approach for tuberculum sellae meningiomas.  Neurosurgery. 2008;  62 (6) 1192-1201
    PubMedGoogle Scholar
  • 14 Gardner P A, Kassam A B, Thomas A et al.. Endoscopic endonasal resection of anterior cranial base meningiomas.  Neurosurgery. 2008;  63 36-52 discussion 52-54
    CrossrefPubMedGoogle Scholar
  • 15 Dehdashti A R, Ganna A, Witterick I, Gentili F. Expanded endoscopic endonasal approach for anterior cranial base and suprasellar lesions: indications and limitations.  Neurosurgery. 2009;  64 677-687 discussion 687-689
    CrossrefPubMedGoogle Scholar
  • 16 Frank G, Sciarretta V, Calbucci F, Farneti G, Mazzatenta D, Pasquini E. The endoscopic transnasal transsphenoidal approach for the treatment of cranial base chordomas and chondrosarcomas.  Neurosurgery. 2006;  59 (1) ONS50-ONS57 discussion ONS50-ONS57
    PubMedGoogle Scholar
  • 17 Laufer I, Anand V K, Schwartz T H. Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions.  J Neurosurg. 2007;  106 400-406
    CrossrefPubMedGoogle Scholar
  • 18 Taylor S L, Tyrrell J B, Wilson C B. Delayed onset of hyponatremia after transsphenoidal surgery for pituitary adenomas.  Neurosurgery. 1995;  37 649-653 discussion 653-654
    CrossrefPubMedGoogle Scholar
  • 19 Ganly I, Patel S G, Singh B et al.. Craniofacial resection for malignant melanoma of the skull base: report of an international collaborative study.  Arch Otolaryngol Head Neck Surg. 2006;  132 73-78
    CrossrefPubMedGoogle Scholar
  • 20 Righi P D, Francis F, Aron B S, Weitzner S, Wilson K M, Gluckman J. Sinonasal undifferentiated carcinoma: a 10-year experience.  Am J Otolaryngol. 1996;  17 167-171
    CrossrefPubMedGoogle Scholar
  • 21 Nicolai P, Battaglia P, Bignami M et al.. Endoscopic surgery for malignant tumors of the sinonasal tract and adjacent skull base: a 10-year experience.  Am J Rhinol. 2008;  22 308-316
    CrossrefPubMedGoogle Scholar
  • 22 Richardson M S. Pathology of skull base tumors.  Otolaryngol Clin North Am. 2001;  34 1025-1042, vii
    Google Scholar
  • 23 Ketcham A S, Wilkins R H, Vanburen J M, Smith R R. A combined intracranial facial approach to the paranasal sinuses.  Am J Surg. 1963;  106 698-703
    CrossrefPubMedGoogle Scholar
  • 24 Cantù G, Riccio S, Bimbi G et al.. Craniofacial resection for malignant tumours involving the anterior skull base.  Eur Arch Otorhinolaryngol. 2006;  263 647-652
    CrossrefPubMedGoogle Scholar
  • 25 Ganly I, Patel S G, Singh B et al.. Craniofacial resection for malignant paranasal sinus tumors: report of an International Collaborative Study.  Head Neck. 2005;  27 575-584
    CrossrefPubMedGoogle Scholar
  • 26 Howard D J, Lund V J, Wei W I. Craniofacial resection for tumors of the nasal cavity and paranasal sinuses: a 25-year experience.  Head Neck. 2006;  28 867-873
    CrossrefPubMedGoogle Scholar
  • 27 Ganly I, Patel S G, Singh B et al.. Complications of craniofacial resection for malignant tumors of the skull base: report of an International Collaborative Study.  Head Neck. 2005;  27 445-451
    CrossrefPubMedGoogle Scholar
  • 28 Sakashita T, Oridate N, Homma A et al.. Complications of skull base surgery: an analysis of 30 cases.  Skull Base Surg. 2009;  19 127-132
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Van Tuyl R, Gussack G S. Prognostic factors in craniofacial surgery.  Laryngoscope. 1991;  101 240-244
    PubMedGoogle Scholar
  • 30 Dave S P, Bared A, Casiano R R. Surgical outcomes and safety of transnasal endoscopic resection for anterior skull tumors.  Otolaryngol Head Neck Surg. 2007;  136 920-927
    CrossrefPubMedGoogle Scholar
  • 31 Devaiah A K, Andreoli M T. Treatment of esthesioneuroblastoma: a 16-year meta-analysis of 361 patients.  Laryngoscope. 2009;  119 1412-1416
    CrossrefPubMedGoogle Scholar
  • 32 Folbe A, Herzallah I, Duvvuri U et al.. Endoscopic endonasal resection of esthesioneuroblastoma: a multicenter study.  Am J Rhinol Allergy. 2009;  23 91-94
    CrossrefPubMedGoogle Scholar
  • 33 Unger F, Haselsberger K, Walch C, Stammberger H, Papaefthymiou G. Combined endoscopic surgery and radiosurgery as treatment modality for olfactory neuroblastoma (esthesioneuroblastoma).  Acta Neurochir (Wien). 2005;  147 595-601 discussion 601-602
    CrossrefPubMedGoogle Scholar
  • 34 Frank G, Pasquini E, Doglietto F et al.. The endoscopic extended transsphenoidal approach for craniopharyngiomas.  Neurosurgery. 2006;  59 (1) ONS75-ONS83 discussion ONS75-ONS83
    Google Scholar
  • 35 Fraser J F, Nyquist G G, Moore N, Anand V K, Schwartz T H. Endoscopic endonasal transclival resection of chordomas: operative technique, clinical outcome, and review of the literature.  J Neurosurg. 2010;  112 1061-1069
    CrossrefPubMedGoogle Scholar
  • 36 Solares C A, Fakhri S, Batra P S, Lee J, Lanza D C. Transnasal endoscopic resection of lesions of the clivus: a preliminary report.  Laryngoscope. 2005;  115 1917-1922
    CrossrefPubMedGoogle Scholar
  • 37 Stamm A C, Vellutini E, Harvey R J, Nogeira Jr J F, Herman D R. Endoscopic transnasal craniotomy and the resection of craniopharyngioma.  Laryngoscope. 2008;  118 1142-1148
    CrossrefPubMedGoogle Scholar
  • 38 Stippler M, Gardner P A, Snyderman C H, Carrau R L, Prevedello D M, Kassam A B. Endoscopic endonasal approach for clival chordomas.  Neurosurgery. 2009;  64 268-277 discussion 277-278
    CrossrefPubMedGoogle Scholar
  • 39 Fraser J F, Mass A Y, Brown S, Anand V K, Schwartz T H. Transnasal endoscopic resection of a cavernous sinus hemangioma: technical note and review of the literature.  Skull Base. 2008;  18 309-315
    Article in Thieme ConnectPubMedGoogle Scholar
  • 40 Kassam A B, Thomas A J, Zimmer L A et al.. Expanded endonasal approach: a fully endoscopic completely transnasal resection of a skull base arteriovenous malformation.  Childs Nerv Syst. 2007;  23 491-498
    CrossrefPubMedGoogle Scholar
  • 41 Kassam A B, Gardner P A, Mintz A, Snyderman C H, Carrau R L, Horowitz M. Endoscopic endonasal clipping of an unsecured superior hypophyseal artery aneurysm. Technical note.  J Neurosurg. 2007;  107 1047-1052
    CrossrefPubMedGoogle Scholar
  • 42 Zanation A M, Snyderman C H, Carrau R L, Gardner P A, Prevedello D M, Kassam A B. Endoscopic endonasal surgery for petrous apex lesions.  Laryngoscope. 2009;  119 19-25
    CrossrefPubMedGoogle Scholar

Alexander G ChiuM.D. 

Associate Professor, Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania

3400 Spruce Street, 5th Floor Silverstein Building, Philadelphia, PA 19103

Email: alexander.chiu@uphs.upenn.edu

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