Search

A 14-year-old boy had undergone an orbitozygomatic craniotomy for a pontine lesion. There was growth on surveillance imaging with involvement of posterior clinoids, clivus, and left pons suggestive of chordoma (Fernandez-Miranda et al., 2014b). An endoscopic endonasal approach was undertaken involving full upper and midclival exposure including bilateral posterior clinoidectomy (Fernandez-Miranda et al., 2014a; Truong et al., 2019a, 2019b). The internal carotid artery was skeletonized to maximize exposure and facilitate safe resection. The tumor was removed from between the dural layers of the midclivus while preserving the interdural abducens nerve (Barges-Coll et al., 2010). The brainstem component was resected while preserving the pontine perforators. Postoperative diagnosis was chordoma with MRI demonstrating complete resection. The patient was intact postoperatively. The video can be found here: https://youtu.be/g6SQ5JVK0Ko.

Background Sinonasal debridement is typically performed in the weeks following endonasal skull base surgery (ESBS). In the pediatric population, this second-look procedure may require general anesthesia; however, there is currently little evidence assessing the benefit of this practice. Methods This was a multicenter retrospective study of pediatric patients (age <18 years) undergoing a planned second-look debridement under general anesthesia following ESBS. Intraoperative findings, interventions performed, and perioperative complications were reviewed. Multivariate regression analysis was performed to identify associations between intraoperative findings and clinical factors. Results We reviewed 69 cases of second-look debridements (age mean 8.6 ± 4.2 years, range: 2–18 years), occurring a mean of 18.3 ± 10.3 days following ESBS. All abnormal findings were noted in patients age ≤12 years. Synechiae were noted in 8.7% of cases, bacterial rhinosinusitis in 2.9%, and failed reconstruction with cerebrospinal fluid leak in 4.5% (two cases of flap malposition and one case of flap necrosis). All failed reconstructions were noted following expanded endonasal cases for craniopharyngioma, and in each case, a revision reconstruction was performed during the second-look surgery. Synechiae were not significantly associated with younger age, revision cases, or cases with reconstructive flaps. There were no perioperative complications. Conclusion Second-look debridement under general anesthesia may be useful in the identification and intervention of sinonasal pathology following endoscopic skull base surgery, particularly in children ≤12 years old or those with pedicled flap reconstructions. Larger controlled studies are warranted to validate this practice and refine indications and timing of this second procedure. [ABSTRACT FROM AUTHOR]

This article, published in the Journal of Neurological Surgery, discusses a case presentation of a 2-year-old boy with a tubero-infundibular craniopharyngioma. The boy had a history of previous surgeries and developed visual abnormalities due to the growth of the tumor. The authors used an endoscopic endonasal transplanum approach to completely remove the tumor, resulting in improvement of visual symptoms. However, the patient did develop diabetes insipidus postoperatively. The article provides valuable insights into the treatment of pediatric patients with craniopharyngioma. [Extracted from the article]

This article, titled "Cavernous Sinus Exenteration for Invasive Mucormycosis," discusses a case study of a 61-year-old woman with HIV and diabetes mellitus who experienced vision loss due to invasive rhino-orbito-cerebral mucormycosis. Despite initial surgery and antifungal therapy, the disease progressed into the cavernous sinus and trigeminal nerve branches. The authors performed a STA-to-MCA bypass and a middle fossa approach for cavernous sinus exenteration, which successfully controlled the disease. The article highlights the technical aspects of cavernous sinus exenteration. [Extracted from the article]

This article discusses the surgical anatomy of the transmastoid transcervical intradural approach to the jugular foramen, which is a challenging area for skull base surgeons due to the presence of critical structures. The approach is versatile and allows for modifications to tailor it to specific tumors. The article provides a detailed description of the surgical steps and relevant anatomy, including variations such as vertebral artery transposition and facial nerve rerouting. The transmastoid transcervical intradural approach provides excellent exposure to the jugular foramen and surrounding areas, but precise knowledge of the anatomy is crucial due to the complex relationships of vital structures in this region. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, explores the pterygoid-sphenoidal fissure (PSF) as a key landmark for accessing the foramen lacerum in pediatric endoscopic endonasal surgery. The study evaluates the morphometry and developmental variations of the PSF in a general pediatric population using computed tomography scans. The results show that the length, width, and morphology of the PSF vary significantly across different age groups. Understanding these radiological findings is important for preoperative planning and intraoperative guidance in pediatric endoscopic endonasal surgery. [Extracted from the article]

This article discusses seven different techniques for pituitary transposition in endoscopic endonasal surgery. The techniques are categorized based on their relationship with the dura mater and include extradural, hybrid extradural/intradural, interdural transcavernous, extended interdural transcavernous, intradural hemitransposition, intradural, and pituitary sacrifice. The article evaluates the clinical application and selection of these techniques in different anatomical regions and types of pathology. The authors emphasize the importance of selecting the most appropriate technique based on the specific case and preoperative pituitary function for successful surgical outcomes. [Extracted from the article]

This article discusses the surgical technique of endoscopic endonasal pituitary sacrifice (EE-PS) for selected complex tumors with retrochiasmatic and retroclival extension. The study describes the relevant surgical anatomy and step-by-step operative technique of EE-PS. The authors also report their clinical experience with 13 patients who underwent EE-PS, including their indications, outcomes, and complications. The article concludes that EE-PS is a feasible surgical option to improve visibility and accessibility to the retroclival and retrochiasmatic space, thus increasing tumor resectability. [Extracted from the article]

This article discusses the outcomes of endoscopic endonasal transcavernous surgery for pituitary adenomas. The study analyzed data from patients who underwent this surgery between 2018 and 2023. The results showed that transcavernous surgery was more common in repeat surgery patients and those with functioning adenomas. The study also examined the invasion patterns of the cavernous sinus compartments and found that the medial wall was the most frequently involved. The authors concluded that the outcomes of transcavernous surgery can vary depending on the specific compartments involved. [Extracted from the article]

This article discusses the issue of unplanned hospital readmissions following trans-sphenoidal surgery for Cushing's disease. The study analyzed data from a multi-institutional database of patients who underwent this surgery between 2003 and 2023. The results showed that 10.3% of patients experienced unplanned readmissions, with the most common reasons being hyponatremia, CSF leak evaluation, headache/nausea, and epistaxis. The study also found that an increased number of chronic medical conditions and the need for a return to surgery were associated with a higher chance of unplanned readmission. The authors suggest strategies to mitigate these readmissions, such as fluid restriction and optimizing chronic medical conditions. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, explores the microsurgical anatomy of the "true" petrous apex and the feasibility of accessing it through the endoscopic endonasal approach. The study conducted detailed dissections of post-mortem human specimens and identified key anatomical landmarks and neurovascular structures. The authors found that the endoscopic endonasal petrosectomy approach provides access to the "true" petrous apex, with two variants based on its relationship with the internal carotid artery. The study concludes that this approach is an effective surgical alternative for accessing lesions in this region. [Extracted from the article]

This article, published in the Journal of Neurological Surgery, examines the use of indocyanine green (ICG) fluorescence angiography to evaluate the impact of surgical and patient factors on the vascular perfusion of nasoseptal flaps (NSFs) in endoscopic skull base surgery (ESBS). The study found that tobacco smokers had lower baseline fluorescence intensity compared to nonsmokers, and patients who underwent a transpterygoid approach had a greater decrease in fluorescence intensity following reconstruction. Other factors, such as revision case, timing of flap harvest, and concurrent septoplasty, did not significantly influence fluorescence intensity. The article concludes that tobacco use and transpterygoid approaches may be associated with decreased vascular perfusion of NSFs. [Extracted from the article]

The article discusses the extreme lateral supracerebellar infratentorial and transtentorial (ELSIT) approach for accessing lesions in the ambient cistern, a challenging area due to its deep location and vital neurovascular structures. The study conducted a systematic dissection on post-mortem human specimens to investigate the anatomical landmarks and measurements of this approach. The ELSIT approach provides a narrow corridor leading to the ambient cistern, with specific landmarks such as the superior petrous vein and posterior root of the trigeminal nerve. Understanding these anatomical nuances is crucial for optimizing surgical outcomes and minimizing complications. [Extracted from the article]

Objectives Pituitary tumor treatment is hampered by the relative rarity of the disease, absence of a multicenter collaborative platform, and limited translational–clinical research partnerships. Prior studies offer limited insight into the formation of a multicenter consortium. Design The authors describe the establishment of a multicenter research initiative, Registry of Adenomas of the Pituitary and Related Disorders (RAPID), to encourage quality improvement and research, promote scholarship, and apply innovative solutions in outcomes research. Methods The challenges encountered during the formation of other research registries were reviewed with those lessons applied to the development of RAPID. Setting/Participants RAPID was formed by 11 academic U.S. pituitary centers. Results A Steering Committee, bylaws, data coordination center, and leadership team have been established. Clinical modules with standardized data fields for nonfunctioning adenoma, prolactinoma, acromegaly, Cushing's disease, craniopharyngioma, and Rathke's cleft cyst were created using a Health Insurance Portability and Accountability Act-compliant cloud-based platform. Currently, RAPID has received institutional review board approval at all centers, compiled retrospective data and agreements from most centers, and begun prospective data collection at one site. Existing institutional databases are being mapped to one central repository. Conclusion The RAPID consortium has laid the foundation for a multicenter collaboration to facilitate pituitary tumor and surgical research. We sought to share our experiences so that other groups also contemplating this approach may benefit. Future studies may include outcomes benchmarking, clinically annotated biobank tissue, multicenter outcomes studies, prospective intervention studies, translational research, and health economics studies focused on value-based care questions. [ABSTRACT FROM AUTHOR]