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Endoscopic Endonasal Transethmoidal-Transsphenoidal Approach to a Cavernous Sinus Chondrosarcoma

Objective  We illustrate a cavernous sinus chondrosarcoma treated with an endoscopic endonasal transethmoidal-transsphenoidal approach. Design  Case report of a 15-year-old girl with diplopia and esotropia due to complete abducens palsy. Preoperative images showed a right cavernous sinus lesion with...

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Autores principales: Agresta, Gianluca, Campione, Alberto, Pozzi, Fabio, Veiceschi, Pierlorenzo, Venturini, Martina, Agosti, Edoardo, Balbi, Sergio, Battaglia, Paolo, Locatelli, Davide
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Georg Thieme Verlag KG 2021
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9440873/
https://www.ncbi.nlm.nih.gov/pubmed/36068905
http://dx.doi.org/10.1055/s-0041-1726018
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author Agresta, Gianluca
Campione, Alberto
Pozzi, Fabio
Veiceschi, Pierlorenzo
Venturini, Martina
Agosti, Edoardo
Balbi, Sergio
Battaglia, Paolo
Locatelli, Davide
author_facet Agresta, Gianluca
Campione, Alberto
Pozzi, Fabio
Veiceschi, Pierlorenzo
Venturini, Martina
Agosti, Edoardo
Balbi, Sergio
Battaglia, Paolo
Locatelli, Davide
author_sort Agresta, Gianluca
collection PubMed
description Objective  We illustrate a cavernous sinus chondrosarcoma treated with an endoscopic endonasal transethmoidal-transsphenoidal approach. Design  Case report of a 15-year-old girl with diplopia and esotropia due to complete abducens palsy. Preoperative images showed a right cavernous sinus lesion with multiple enhanced septa and intralesional calcified spots ( Fig. 1 ). Considering tumor location and the lateral dislocation of the carotid artery, an endoscopic endonasal approach was performed to relieve symptoms and to optimize the target geometry for adjuvant conformal radiotherapy. Setting  The study was conducted at University of Insubria, Department of Neurosurgery, Varese, Italy. Participants  Skull base team was participated in the study. Main Outcome Measures  A transethmoidal-transsphenoidal approach was performed by using a four-hand technique. We used a route lateral to medial turbinate to access ethmoid and the sphenoid sinus. During the sphenoid phase, we exposed the medial wall of the cavernous sinus ( Fig. 2 ) and the lesion was then removed using curette. Skull base reconstruction was performed with fibrin glue and nasoseptal flap. Results  No complications occurred after surgery, and the patient experienced a complete recovery of symptoms. A postoperative magnetic resonance imaging showed a small residual tumor inside the cavernous sinus ( Fig. 1 ). After percutaneous proton-bean therapy, patient experienced only temporary low-grade toxicity with local control within 2 years after treatment completion. Conclusion  Endoscopic endonasal extended approach is a safe and well-tolerated procedure that is indicated in selected cases (intracavernous tumors, soft tumors not infiltrating the vessels and/or the nerves). A tailored approach according to tumor extension is crucial for the best access to the compartments involved. The link to the video can be found at: https://youtu.be/TsqXjqpuOws .
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spelling pubmed-94408732022-09-05 Endoscopic Endonasal Transethmoidal-Transsphenoidal Approach to a Cavernous Sinus Chondrosarcoma Agresta, Gianluca Campione, Alberto Pozzi, Fabio Veiceschi, Pierlorenzo Venturini, Martina Agosti, Edoardo Balbi, Sergio Battaglia, Paolo Locatelli, Davide J Neurol Surg B Skull Base Objective  We illustrate a cavernous sinus chondrosarcoma treated with an endoscopic endonasal transethmoidal-transsphenoidal approach. Design  Case report of a 15-year-old girl with diplopia and esotropia due to complete abducens palsy. Preoperative images showed a right cavernous sinus lesion with multiple enhanced septa and intralesional calcified spots ( Fig. 1 ). Considering tumor location and the lateral dislocation of the carotid artery, an endoscopic endonasal approach was performed to relieve symptoms and to optimize the target geometry for adjuvant conformal radiotherapy. Setting  The study was conducted at University of Insubria, Department of Neurosurgery, Varese, Italy. Participants  Skull base team was participated in the study. Main Outcome Measures  A transethmoidal-transsphenoidal approach was performed by using a four-hand technique. We used a route lateral to medial turbinate to access ethmoid and the sphenoid sinus. During the sphenoid phase, we exposed the medial wall of the cavernous sinus ( Fig. 2 ) and the lesion was then removed using curette. Skull base reconstruction was performed with fibrin glue and nasoseptal flap. Results  No complications occurred after surgery, and the patient experienced a complete recovery of symptoms. A postoperative magnetic resonance imaging showed a small residual tumor inside the cavernous sinus ( Fig. 1 ). After percutaneous proton-bean therapy, patient experienced only temporary low-grade toxicity with local control within 2 years after treatment completion. Conclusion  Endoscopic endonasal extended approach is a safe and well-tolerated procedure that is indicated in selected cases (intracavernous tumors, soft tumors not infiltrating the vessels and/or the nerves). A tailored approach according to tumor extension is crucial for the best access to the compartments involved. The link to the video can be found at: https://youtu.be/TsqXjqpuOws . Georg Thieme Verlag KG 2021-05-03 /pmc/articles/PMC9440873/ /pubmed/36068905 http://dx.doi.org/10.1055/s-0041-1726018 Text en The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ) 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 Agresta, Gianluca
Campione, Alberto
Pozzi, Fabio
Veiceschi, Pierlorenzo
Venturini, Martina
Agosti, Edoardo
Balbi, Sergio
Battaglia, Paolo
Locatelli, Davide
Endoscopic Endonasal Transethmoidal-Transsphenoidal Approach to a Cavernous Sinus Chondrosarcoma
title Endoscopic Endonasal Transethmoidal-Transsphenoidal Approach to a Cavernous Sinus Chondrosarcoma
title_full Endoscopic Endonasal Transethmoidal-Transsphenoidal Approach to a Cavernous Sinus Chondrosarcoma
title_fullStr Endoscopic Endonasal Transethmoidal-Transsphenoidal Approach to a Cavernous Sinus Chondrosarcoma
title_full_unstemmed Endoscopic Endonasal Transethmoidal-Transsphenoidal Approach to a Cavernous Sinus Chondrosarcoma
title_short Endoscopic Endonasal Transethmoidal-Transsphenoidal Approach to a Cavernous Sinus Chondrosarcoma
title_sort endoscopic endonasal transethmoidal-transsphenoidal approach to a cavernous sinus chondrosarcoma
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9440873/
https://www.ncbi.nlm.nih.gov/pubmed/36068905
http://dx.doi.org/10.1055/s-0041-1726018
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