The surgery begins with a widening of the nasal passage, in order to permit access to the anterior wall of the sphenoid sinus. Apr 01, 2004 this is an excellent historical perspective worth reading. The surgical approach to lesions involving the inferior petrous apex ipa is still challenging. Endoscopic endonasal approach to foramen magnum meningioma. Gardner, md, explains pituitary adenoma tumors and the experience his multidisciplinary team has in treating the tumor with the endoscopic endonasal approach. Endoscopic endonasal transposition of the pituitary gland and its stalk can provide a valuable corridor to the retroinfundibular space and interpeduncular cistern with pituitary function preservation in the majority of patients. Recently the endoscopic endonasal approach to the skull base has been introduced to access the midline skull base. Endonasal endoscopic approach to orbit jaiswal ak neurol india. The endoscopic endonasal transsphenoidal approach to pituitary tumors is a safe and minimally invasive procedure, which can be employed safely in any of our centers in nepal, equipped with endoscopic sinus surgery and endoscopically trained ent and neurosurgeons. The purpose of this study is to demonstrate the anatomical features of the ipa and to assess the applicability of an endoscopic endonasal approach through the foramen lacerum translacerum approach to the ipa. The endoscopic endonasal approach to the hypoglossal canal. Between 1998 and 2017, 12 pediatric craniopharyngiomas were treated via eea at our institution. Transsphenoidal approach in endoscopic endonasal surgery for. They believed that by following these recommendations neurosurgeons can overcome, or even avoid, the difficulties frequently encountered transsphenoidal surgery, allowing them to safely and efficiently perform endonasal transsphenoidal endoscopic procedures.
Mar 30, 2018 one of these options is the endoscopic endonasal approach eea, a technique that allows doctors to remove even very large tumors and lesions through a patients nose. The transsphenoidal route is the surgical approach of choice for most sellar tumors because of the relationship of the sphenoid bone to the nasal cavity below and. Surgical anatomy for the endoscopic endonasal approach to the. Hukm experience discussion pituitary adenomas represent 1012%of all intracranial tumours. The modern endoscopic endonasal approach to the frontal sinus allows the marsupialization of the pathology in all those cases in which the mucocele is reached via the route of nasal drainage and is optimal when the location of the mucocele is medial. Pdf the endoscopic endonasal approach to the lateral recess. The role of endoscopic endonasal approach to pituitary tumours. Anatomy and surgery of the endoscopic endonasal approach to the. Cureus endoscopic endonasal approach for transclival. In patients with large dural defects of the anterior and ventral skull base after endonasal skull base surgery, there is a significant risk of a postoperative cerebrospinal fluid leak after reconstruction.
The endoscopic endonasal approach is an innovative surgical technique used to remove brain tumors and lesionssome as large as softballsall through the nose. Endonasal endoscopic surgery for pediatric anterior. Endoscopic endonasal surgery is a minimally invasive technique used mainly in neurosurgery and otolaryngology. Endoscopic endonasal approach orange county, ca robert. Transsphenoidal approach in endoscopic endonasal surgery. Endoscopic techniques and instruments can be used to safely and effectively approach and resect tumors of the pituitary gland in humans 25, 26. A retrospective clinical outcome study of endoscopic petrous apex surgeries was performed at the university of pittsburgh medical center.
An endonasal approach offers a potential space surgeons can utilise to access the orbit, possibly providing additional exposure, illumination and magnification to the medial and apical aspects of selected. Research article open access clinical study of endoscopic. Role of the superior turbinate when performing endoscopic. The endoscopic endonasal pituitary tumor removal code 62165 is intended only for resection of pituitary tumors via this approach. Endoscopic endonasal approach to the ventral brainstem. Endoscopic endonasal surgery for petrous apex lesions. The major potential advantage of the endoscopic endonasal technique is to provide a direct anatomical route to the lesion since it does not traverse any major neurovascular structures, thereby obviating brain retraction. An appropriate, lessinvasive approach should be applied depending on the size, location, and type of lesion. The standard endoscopic endonasal transsphenoidal approach to the sella is suitable for the removal of pituitary tumors, both microadenomas and macroadenomas, and the indications are the same as. We are thinking about starting an endoscopic skull base surgery program and doing skull base procedures via an expanded endonasalendoscopic approach. The endoscopic endonasal approach to the lateral recess of the sphenoid sinus via the pterygopalatine fossa. Pdf anatomy and surgery of the endoscopic endonasal.
Endoscopic pituitary and skull base surgery karl storz. Endoscopic endonasal transclival approach to the jugular. Endoscopic endonasal transturbinate approach to the. Rathkes cleft cysts rccs are quite uncommon sellar lesions that can extend or even arise in the suprasellar area. Endoscopic endonasal approach in the management of rathkes. Results twentyeight cases of ica injury occurred during 7160 expanded endoscopic endonasal approach procedures incidence of 0. Furthermore it avoids some of the disadvantages related to the transoral approach, such as the need for mouth retractors and splitting of the soft palate. The endonasal endoscopic approach to the orbit is a promising technique for excising welldefined encapsulated, intraconal lesions, particularly chs, located predominantly in the medial and inferior part of the orbit and the orbital apex. Presently, there are no existing cpt codes that accurately describe endoscopic endonasal surgery also known as extended endonasal approach for removal of a skull base tumor. The endoscopic endonasal transclival approach has been widely described for its use to resect clivus chordomas, but there have only been isolated reports of its use for petroclival meningiomas. This technique has several advantages, such as minimal invasiveness, direct approach. In line with previous results, we found that endonasal endoscopic access to the mesencephalon necessitates opening the sella.
Despite their histological benign nature, the mass effect on. Despite their histological benign nature, the mass effect on the optic. Pickard jd, akalan n, di rocco c, dolenc vv, lobo antunes j, mooij jja, schramm j, sindou m eds advances and technical standards in neurosurgery. New frontiers in managing clival tumors the extended. The endoscopic endonasal approach eea permits a direct extradural route without brain retraction and shorter postoperative recovery. Pdf endoscopic endonasal transclival approach for resection. Outcomes in transcranial microsurgery versus extended endoscopic. Endoscopic endonasal transsphenoidal approach springerlink. The endoscopic endonasal approach for pediatric craniopharyngiomas. Pdf endoscopic endonasal transsphenoidal approach to. Endoscopic endonasal trans sphenoidal approach to the sellar. Such considerations give an idea of the extended endoscopic endonasal. Our multidisciplinary team of neurosurgeons, otolaryngologists, ophthalmic surgeons, and spine surgeons have developed and refined this technique, and are among the most experienced in the world. Endoscopic endonasal transsphenoidal surgery american.
With these advances, the need for more robust skull base reconstructive techniques was vital. The endoscopic endonasal transsphenoidal approach is actually widely recommended for sellar lesions, even in the case of cavernous sinus invasion or suprasellar extension. Endoscopic endonasal transplanum transtuberculum approach. They are histologically benign lesions originating in the adenohypophyseal cells.
Analysis of the petrous portion of the internal carotid. Endoscopic endonasal translacerum approach to the inferior. Endoscopic skull base surgery and reconstruction upmc. Endoscopic endonasal transsphenoidal approach request pdf. Predicting the limits of the endoscopic endonasal approach in children. It has distinctive advantages over the external approaches. Even within the confines of the pediatric nasal corridor, the endoscopic endonasal approach represents a viable option for appropriately selected tumors 29 and can be optimized by meticulous attention to the creation of an adequate nasal corridor, microsurgical tumor resection, and robust skull base reconstruction. Endoscopic endonasal approach in the management of rathke.
Endoscopic reconstruction with vascularized tissue is desirable to facilitate rapid healing, especially in irradiated patients. Anatomy and surgery of the endoscopic endonasal approach to. Endoscopic endonasal approach eea endoscopic endonasal skull base surgery has dramatically changed and expanded over recent years due to significant advancements in instrumentation, techniques, and anatomic understanding. A bimanual teleoperated system for endonasal skull base surgery. Most patients undergoing eea spend only 1 to 2 days in the hospital. Endoscopic endonasal brain surgery is a minimally invasive technique that is associated with reduced recovery times compared with traditional techniques such as craniotomy. To learn more, visit the upmc neurosurgery website. The endoscopic endonasal approach proved successful in the management of this case and it should be considered in the surgical management of extraconal orbital apex lesions with medial or inferior extension.
The anatomy and endonasal approach are depicted in fig. This is an excellent historical perspective worth reading. These complications include infections associated with large scalp incisions and the side effects seen with brain retraction. If the suprasellar extension is very important, a fully endoscopic twostaged procedure may be performed, while waiting for the natural descent of the residue 8. For all of these approaches, the sphenoid sinus is the starting point, and provides orientation to important vascular and neural structures. Upmc neurosurgeons have treated more than 2,000 patients using eea. Comparison of endoscopic and radiological landmarks. Endoscopic endonasal transplanum transtuberculum approach for retrochiasmatic craniopharyngiomas. Endoscopic endonasal approach is an innovative surgical technique that uses the nose and sinuses as a natural pathways to access and remove brain tumors and lesions in the critical areas of the base of the skull and upper spine.
The role of endoscopic endonasal approach to pituitary. Endoscopic endonasal removal of a cavernous hemangioma of. However, over the years, skull base surgery has evolved from standard open craniotomies to the use of microscopes and, more recently, to the development of endoscopic techniques. Endoscopic resection, hemangioma, minimally invasive, orbit, transethmoidal, transmaxillary, transphenoidal. Endonasal endoscopic approach with double layer surgical technique for defect closure was chosen as treatment. Schwartzthe endoscopic endonasal approach to repair of iatrogenic and noniatrogenic. With this article, the pittsburgh group adds to their already extensive contributions to the endonasal endoscopic skull base literature.
Internal carotid injury in expanded endoscopic endonasal. Pdf objectives access to the pterygopalatine fossa is very difficult due to its complex anatomy. Pterygopalatine fossa ppf is a difficulttoaccess anatomic area located behind the posterior wall of the maxillary sinus. Endonasal endoscopic surgery for pediatric anterior cranial fossa encephaloceles. The mean age of the patients was 49 years, with a female to male predominance ratio of 1. An endoscopic, endonasal approach was used to treat a variety of conditions of the anterior skull base arising in front of the sphenoid sinus and. The first cadaveric study conducted in 2002 showed the feasibility of the procedure 23 and since then endoscopy has not ceased to find other applications. These tumors are most often resected utilizing open transpetrosal approaches, but these operations, difficult even in the hands of dedicated skull base surgeons, are particularly challenging if the. One of these options is the endoscopic endonasal approach eea, a technique that allows doctors to remove even very large tumors and lesions through a patients nose. The surgical anatomy, feasibility, and limitations of the eea for intrinsic brainstem lesions are still poorly understood. A neurosurgeon or an otolaryngologist, using an endoscope that is entered through the nose, fixes or removes brain defects or tumors in the anterior skull base. Endoscopic surgery is the preferred procedure for this type of tumor. Dec 31, 2008 a retrospective clinical outcome study of endoscopic petrous apex surgeries was performed at the university of pittsburgh medical center. The use of the microscope popularized the transsphenoidal approach to the sellar region, which has eventually given way to the endoscope in conjunction with the use of endoscopic procedures in general by ear, nose, and throat surgeons, to replace the more invasive sinus surgery.
Demographic data, preoperative assessment, tumor features. The purpose of this study is to evaluate the effectiveness of both standard and extended endoscopic endonasal approaches in the management of different located rccs. Endoscopic endonasal approach to the ppf without endangering all other nasal structures is useful in the management of jna. The expanded endonasal approach allows access to skull base tumors without the complications often seen with open skull base surgery. Pdf endoscopic endonasal approach for removal of tuberculum.
The endoscopic endonasal transsphenoidal approach to pituitary tumors is a safe and minimally invasive procedure, which can be employed safely in any of our centers in nepal, equipped. Upmc center for cranial base surgery codirector paul a. Jan 18, 2012 the endoscopic endonasal approach provides the same advantages of direct route and minimal neurovascular manipulation offered by the transoral approach, but with a wider and closer view. Objective to describe the surgical planning, anatomy, and technique of an intrinsic pontine glioma operated via eea. International journal of pediatric otorhinolaryngology. Expanded endonasal approach eea aurora health care.
In this cadaveric study, an approach to the hypoglossal canal through a lateral extension of the inferior endoscopic endonasal transclival approach was described. Recently, with the development of endoscopic endonasal surgery, the enhanced exposure offered by extended endoscopic approaches has encouraged some authors to attempt resection of brainstem tumors, particularly pontine cavernous malformations, with satisfying results. This approach should only be pursued once significant experience with endoscopic endonasal approaches has been acquired. What radiologists and surgeons need to know1 in the last 2 decades, endoscopic endonasal transsphenoidal sur gery has become the most popular choice of neurosurgeons and otolaryngologists to treat lesions of the skull base, with minimal. Endoscopic endonasal transsphenoidal surgery springerlink. Endoscopic endonasal pituitary transposition for a. The endoscopic endonasal approach to the infratemporal fossa with exposure of the petrous ica afforded complete visualization of the entire segment of this portion of the ica with limited anatomical obstruction. Extended endoscopic endonasal approach to the midline skull. Specializes in endoscopic endonasal approach in orange county, southern california. If the suprasellar extension is very important, a fullyendoscopic twostaged procedure may be performed, while waiting for the natural descent of the residue 8. The aim of this study was to evaluate the effectiveness of the endoscopic endonasal transsphenoidal approach for the removal of recurrent and residual pituitary adenomas, already treated by a. A transcranial extradural approach to the middle cranial fossa mcf requires separation of the dural layers of the lateral wall of the cavernous sinus.
Pdf tuberculum sellae meningiomas are challenging lesions. Recently, the extended endoscopic endonasal approach is increasingly utilized in the management of midline skull base tumors. Background the endoscopic endonasal approach eea has been proposed as a potential alternative for ventral brainstem lesions. Endoscopic endonasal approach to the lateral wall of the. Demographic data, preoperative assessment, tumor features, surgical.
The endoscopic endonasal approach provides the same advantages of direct route and minimal neurovascular manipulation offered by the transoral approach, but with a wider and closer view. Endoscopic endonasal transplanum transtuberculum approach for. The endoscopic endonasal approach to the sellar region is an evolution of the conventional transsphenoidal technique performed with the operating microscope. The increased confidence in endoscopic techniques allowed a widespread application of the extended endoscopic approach to treat clival lesions. Combined endoscopic endonasal and transcranial approach. Operative nuances suresh k sankhla 1, narayan jayashankar 2, ghulam m khan 1 1 department of neurosurgery, nanavati super speciality hospital, vile parle, mumbai, maharashtra, india 2 department of ent, nanavati super speciality hospital, vile. The endoscopic anatomy of the nasal cavity, sphenoid sinus and the sellar region was studied in 30 fresh cadavers mean age 42. Transsphenoidal approach in endoscopic endonasal surgery for skull base lesions.
Pdf endoscopic endonasal approach for mass resection of the. The anterior perspective on the anatomy, limitations, and surgical feasibility of the endonasal endoscopic approach is still missing. The foramen rotundum, ovale, and spinosum were successfully identified and dissected with preservation of their neurovascular contents. The authors tested the feasibility of an endonasal approach for this separation. Endoscopic endonasal approach, pituitary tumor, saddle diaphragm, suprasellar region background pituitary adenoma is the most common tumor in the sellar region. Ive looked in the cpt book for codes and it looks like cpt 6158061619 are just what im looking for. The incidence of intracranial tumors ranks third, accounting for 10 to 15%, among all. Endoscopic endonasal transethmoidal transcribriform transfovea. Juvenile nasopharyngeal angiofibroma jna often affects this area, and the management of feeding artery to the tumor is important in the surgery.