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Extended Endoscopic Endonasal Approach for Craniopharyngioma Removal
Objective Endoscopic transsphenoidal extended endoscopic approach (EEA) represents a valid alternative to microsurgery for craniopharyngiomas removal, especially for retrochiasmatic lesions without large parasellar extension. The present video illustrates the salient surgical steps of the EEA for c...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Georg Thieme Verlag KG
2018
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5796831/ https://www.ncbi.nlm.nih.gov/pubmed/29404250 http://dx.doi.org/10.1055/s-0038-1623527 |
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author | Messerer, Mahmoud Maduri, Rodolfo Daniel, Roy Thomas |
author_facet | Messerer, Mahmoud Maduri, Rodolfo Daniel, Roy Thomas |
author_sort | Messerer, Mahmoud |
collection | PubMed |
description | Objective Endoscopic transsphenoidal extended endoscopic approach (EEA) represents a valid alternative to microsurgery for craniopharyngiomas removal, especially for retrochiasmatic lesions without large parasellar extension. The present video illustrates the salient surgical steps of the EEA for craniopahryngioma removal. Patient A 52-year-old man presented with a bitemporal hemianopia and a bilateral decreased visual acuity. MRI showed a Kassam type III cystic craniopharyngioma with a solid component ( Fig. 1 , panels A and B). Surgical Procedure The head is rotated 10 degrees toward the surgeons. The nasal step is started through the left nostril with a middle turbinectomy. A nasoseptal flap is harvested and positioned in the left choana. The binostril approach allows a large sphenoidotomy to expose the key anatomic landmarks. The craniotomy boundaries are the planum sphenoidale superiorly, the median opticocarotid recesses, the internal carotid artery laterally and the clival recess inferiorly. After dural opening and superior intercavernous sinus coagulation, the tumor is entirely removed ( Fig. 2 , panels A and B). Skull base reconstruction is ensured by fascia lata grafting and nasoseptal flap positioning. Results Postoperative MRI showed the complete tumor resection ( Fig. 1 , panels C and D). At 3 months postoperatively, the bitemporal hemianopia regressed and the visual acuity improved. A novel left homonymous hemianopia developed secondary to optic tract manipulation. Conclusions The extended EEA is a valid surgical approach for craniopharyngioma resection. A comprehensive knowledge of the sellar and parasellar anatomy is mandatory for safe tumor removal with decreased morbidity and satisfactory oncologic results. The link to the video can be found at: https://youtu.be/NrCPPnVK2qA . |
format | Online Article Text |
id | pubmed-5796831 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Georg Thieme Verlag KG |
record_format | MEDLINE/PubMed |
spelling | pubmed-57968312019-02-01 Extended Endoscopic Endonasal Approach for Craniopharyngioma Removal Messerer, Mahmoud Maduri, Rodolfo Daniel, Roy Thomas J Neurol Surg B Skull Base Objective Endoscopic transsphenoidal extended endoscopic approach (EEA) represents a valid alternative to microsurgery for craniopharyngiomas removal, especially for retrochiasmatic lesions without large parasellar extension. The present video illustrates the salient surgical steps of the EEA for craniopahryngioma removal. Patient A 52-year-old man presented with a bitemporal hemianopia and a bilateral decreased visual acuity. MRI showed a Kassam type III cystic craniopharyngioma with a solid component ( Fig. 1 , panels A and B). Surgical Procedure The head is rotated 10 degrees toward the surgeons. The nasal step is started through the left nostril with a middle turbinectomy. A nasoseptal flap is harvested and positioned in the left choana. The binostril approach allows a large sphenoidotomy to expose the key anatomic landmarks. The craniotomy boundaries are the planum sphenoidale superiorly, the median opticocarotid recesses, the internal carotid artery laterally and the clival recess inferiorly. After dural opening and superior intercavernous sinus coagulation, the tumor is entirely removed ( Fig. 2 , panels A and B). Skull base reconstruction is ensured by fascia lata grafting and nasoseptal flap positioning. Results Postoperative MRI showed the complete tumor resection ( Fig. 1 , panels C and D). At 3 months postoperatively, the bitemporal hemianopia regressed and the visual acuity improved. A novel left homonymous hemianopia developed secondary to optic tract manipulation. Conclusions The extended EEA is a valid surgical approach for craniopharyngioma resection. A comprehensive knowledge of the sellar and parasellar anatomy is mandatory for safe tumor removal with decreased morbidity and satisfactory oncologic results. The link to the video can be found at: https://youtu.be/NrCPPnVK2qA . Georg Thieme Verlag KG 2018-02 2018-01-16 /pmc/articles/PMC5796831/ /pubmed/29404250 http://dx.doi.org/10.1055/s-0038-1623527 Text en https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited. |
spellingShingle | Messerer, Mahmoud Maduri, Rodolfo Daniel, Roy Thomas Extended Endoscopic Endonasal Approach for Craniopharyngioma Removal |
title | Extended Endoscopic Endonasal Approach for Craniopharyngioma Removal |
title_full | Extended Endoscopic Endonasal Approach for Craniopharyngioma Removal |
title_fullStr | Extended Endoscopic Endonasal Approach for Craniopharyngioma Removal |
title_full_unstemmed | Extended Endoscopic Endonasal Approach for Craniopharyngioma Removal |
title_short | Extended Endoscopic Endonasal Approach for Craniopharyngioma Removal |
title_sort | extended endoscopic endonasal approach for craniopharyngioma removal |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5796831/ https://www.ncbi.nlm.nih.gov/pubmed/29404250 http://dx.doi.org/10.1055/s-0038-1623527 |
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