Neuronavigation using an image-guided endoscopic transnasal-sphenoethmoidal approach to clival chordomas.
ABSTRACT Surgical approaches described for resection of clival tumors have been complicated, extensive, traumatic, and invasive. They are also associated with significant mortality and morbidity rates. We describe a minimally invasive, endoscopic transsphenoidal surgical treatment for clival tumors.
Three men, aged 43, 46, and 66 years, each presented with a history of headaches, diplopia, and multiple cranial nerve deficits. All preoperative magnetic resonance imaging scans showed large clival tumors. A neuronavigational image-guided endoscopic transnasal-sphenoethmoidal approach was performed to resect the clival tumors.
All three patients had near-total removal of clival tumors using this method, and the histology revealed chordomas. They underwent postoperative adjuvant radiotherapy. No complications were encountered. All patients were able to resume their usual activities on the same day after surgery. Furthermore, this technique greatly reduced patient discomfort, hastened recovery, and shortened the hospital stay.
The neuronavigation image-guided transsphenoidal approach is a viable, minimally invasive alternative for surgical treatment of clival tumors.
- Journal of Hepatology - J HEPATOL. 01/2011; 54.
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ABSTRACT: Over the last decade, endoscopic intraventricular and skull base operations have become widely used for a variety of evolving indications. The authors performed a global survey of practicing endoscopic neurosurgeons to characterize patters of usage regarding endoscopy equipment, instrumentation, and the indications for using image-guided surgery systems (IGSS). An online survey consisting of 8 questions was completed by 235 neurosurgeons with endoscopic surgical experience. Responses were entered into a database and subsequently analyzed. The median number of operations performed per year by intraventricular and skull base endoscopic surgeons was 27 and 25, respectively. Data regarding endoscopic equipment brand, diameter, and length are presented. The most commonly reported indications for IGSS during intraventricular endoscopic surgery were: tumor biopsy/resection, intraventricular cyst fenestration, septostomy/pellucidotomy, endoscopic third ventriculostomy (ETV), and aqueductal stent placement. Intraventricular surgeons reported using IGSS for all cases in 16.6% and never in 24.4%. Overall, endoscopic skull base surgeons reported using IGSS for all cases in 23.9% and never in 18.9%. The most commonly reported indications for IGSS during endoscopic skull base operations were: complex sinus/skull base anatomy, extended approaches, and reoperation. Many variations and permutations for performing intraventricular and skull base endoscopic surgery exist worldwide. Much can be learned by studying the patterns and indications for using various types of equipment and operative adjuncts such as IGSS.World Neurosurgery 07/2013; · 2.42 Impact Factor
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ABSTRACT: Objectives To present a critical evaluation of our experience using an expanded endoscopic endonasal approach (EEEA) to clival lesions and evaluate, based on the location of residual tumor, what the anatomic limitations to the approach are. Design A retrospective review of all endoscopic endonasal operations performed at our institution identified 19 patients with lesions involving the clivus. Extent of resection was determined by preoperative and postoperative tumor volumes. Results Three patients underwent planned subtotal resections. Of the remaining patients, gross total resection was achieved in 8/16 (50%), > 95% in 5/16 (31%), and < 95% in 3/16 (19%). Residual tumor occurred, most commonly with extension posterior and lateral to the internal carotid artery, with inferior, lateral invasion of the occipital condyle and with deep inferior extension to the midportion of the dens. Conclusions The EEEA represents a safe and effective technique for the resection of clival lesions. Despite excellent overall visualization of this region we found that adequate exposure of the most lateral and inferior portions of large tumors is often difficult. Knowledge of these limitations allows us to determine which tumors are best suited for an EEEA and which may be more appropriate for an open skull base or combined technique.Journal of neurological surgery. Part B, Skull base. 08/2013; 74(4):217-24.