Download PDF
J Neurol Surg B Skull Base 2021; 82(S 03): e172-e178
DOI: 10.1055/s-0040-1702218
Original Article

Endoscope-Assisted Middle Fossa Approach: Optimizing the Surgical Corridor for the Resection of Multicompartmental Chordomas

André Beer-Furlan 
1   São Paulo Skull Base Center, São Paulo, Brazil
2   DFVneuro Neurosurgical Group, São Paulo, Brazil
3   Department of Neurological Surgery, Rush University, Chicago, United States
,
Eduardo de Arnaldo Silva Vellutini
1   São Paulo Skull Base Center, São Paulo, Brazil
2   DFVneuro Neurosurgical Group, São Paulo, Brazil
,
Leonardo Balsalobre
1   São Paulo Skull Base Center, São Paulo, Brazil
4   Department of Otolaryngology, São Paulo ENT Center, Hospital Professor Edmundo Vasconcelos, São Paulo, Brazil
,
Aldo Cassol Stamm
1   São Paulo Skull Base Center, São Paulo, Brazil
4   Department of Otolaryngology, São Paulo ENT Center, Hospital Professor Edmundo Vasconcelos, São Paulo, Brazil
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Background Skull base chordomas are a major therapeutic challenge. The surgical management involves selecting an approach that will offer the patient the best chance of largest/complete removal while minimizing morbidity and mortality.

Methods Medical records and imaging review of two skull base chordomas involving the middle fossa and posterior fossa that were successfully treated with an endoscope-assisted middle fossa approach.

Results The use of angled endoscopes provided better identification of anatomical landmarks and improved tumor resection when compared with the microscopic surgical exposure. The approach selection, anatomical landmarks, and technical aspects of the intraoperative setting of the endoscope-assisted approach are discussed.

Conclusion Endoscopic assistance in the middle fossa approach is a safe and valuable tool for maximizing the reach of the surgical corridor when treating skull base chordomas.

Keywords

endoscope-assisted approach - transcranial endoscopy - middle fossa - subtemporal - chordoma - skull base chordoma


Publication History

Received: 25 September 2019

Accepted: 10 January 2020

Article published online:
06 March 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Mitchell A, Scheithauer BW, Unni KK, Forsyth PJ, Wold LE, McGivney DJ. Chordoma and chondroid neoplasms of the spheno-occiput. An immunohistochemical study of 41 cases with prognostic and nosologic implications. Cancer 1993; 72 (10) 2943-2949
    CrossrefPubMedGoogle Scholar
  • 2 Eriksson B, Gunterberg B, Kindblom LG. Chordoma. A clinicopathologic and prognostic study of a Swedish national series. Acta Orthop Scand 1981; 52 (01) 49-58
    CrossrefPubMedGoogle Scholar
  • 3 Sen C, Triana A. Cranial chordomas: results of radical excision. Neurosurg Focus 2001; 10 (03) E3
    PubMedGoogle Scholar
  • 4 Sen CN, Sekhar LN, Schramm VL, Janecka IP. Chordoma and chondrosarcoma of the cranial base: an 8-year experience. Neurosurgery 1989; 25 (06) 931-940
    CrossrefPubMedGoogle Scholar
  • 5 al-Mefty O, Borba LA. Skull base chordomas: a management challenge. J Neurosurg 1997; 86 (02) 182-189
    CrossrefPubMedGoogle Scholar
  • 6 Arnold H, Herrmann HD. Skull base chordoma with cavernous sinus involvement. Partial or radical tumour-removal?. Acta Neurochir (Wien) 1986; 83 (1,2): 31-37
    CrossrefPubMedGoogle Scholar
  • 7 Colli B, Al-Mefty O. Chordomas of the craniocervical junction: follow-up review and prognostic factors. J Neurosurg 2001; 95 (06) 933-943
    CrossrefPubMedGoogle Scholar
  • 8 Colli BO, Al-Mefty O. Chordomas of the skull base: follow-up review and prognostic factors. Neurosurg Focus 2001; 10 (03) E1
    CrossrefPubMedGoogle Scholar
  • 9 Mangussi-Gomes J, Beer-Furlan A, Balsalobre L, Vellutini EA, Stamm AC. Endoscopic endonasal management of skull base chordomas: surgical technique, nuances, and pitfalls. Otolaryngol Clin North Am 2016; 49 (01) 167-182
    CrossrefPubMedGoogle Scholar
  • 10 Chibbaro S, Cornelius JF, Froelich S. et al. Endoscopic endonasal approach in the management of skull base chordomas--clinical experience on a large series, technique, outcome, and pitfalls. Neurosurg Rev 2014; 37 (02) 217-224
    CrossrefPubMedGoogle Scholar
  • 11 Fernandez-Miranda JC, Gardner PA, Snyderman CH. et al. Clival chordomas: A pathological, surgical, and radiotherapeutic review. Head Neck 2014; 36 (06) 892-906
    CrossrefPubMedGoogle Scholar
  • 12 Jahangiri A, Jian B, Miller L, El-Sayed IH, Aghi MK. Skull base chordomas: clinical features, prognostic factors, and therapeutics. Neurosurg Clin N Am 2013; 24 (01) 79-88
    CrossrefPubMedGoogle Scholar
  • 13 Koutourousiou M, Gardner PA, Tormenti MJ. et al. Endoscopic endonasal approach for resection of cranial base chordomas: outcomes and learning curve. Neurosurgery 2012; 71 (03) 614-624
    CrossrefPubMedGoogle Scholar
  • 14 Saito K, Toda M, Tomita T, Ogawa K, Yoshida K. Surgical results of an endoscopic endonasal approach for clival chordomas. Acta Neurochir (Wien) 2012; 154 (05) 879-886
    CrossrefPubMedGoogle Scholar
  • 15 Koechlin NO, Simmen D, Briner HR, Reisch R. Combined transnasal and transcranial removal of a giant clival chordoma. J Neurol Surg Rep 2014; 75 (01) e98-e102
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Drazin D, Wang JM, Alonso F. et al. Intracranial anatomical triangles: a comprehensive illustrated review. Cureus 2017; 9 (10) e1741
    PubMedGoogle Scholar
  • 17 Hug EB, Loredo LN, Slater JD. et al. Proton radiation therapy for chordomas and chondrosarcomas of the skull base. J Neurosurg 1999; 91 (03) 432-439
    Google Scholar
  • 18 Gagliardi F, Boari N, Roberti F. et al. Extradural subtemporal transzygomatic approach to the clival and paraclival region with endoscopic assist. J Craniofac Surg 2012; 23 (05) 1468-1475
    CrossrefPubMedGoogle Scholar
  • 19 Kocaoğullar Y, Avci E, Fossett D, Caputy A. The extradural subtemporal keyhole approach to the sphenocavernous region: anatomic considerations. Minim Invasive Neurosurg 2003; 46 (02) 100-105
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Komatsu F, Komatsu M, Di Ieva A, Tschabitscher M. Endoscopic extradural subtemporal approach to lateral and central skull base: a cadaveric study. World Neurosurg 2013; 80 (05) 591-597
    CrossrefPubMedGoogle Scholar
  • 21 Perneczky A, Fries G. Endoscope-assisted brain surgery: part 1--evolution, basic concept, and current technique. Neurosurgery 1998; 42 (02) 219-224
    CrossrefPubMedGoogle Scholar
  • 22 Mourgela S, Sakellaropoulos A, Anagnostopoulou S. Middle cranial fossa endoscopy using a rigid endoscope. Minim Invasive Ther Allied Technol 2007; 16 (06) 355-359
    CrossrefPubMedGoogle Scholar
  • 23 Taniguchi M, Perneczky A. Subtemporal keyhole approach to the suprasellar and petroclival region: microanatomic considerations and clinical application. Neurosurgery 1997; 41 (03) 592-601
    PubMedGoogle Scholar
  • 24 Salma A, Wang S, Ammirati M. Extradural endoscope-assisted subtemporal posterior clinoidectomy: a cadaver investigation study. Neurosurgery 2010; 67 (3, Suppl Operative): ons43-ons48
    CrossrefPubMedGoogle Scholar
  • 25 Beer-Furlan A, Evins AI, Rigante L, Anichini G, Stieg PE, Bernardo A. Dual-Port 2D and 3D endoscopy: expanding the limits of the endonasal approaches to midline skull base lesions with lateral extension. J Neurol Surg B Skull Base 2014; 75 (03) 187-197
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Beer-Furlan A, Evins AI, Rigante L. et al. Endoscopic extradural anterior clinoidectomy and optic nerve decompression through a pterional port. J Clin Neurosci 2014; 21 (05) 836-840
    CrossrefPubMedGoogle Scholar
  • 27 Figueiredo EG, Beer-Furlan A, Nakaji P. et al. The role of endoscopic assistance in ambient cistern surgery: analysis of four surgical approaches. World Neurosurg 2015; 84 (06) 1907-1915
    CrossrefPubMedGoogle Scholar
  • 28 de Divitiis O, Cavallo LM, Dal Fabbro M, Elefante A, Cappabianca P. Freehand dynamic endoscopic resection of an epidermoid tumor of the cerebellopontine angle: technical case report. Neurosurgery 2007; 61 (5, Suppl 2): E239-E240
    CrossrefPubMedGoogle Scholar
  • 29 Tuchman A, Platt A, Winer J, Pham M, Giannotta S, Zada G. Endoscopic-assisted resection of intracranial epidermoid tumors. World Neurosurg 2014; 82 (3,4): 450-454
    CrossrefPubMedGoogle Scholar
  • 30 Zhang J, Hua W, Zhang X. et al. Pure endoscopic surgery via subtemporal extradural keyhole approach for middle cranial fossa tumors. World Neurosurg 2019; 130: e487-e497
    CrossrefPubMedGoogle Scholar
  • 31 Master AN, Roberts DS, Wilkinson EP, Slattery WH, Lekovic GP. Endoscope-assisted middle fossa craniotomy for resection of inferior vestibular nerve schwannoma extending lateral to transverse crest. Neurosurg Focus 2018; 44 (03) E7
    CrossrefPubMedGoogle Scholar
  • 32 Montaser AS, Todeschini AB, Harris MS, Adunka OF, Prevedello DM. Role of endoscopy in resection of intracanalicular vestibular schwannoma via middle fossa approach: technical nuances. World Neurosurg 2018; 120: 395-399
    CrossrefPubMedGoogle Scholar