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.
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ABSTRACT: Object Endoscopic transsphenoidal surgery is expanding in acceptance, yet postoperative CSF leak rates remain a concern. This study presents the Cornell closure protocol, which has yielded significantly lower postoperative CSF leak rates compared with prior reports, as an algorithm that can be used by centers having difficulty with CSF leak. Methods A single closure algorithm for endoscopic surgery has been used since January 2010 at Weill Cornell Medical College. A prospective database noting intraoperative CSF leak, closure technique, and postoperative CSF leak was reviewed. The authors used a MEDLINE search to identify similar studies and compared CSF leak rates to those of patients treated using the Cornell algorithm. Results The retrospective study of a prospectively acquired database included 209 consecutive patients. In 84 patients (40%) there was no intraoperative CSF leak and no postoperative CSF leak. In the 125 patients (60%) with an intraoperative CSF leak, 35 of them with high-flow leaks, there were 0 (0%) postoperative CSF leaks. Conclusions It is possible to achieve a CSF leak rate of 0% by using this closure protocol. With proper experience, endoscopic skull base surgery should not be considered to have a higher CSF leak rate than open transcranial or microscopic transsphenoidal surgery.Journal of Neurosurgery 05/2013; · 3.15 Impact Factor
- World Neurosurgery 11/2012; · 1.77 Impact Factor
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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; · 1.77 Impact Factor