44 results on '"Ditzel Filho, Leo F."'
Search Results
2. Optic Canal Decompression: Comparison of 2 Surgical Techniques
- Author
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Mesquita Filho, Paulo M., Prevedello, Daniel M., Prevedello, Luciano M., Ditzel Filho, Leo F., Fiore, Mariano E., Dolci, Ricardo L., Buohliqah, Lamia, Otto, Bradley A., and Carrau, Ricardo L.
- Published
- 2017
- Full Text
- View/download PDF
3. Endoscopic endonasal study of the cavernous sinus and quadrangular space: Anatomic relationships
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Dolci, Ricardo L. L., Upadhyay, Smita, Ditzel Filho, Leo F. S., Fiore, Mariano E., Buohliqah, Lamia, Lazarini, Paulo R., Prevedello, Daniel M., and Carrau, Ricardo L.
- Published
- 2016
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- View/download PDF
4. Perioperative Considerations: Planning, Intraoperative and Postoperative Management
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Ditzel Filho, Leo F. S., Prevedello, Daniel M., Patel, Mihir R., Otto, Bradley A., and Carrau, Ricardo L.
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- 2013
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- View/download PDF
5. Management of large intraventricular meningiomas with minimally invasive port technique: a three-case series
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Jamshidi, Ali O., primary, Beer-Furlan, Andre, additional, Hardesty, Douglas A., additional, Ditzel Filho, Leo F. S., additional, Prevedello, Luciano M., additional, and Prevedello, Daniel M., additional
- Published
- 2020
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- View/download PDF
6. Recurrent and Residual Tumors of the Suprasellar Space: Utility of the Supraorbital Approach
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McLaughlin, Nancy, Ditzel Filho, Leo F. S., Kassam, Amin B., and Kelly, Daniel F.
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- 2024
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- View/download PDF
7. The Transpterygoid Approach for Removal of a Vidian Nerve Neurofibroma
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McLaughlin, Nancy, Bresson, Damien, Ditzel Filho, Leo F. S., Carrau, Ricardo L., Kelly, Daniel F., Prevedello, Daniel M., and Kassam, Amin B.
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- 2024
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- View/download PDF
8. Use of a Novel Side-Cutting Aspiration Device for Microscopic and Endoscopic Skull Base Tumor Resection
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McLaughlin, Nancy, Kelly, Daniel F., Shahlaie, Kiarash, Ditzel Filho, Leo F. S., Prevedello, Daniel M., Carrau, Ricardo L., and Kassam, Amin B.
- Published
- 2024
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- View/download PDF
9. Anatomical nuances of the internal carotid artery in relation to the quadrangular space
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Dolci, Ricardo L. L., primary, Ditzel Filho, Leo F. S., additional, Goulart, Carlos R., additional, Upadhyay, Smita, additional, Buohliqah, Lamia, additional, Lazarini, Paulo R., additional, Prevedello, Daniel M., additional, and Carrau, Ricardo L., additional
- Published
- 2018
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10. Comparative analysis of the anterior transpetrosal approach with the endoscopic endonasal approach to the petroclival region
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Muto, Jun, primary, Prevedello, Daniel M., additional, Ditzel Filho, Leo F. S., additional, Tang, Ing Ping, additional, Oyama, Kenichi, additional, Kerr, Edward E., additional, Otto, Bradley A., additional, Kawase, Takeshi, additional, Yoshida, Kazunari, additional, and Carrau, Ricardo L., additional
- Published
- 2016
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- View/download PDF
11. Endoscopic endonasal anatomical study of the cavernous sinus segment of the ophthalmic nerve
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Dolci, Ricardo L. L., primary, Carrau, Ricardo L., additional, Buohliqah, Lamia, additional, Zoli, Matteo, additional, Mesquita Filho, Paulo M., additional, Lazarini, Paulo R., additional, Ditzel Filho, Leo F. S., additional, and Prevedello, Daniel M., additional
- Published
- 2014
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12. Immediate complications associated with high-flow cerebrospinal fluid egress during endoscopic endonasal skull base surgery
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Kerr, Edward E., primary, Prevedello, Daniel M., additional, Jamshidi, Ali, additional, Ditzel Filho, Leo F., additional, Otto, Bradley A., additional, and Carrau, Ricardo L., additional
- Published
- 2014
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- View/download PDF
13. Sinonasal Carcinomas with Neuroendocrine Features: Histopathological Differentiation and Treatment Outcomes.
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Soldatova, Liuba, Campbell, Raewyn G., Carrau, Ricardo L., Prevedello, Daniel M., Wakely Jr., Paul, Otto, Bradley A., and Ditzel Filho, Leo F.
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PARANASAL sinuses ,HISTOPATHOLOGY ,TREATMENT effectiveness ,NEUROENDOCRINOLOGY ,CANCER relapse ,CANCER - Abstract
Objectives Sinonasal cancers with neuroendocrine features share similar clinical, radiological, and histopathological features; however, these tumors often exhibit varying degrees of aggressive behavior presenting significant treatment challenges. The objective of this study was to report our experience with these rare malignancies and to present a review of current literature. Methods Following institutional review board approval, the records of all patients with biopsy-proven sinonasal malignancies over a 5-year period were reviewed. Results The study included 14 patients with olfactory neuroblastomas (ONBs), 7 patients with sinonasal undifferentiated carcinomas (SNUC), and 2 patients with sinonasal neuroendocrine carcinomas (SNEC). Histopathologic markers aided in final diagnosis, but showed variable specificity. In patients with sufficient follow-up, the 2-year disease-free survival rate was 81% (9/11) for ONB and 75% (3/4) for SNUC. Three patients developed a regional or distant recurrence (two with ONBs and one with SNUC). Two patients, one with SNEC and one with ONB, succumbed to brain radionecrosis related to proton radiation therapy. Conclusions Overlapping clinical and histopathological features in poorly differentiated sinonasal cancers with neuroendocrine features continue to present a diagnostic challenge. Individualized assessment and treatment strategies can improve the accuracy of the initial assessment and the treatment outcomes. [ABSTRACT FROM AUTHOR]
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- 2016
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14. Retrosigmoid approach for resection of petrous apex meningioma
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de Souza, Daniel G., primary, Ditzel Filho, Leo F. S., additional, Makonnen, Girma, additional, Zoli, Matteo, additional, Naudy, Cristian, additional, Muto, Jun, additional, and Prevedello, Daniel M., additional
- Published
- 2014
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15. Transsphenoidal approach with nasoseptal flap pedicle transposition: Modified rescue flap technique
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Otto, Bradley A., primary, Bowe, Sarah N., additional, Carrau, Ricardo L., additional, Prevedello, Daniel M., additional, Ditzel Filho, Leo F., additional, and de Lara, Danielle, additional
- Published
- 2013
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16. Applications of transoral, transcervical, transnasal, and transpalatal corridors for Robotic surgery of the skull base
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Ozer, Enver, primary, Durmus, Kasim, additional, Carrau, Ricardo L., additional, de Lara, Danielle, additional, Ditzel Filho, Leo F. S., additional, Prevedello, Daniel M., additional, Otto, Bradley A., additional, and Old, Matthew O., additional
- Published
- 2013
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17. Endoscopic treatment of a third ventricle choroid plexus cyst
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de Lara, Danielle, primary, Ditzel Filho, Leo F. S., additional, Muto, Jun, additional, and Prevedello, Daniel M., additional
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- 2013
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18. Effect of Incremental Endoscopic Maxillectomy on Surgical Exposure of the Pterygopalatine and Infratemporal Fossae.
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Upadhyay, Smita, Dolci, Ricardo L. L., Buohliqah, Lamia, Fiore, Mariano E., Ditzel Filho, Leo F. S., Prevedello, Daniel M., Otto, Bradley A., and Carrau, Ricardo L.
- Subjects
PTERYGOPALATINE ganglion ,NEUROVASCULAR diseases ,MAXILLECTOMY - Abstract
Objective Access to the pterygopalatine and infratemporal fossae presents a significant surgical challenge, owing to their deep-seated location and complex neurovascular anatomy. This study elucidates the benefits of incremental medial maxillectomies to access this region. We compared access to the medial aspect of the infratemporal fossa provided by medial maxillectomy, anteriorly extended medial maxillectomy, endoscopic Denker approach (i.e., Sturmann-Canfield approach), contralateral transseptal approach, and the sublabial anterior maxillotomy (SAM). Methods We studied 10 cadaveric specimens (20 sides) dissecting the pterygopalatine and infratemporal fossae bilaterally. Radius of access was calculated using a navigation probe aligned with the endoscopic line of sight. Area of exposure was calculated as the area removed from the posterior wall of maxillary sinus. Surgical freedom was calculated by computing the working area at the proximal end of the instrument with the distal end fixed at a target. Results The endoscopic Denker approach offered a superior area of exposure (8.46 ± 1.56 cm
2 ) and superior surgical freedom. Degree of lateral access with the SAM approach was similar to that of the Denker. Conclusion Our study suggests that an anterior extension of the medial maxillectomy or a cross-court approach increases both the area of exposure and surgical freedom. Further increases can be seen upon progression to a Denker approach. [ABSTRACT FROM AUTHOR]- Published
- 2016
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19. Endonasal management of sellar arachnoid cysts: simple cyst obliteration technique
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McLaughlin, Nancy, primary, Vandergrift, Alexander, additional, Ditzel Filho, Leo F., additional, Shahlaie, Kiarash, additional, Eisenberg, Amalia A., additional, Carrau, Ricardo L., additional, Cohan, Pejman, additional, and Kelly, Daniel F., additional
- Published
- 2012
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20. Recurrent and Residual Tumors of the Suprasellar Space: Utility of the Supraorbital Approach
- Author
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McLaughlin, Nancy, primary, Ditzel Filho, Leo F., additional, Kassam, Amin, additional, and Kelly, Daniel, additional
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- 2011
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- View/download PDF
21. Use of a Novel Side-Cutting Aspiration Device for Microscopic and Endoscopic Skull Base Tumor Resection
- Author
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McLaughlin, Nancy, primary, Kelly, Daniel, additional, Shahlaie, Kiarash, additional, Ditzel Filho, Leo F., additional, Prevedello, Daniel, additional, Carrau, Ricardo, additional, and Kassam, Amin, additional
- Published
- 2011
- Full Text
- View/download PDF
22. Endoscopic endonasal anatomical study of the cavernous sinus segment of the ophthalmic nerve.
- Author
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Dolci, Ricardo L. L., Carrau, Ricardo L., Buohliqah, Lamia, Zoli, Matteo, Mesquita Filho, Paulo M., Lazarini, Paulo R., Ditzel Filho, Leo F. S., and Prevedello, Daniel M.
- Abstract
Objectives/Hypothesis This cadaveric study analyzes the endoscopic endonasal anatomy of the ophthalmic division of the trigeminal nerve (V
1 ), from the middle fossa to its orbital entry via the superior orbital fissure. Anatomical relationships with the surrounding cranial nerves and blood vessels are described, with emphasis on their clinical correlation during surgery in this region. Our objective was to describe the anatomical relationships of the ophthalmic division of the trigeminal nerve. Study Design Cadaveric study. Methods Thirty middle cranial fossae, in adult human cadaveric specimens, were dissected endonasally under direct endoscopic visualization. During the dissection, we noted the relationships of the V1 nerve with the other trigeminal branches, as well as with the oculomotor and trochlear nerves, the paraclival and cavernous portions of the internal carotid artery, and the superior orbital fissure (SOF). Results The V1 nerve is the most superior trigeminal branch and runs upward and obliquely, along the middle portion of the lateral wall of the cavernous sinus. The V1 nerve joins the oculomotor and trochlear nerves to exit the cavernous sinus and enter the orbit through the SOF. Ten percent of the specimens displayed the trochlear nerve running along as a mate of the V1 nerve. The V1 nerve borders two key triangles in the lateral wall of the cavernous sinus, and the Parkinson's and anteromedial triangles. Conclusions In this study, the V1 nerve was a constant and reliable landmark, thus allowing the identification of the anteromedial triangle. This potential space can serve as an adequate window to access the temporal lobe. Knowledge of this anatomy is essential when planning and executing endonasal surgery in this region. Level of Evidence NA Laryngoscope, 125:1284-1290, 2015 [ABSTRACT FROM AUTHOR]- Published
- 2015
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23. Clinical Correlates of the Anatomical Relationships of the Foramen Ovale: A Radioanatomical Study.
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Youssef, Ahmed, Carrau, Ricardo L., Tantawy, Ahmed, Ibrahim, Ahmed Ali, Prevedello, Daniel M., Otto, Bradley A., Solares, Arturo C., Ditzel Filho, Leo F. S., and Rompaey, Jason
- Subjects
NASAL cavity ,ENDOSCOPIC surgery ,CAROTID artery surgery ,COMPUTED tomography ,COLUMELLA auris ,SURGERY - Abstract
Introduction Endonasal endoscopic transpterygoid approaches are commonly used techniques to access the infratemporal fossa and parapharyngeal space. Important endoscopic endonasal landmarks for the poststyloid parapharyngeal space, hence the internal carotid artery, include the mandibular nerve at the level of foramen ovale and the lateral pterygoid plate. This study aims to define the anatomical relationships of the foramen ovale, establishing its distance to other important anatomical landmarks such as the pterygoid process and columella. Methods Distances between the foramen ovale, foramen rotundum, and fixed anatomical landmarks like the columella and pterygoid process were measured using computed tomography (CT) scans and cadaveric dissections of the pterygopalatine and infratemporal fossae. Results The mean distances from the foramen ovale to columella and from the foramen rotundum to columella were found to be 9.15 cm and 7.09 cm, respectively. Analysis of radiologic measurements detected no statistically significant differences between sides or gender. Conclusions The pterygoid plates and V3 are prominent landmarks of the endonasal endoscopic approach to the infratemporal fossa and poststyloid parapharyngeal space. A better understanding of the endoscopic anatomy of the infratemporal fossa and awareness of the approximate distances and geometry among anatomical landmarks facilitates a safe and complete resection of lesions arising or extending to these regions. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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24. Nuances in the Treatment of Malignant Tumors of the Clival and Petroclival Region.
- Author
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Mohyeldin, Ahmed, Prevedello, Daniel M., Jamshidi, Ali O., Ditzel Filho, Leo F. S., and Carrau, Ricardo L.
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SKULL base abnormalities ,CANCER ,ENDOSCOPIC surgery ,CYSTS (Pathology) ,CRANIOTOMY ,CHORDOMA - Abstract
Introduction Malignancies of the clivus and petroclival region are mainly chordomas and chondrosarcomas. Although a spectrum of malignancies may present in this area, a finite group of commonly encountered malignant pathologies will be the focus of this review, as they are recognized to be formidable pathologies due to adjacent critical neurovascular structures and challenging surgical approaches. Objectives The objective is to review the literature regarding medical and surgical management of malignant tumors of the clival and petroclival region with a focus on clinical presentation, diagnostic identification, and associated adjuvant therapies. We will also discuss our current treatment paradigm using endoscopic, open, and combined approaches to the skull base. Data Synthesis A literature review was conducted, searching for basic science and clinical evidence from PubMed, Medline, and the Cochrane Database. The selection criteria encompassed original articles including data from both basic science and clinical literature, case series, case reports, and review articles on the etiology, diagnosis, treatment, and management of skull base malignancies in the clival and petroclival region. Conclusions The management of petroclival malignancies requires a multidisciplinary team to deliver the most complete surgical resection, with minimal morbidity, followed by appropriate adjuvant therapy. We advocate the combination of endoscopic and open approaches (traditional or minimally invasive) as required by the particular tumor followed by radiation therapy to optimize oncologic outcomes. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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25. Application of image guidance in pituitary surgery.
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de Lara, Danielle, Ditzel Filho, Leo F. S., Prevedello, Daniel M., Otto, Bradley A., and Carrau, Ricardo L.
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MEDICAL imaging systems ,PITUITARY cancer ,PITUITARY surgery ,STEREOTAXIC techniques ,INTRAOPERATIVE monitoring - Abstract
Background: Surgical treatment of pituitary pathologies has evolved along the years, adding safety and decreasing morbidity related to the procedure. Advances in the field of radiology, coupled with stereotactic technology and computer modeling, have culminated in the contemporary and widespread use of image guidance systems, as we know them today. Image guidance navigation has become a frequently used technology that provides continuous three-dimensional information for the accurate performance of neurosurgical procedures. We present a discussion about the application of image guidance in pituitary surgeries. Methods: Major indications for image guidance neuronavigation application in pituitary surgery are presented and demonstrated with illustrative cases. Limitations of this technology are also presented. Results: Patients presenting a history of previous transsphenoidal surgeries, anatomical variances of the sphenoid sinus, tumors with a close relation to the internal carotid arteries, and extrasellar tumors are the most important indications for image guidance in pituitary surgeries. The high cost of the equipment, increased time of surgery due to setup time, and registration and the need of specific training for the operating room personnel could be pointed as limitations of this technology. Conclusion: Intraoperative image guidance systems provide real-time images, increasing surgical accuracy and enabling safe, minimally invasive interventions. However, the use of intraoperative navigation is not a replacement for surgical experience and a systematic knowledge of regional anatomy. It must be recognized as a tool by which the neurosurgeon can reduce the risk associated with surgical approach and treatment of pituitary pathologies. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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26. Endoscopic endonasal anatomical study of the cavernous sinus segment of the ophthalmic nerve
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Ricardo L L, Dolci, Ricardo L, Carrau, Lamia, Buohliqah, Matteo, Zoli, Paulo M, Mesquita Filho, Paulo R, Lazarini, Leo F S, Ditzel Filho, Daniel M, Prevedello, Dolci, Ricardo L. L., Carrau, Ricardo L., Buohliqah, Lamia, Zoli, Matteo, Mesquita Filho, Paulo M., Lazarini, Paulo R., Ditzel Filho, Leo F. S., and Prevedello, Daniel M.
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endoscopic ,cavernous sinu ,Medicine (all) ,Otorhinolaryngology2734 Pathology and Forensic Medicine ,endonasal ,skull base ,Ophthalmic Nerve ,Endoscopy ,Nose ,parasitic diseases ,Cadaver ,Humans ,Cavernous Sinus ,trigeminal nerve ,superior orbital fissure ,Human - Abstract
Objectives/Hypothesis This cadaveric study analyzes the endoscopic endonasal anatomy of the ophthalmic division of the trigeminal nerve (V1), from the middle fossa to its orbital entry via the superior orbital fissure. Anatomical relationships with the surrounding cranial nerves and blood vessels are described, with emphasis on their clinical correlation during surgery in this region. Our objective was to describe the anatomical relationships of the ophthalmic division of the trigeminal nerve. Study Design Cadaveric study. Methods Thirty middle cranial fossae, in adult human cadaveric specimens, were dissected endonasally under direct endoscopic visualization. During the dissection, we noted the relationships of the V1 nerve with the other trigeminal branches, as well as with the oculomotor and trochlear nerves, the paraclival and cavernous portions of the internal carotid artery, and the superior orbital fissure (SOF). Results The V1 nerve is the most superior trigeminal branch and runs upward and obliquely, along the middle portion of the lateral wall of the cavernous sinus. The V1 nerve joins the oculomotor and trochlear nerves to exit the cavernous sinus and enter the orbit through the SOF. Ten percent of the specimens displayed the trochlear nerve running along as a mate of the V1 nerve. The V1 nerve borders two key triangles in the lateral wall of the cavernous sinus, and the Parkinson's and anteromedial triangles. Conclusions In this study, the V1 nerve was a constant and reliable landmark, thus allowing the identification of the anteromedial triangle. This potential space can serve as an adequate window to access the temporal lobe. Knowledge of this anatomy is essential when planning and executing endonasal surgery in this region.
- Published
- 2015
27. Supraorbital eyebrow craniotomy for removal of intraaxial frontal brain tumors: A technical note
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Daniel F. Kelly, Damien Bresson, Domenico Solari, Nancy McLaughlin, Leo F. S. Ditzel Filho, Amin B. Kassam, Ditzel Filho, Leo F. S., Mclaughlin, Nancy, Bresson, Damien, Solari, Domenico, Kassam, Amin B., and Kelly, Daniel F.
- Subjects
Male ,medicine.medical_specialty ,Metastatic brain tumor ,Supraorbital craniotomy ,medicine.medical_treatment ,Eyebrow ,Radiosurgery ,Metastatic carcinoma ,Follow-Up Studie ,Lesion ,Brain Neoplasm ,Craniopharyngioma ,Retrospective Studie ,Glioma ,Meningeal Neoplasms ,medicine ,Humans ,Pituitary Neoplasms ,Pituitary Neoplasm ,Meningeal Neoplasm ,Melanoma ,Craniotomy ,Retrospective Studies ,Aged ,medicine.diagnostic_test ,Brain Neoplasms ,business.industry ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,Surgery ,Frontal Lobe ,Intraaxial ,medicine.anatomical_structure ,Treatment Outcome ,Frontal lobe ,Length of stay ,Neurology (clinical) ,medicine.symptom ,business ,Meningioma ,Keyhole craniotomy ,Orbit ,Frontal Pole ,Follow-Up Studies ,Human - Abstract
Objective To present the utility and selection criteria for the supraorbital (SO) craniotomy, an approach commonly used to remove extraaxial tumors such as meningiomas and craniopharyngiomas, to resect intraaxial frontal brain lesions. Methods All consecutive patients who underwent a SO craniotomy for an intraaxial lesion were retrospectively analyzed for lesion location, pathology, extent of resection, operative times, length of stay, and complications. Results During 28 months, 10 patients (mean age, 67.6 years; 7 women) underwent 11 SO procedures to resect intraaxial brain lesions. Pathologies included metastatic carcinoma (n = 7), glioma (n = 2), and radiation necrosis (n = 1). The mean distance of the shortest trajectory to the lesion was 2.4 mm. Gross total or near-total removal was achieved in 80% of the cases. Median length of hospital stay was 3 days (range, 2–6 days); it was 2 days for patients admitted electively for SO craniotomy. There were no new neurologic deficits, postoperative hematomas, or cerebrospinal fluid leaks. Conclusions The SO “eyebrow” craniotomy is a safe and effective keyhole method to remove intraaxial frontal lobe lesions, particularly lesions of the frontal pole and orbitofrontal region, allowing for minimal disruption of normal brain parenchyma and promoting a rapid recovery and short hospital stay. Metastatic tumors and select gliomas in this area are most amenable to this approach. Deeper intraaxial tumors can also be effectively accessed via this route with excellent clinical outcomes.
- Published
- 2014
28. Expanded endonasal approaches to middle cranial fossa and posterior fossa tumors
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Domenico Solari, Ricardo L. Carrau, Leo F. S. Ditzel Filho, Daniel M. Prevedello, Amin B. Kassam, Prevedello, Daniel M., Ditzel Filho, Leo F. S., Solari, Domenico, Carrau, Ricardo L., and Kassam, Amin B.
- Subjects
medicine.medical_specialty ,Endoscope ,Less invasive ,Infratentorial Neoplasms ,Middle cranial fossa ,Neurosurgical Procedure ,Middle fossa ,Skull Base Neoplasms ,Neurosurgical Procedures ,Posterior fossa ,Skull base tumor ,Surgical anatomy ,Medicine ,Humans ,Minimally Invasive Surgical Procedures ,Expanded endoscopic approach ,Infratentorial Neoplasm ,Surgical approach ,Cranial Fossa, Middle ,business.industry ,General Medicine ,Anatomy ,Minimally Invasive Surgical Procedure ,Skull Base Neoplasm ,Posterior Fossa Tumors ,Extended transphenoidal ,Skull ,medicine.anatomical_structure ,Cranial Fossa, Posterior ,Endonasal ,Surgery ,Radiology ,Neurology (clinical) ,Nasal Cavity ,business ,Meckel cave ,Human - Abstract
Skull base lesions that involve the middle and posterior cerebral fossae have been historically managed through extensive transcranial approaches. The development of endoscopic endonasal techniques during the past decade has made possible a vast array of alternative routes to the ventral skull base, providing the ability to expose lesions in difficult-to-access regions of the cranial base in a less invasive manner. In this review, the authors detail the endoscopic surgical anatomy and the operative nuances of the expanded endoscopic endonasal approaches to tumors of the middle and posterior cranial fossae. These techniques offer excellent exposure of the targeted regions yielding optimal resections, while avoiding the morbidity associated with transcranial surgical approaches.
- Published
- 2010
29. Retrosigmoid approach for resection of petrous apex meningioma
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Girma Makonnen, Daniel G. de Souza, Leo F. S. Ditzel Filho, Daniel M. Prevedello, Matteo Zoli, Jun Muto, Cristian Naudy, de Souza, Daniel G., Ditzel Filho, Leo F. S, Makonnen, Girma, Zoli, Matteo, Naudy, Cristian, Muto, Jun, and Prevedello, Daniel M.
- Subjects
medicine.medical_specialty ,Petrous Apex Meningioma ,Cerebellopontine Angle ,Neurosurgical Procedure ,Neurosurgical Procedures ,Meningioma ,Trigeminal neuralgia ,Vertigo ,Meningeal Neoplasms ,medicine ,Humans ,Meningeal Neoplasm ,biology ,business.industry ,Petrous Apex ,Medicine (all) ,Cranial nerves ,General Medicine ,Middle Aged ,medicine.disease ,biology.organism_classification ,Cerebellopontine angle ,Magnetic Resonance Imaging ,Surgery ,Dissection ,Treatment Outcome ,Female ,Neurology (clinical) ,business ,Brain Stem ,Human - Abstract
We present the case of a 50-year-old female with a 1-year history of right-side facial numbness, as well as an electric shock-like sensation on the right-side of the face and tongue. She was previously diagnosed with vertigo and trigeminal neuralgia. MRI was obtained showing a large right cerebellopontine angle mass. A retrosigmoid approach was performed and total removal was achieved after dissection of tumor from brainstem and cranial nerves IV, V, VI, VII and VIII. Pathology confirmed the diagnosis of a meningioma (WHO Grade I). The patient was discharged neurologically intact on the third postoperative day free of complications.The video can be found here: http://youtu.be/-tR0FtMiUDg.
- Published
- 2014
30. Newly Diagnosed Sellar Tumors in Patients with Cancer: A Diagnostic Challenge and Management Dilemma.
- Author
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Goulart CR, Upadhyay S, Ditzel Filho LFS, Beer-Furlan A, Carrau RL, Prevedello LM, and Prevedello DM
- Subjects
- Adenocarcinoma diagnostic imaging, Adenocarcinoma secondary, Adenocarcinoma, Follicular diagnostic imaging, Adenocarcinoma, Follicular secondary, Adenoma pathology, Adult, Aged, Aged, 80 and over, Breast Neoplasms pathology, Carcinoma, Non-Small-Cell Lung diagnostic imaging, Carcinoma, Non-Small-Cell Lung secondary, Carcinoma, Renal Cell diagnostic imaging, Carcinoma, Renal Cell secondary, Colorectal Neoplasms pathology, Diagnosis, Differential, Female, Granular Cell Tumor pathology, Humans, Kidney Neoplasms pathology, Lung Neoplasms pathology, Magnetic Resonance Imaging, Male, Melanoma diagnostic imaging, Melanoma secondary, Middle Aged, Neoplasm Metastasis pathology, Neoplasm Staging, Neuroendocrine Tumors diagnostic imaging, Neuroendocrine Tumors secondary, Pituitary Neoplasms pathology, Pituitary Neoplasms secondary, Positron Emission Tomography Computed Tomography, Retrospective Studies, Skin Neoplasms pathology, Thyroid Neoplasms pathology, Adenoma diagnostic imaging, Granular Cell Tumor diagnostic imaging, Incidental Findings, Neoplasm Metastasis diagnostic imaging, Pituitary Neoplasms diagnostic imaging
- Abstract
Background: The use of combined positron emission tomography/computed tomography for staging in patients with cancer and the widespread use of magnetic resonance imaging has led to increased detection of incidental sellar masses. The imaging findings can be suggestive of a benign pituitary tumor, but metastasis can never be completely ruled out with noninvasive work-up. Appropriate diagnosis of sellar masses is critical, as the treatment paradigm might change in the presence of a pituitary metastasis. Definitive tissue diagnosis might prevent unnecessary radiotherapy to the skull base or the need for systemic treatment when benign pituitary disease is confirmed., Methods: A retrospective chart review from 2010 to 2015 of all patients with recently diagnosed cancer and undergoing surgery for sellar region masses was performed., Results: There were 9 patients (3 female and 6 male) identified. Lung cancer was the primary condition in 4 patients; the remaining 5 patients had breast cancer, follicular thyroid cancer, cutaneous melanoma, colorectal carcinoma, and renal cell carcinoma. On final pathology, the sellar mass was a benign pituitary adenoma in 5 patients, metastatic cancer in 3 patients, and a granular cell tumor in 1 patient., Conclusions: Surgical resection of a sellar mass in patients with known cancer helps in the definitive diagnosis, relieves compressive symptoms, and avoids unnecessary empiric radiotherapy in cases of confirmed benign pituitary disease., (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Published
- 2017
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31. Role of Leukocyte-Platelet-Rich Fibrin in Endoscopic Endonasal Skull Base Surgery Defect Reconstruction.
- Author
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Soldatova L, Campbell RG, Elkhatib AH, Schmidt TW, Pinto NR, Pinto JM, Prevedello DM, Ditzel Filho LF, Otto BA, and Carrau RL
- Abstract
Objective Advancements in endoscopic endonasal approaches have increased the extent and complexity of skull base resections, in turn demanding the development of novel techniques for skull base defect reconstruction. The objective of this pilot study was to investigate the effect of leukocyte-platelet-rich fibrin (L-PRF) on the postoperative healing after endoscopic skull base surgery. Methods Between January and May of 2015, 47 patients underwent endoscopic endonasal resection of sellar, parasellar, and suprasellar lesions with the application of L-PRF membranes during the skull base reconstruction at two surgical centers. Early postoperative records were retrospectively reviewed. Results We found that 21 days following the surgery, 17/41 patients (42%) demonstrated improvement in the crusting score as compared with their 7 day postoperative examination. Ten of these patients (23%) showed no crusting. Fourteen (34%) patients had no change in the crusting score. Six patient records were incomplete. A total of 4/47 cases (8.5%) had postoperative cerebrospinal fluid leak requiring surgical repair. Conclusion This study demonstrates the potential utility of L-PRF membranes for skull base defect reconstruction. Future studies will be conducted to better assess the role of L-PRF in endoscopic skull base surgery.
- Published
- 2017
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32. Magnetic resonance imaging fluid-attenuated inversion recovery sequence signal reduction after endoscopic endonasal transcribiform total resection of olfactory groove meningiomas.
- Author
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Prevedello DM, Ditzel Filho LF, Fernandez-Miranda JC, Solari D, do Espírito Santo MP, Wehr AM, Carrau RL, and Kassam AB
- Abstract
Background: Olfactory groove meningiomas grow insidiously and compress adjacent cerebral structures. Achieving complete removal without further damage to frontal lobes can be difficult. Microsurgical removal of large lesions is a challenging procedure and usually involves some brain retraction. The endoscopic endonasal approaches (EEAs) for tumors arising from the anterior fossa have been well described; however, their effect on the adjacent brain tissue has not. Herein, the authors utilized the magnetic resonance imaging fluid attenuated inversion recovery (FLAIR) sequence signal as a marker for edema and gliosis on pre- and post-operative images of olfactory groove meningiomas, thus presenting an objective parameter for brain injury after surgical manipulation., Methods: Imaging of 18 olfactory groove meningiomas removed through EEAs was reviewed. Tumor and pre/postoperative FLAIR signal volumes were assessed utilizing the DICOM image viewer OsiriX(®). Inclusion criteria were: (1) No previous treatment; (2) EEA gross total removal; (3) no further treatment., Results: There were 14 females and 4 males; the average age was 53.8 years (±8.85 years). Average tumor volume was 24.75 cm(3) (±23.26 cm(3), range 2.8-75.7 cm(3)), average preoperative FLAIR volume 31.17 cm(3) (±39.38 cm(3), range 0-127.5 cm(3)) and average postoperative change volume, 4.16 cm(3) (±6.18 cm(3), range 0-22.2 cm(3)). Average time of postoperative scanning was 6 months (range 0.14-20 months). In all cases (100%) gross total tumor removal was achieved. Nine patients (50%) had no postoperative FLAIR changes. In 2 patients (9%) there was minimal increase of changes postoperatively (2.2 cm(3) and 6 cm(3) respectively); all others demonstrated image improvement. The most common complication was postoperative cerebrospinal fluid leakage (27.8%); 1 patient (5.5%) died due to systemic complications and pulmonary sepsis., Conclusions: FLAIR signal changes tend to resolve after endonasal tumor resection and do not seem to worsen with this operative technique.
- Published
- 2015
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33. The Endoscopic Endonasal Approach for Removal of Petroclival Chondrosarcomas.
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Ditzel Filho LF, Prevedello DM, Dolci RL, Jamshidi AO, Kerr EE, Campbell R, Otto BA, and Carrau RL
- Subjects
- Humans, Natural Orifice Endoscopic Surgery methods, Nose, Chondrosarcoma surgery, Cranial Fossa, Posterior surgery, Neuroendoscopy methods, Skull Base Neoplasms surgery
- Abstract
Chondrosarcomas of the skull base are rare, locally invasive tumors that typically arise in the petroclival region, from degenerated chondroid cells located within the synchondrosis. Given their usually slow growth rate, they are capable of reaching sizable dimensions, promoting bone erosion and significant displacement of neurovascular structures before causing symptomatology that will eventually lead to diagnosis; cranial neuropathies and headaches are common complaints. This article discusses the pertinent surgical anatomy, patient selection criteria, technical nuances and complication management of the endonasal resection of skull base chondrosarcomas., (Copyright © 2015 Elsevier Inc. All rights reserved.)
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- 2015
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34. Endoscopic Endonasal Approach for Removal of Tuberculum Sellae Meningiomas.
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Ditzel Filho LF, Prevedello DM, Jamshidi AO, Dolci RL, Kerr EE, Campbell R, Otto BA, Carrau RL, and Kassam A
- Subjects
- Humans, Natural Orifice Endoscopic Surgery methods, Nose, Treatment Outcome, Meningeal Neoplasms surgery, Meningioma surgery, Neuroendoscopy methods, Sphenoid Bone surgery
- Abstract
Tuberculum sellae meningiomas are challenging lesions; their critical location and often insidious growth rate enables significant distortion of the superjacent optic apparatus before the patient notices any visual impairment. This article describes the technical nuances, selection criteria and complication avoidance strategies for the endonasal resection of tuberculum sellae meningiomas. A stepwise description of the surgical technique is presented; indications, adjuvant technologies, pitfalls and the relevant anatomy are also reviewed. Tuberculum sellae meningiomas may be safely and effectively resected through the endonasal route; invasion of the optic canals does not represent a limitation., (Copyright © 2015 Elsevier Inc. All rights reserved.)
- Published
- 2015
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35. Endoscopic endonasal cranial base surgery simulation using an artificial cranial base model created by selective laser sintering.
- Author
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Oyama K, Ditzel Filho LF, Muto J, de Souza DG, Gun R, Otto BA, Carrau RL, and Prevedello DM
- Subjects
- Cadaver, Carotid Artery, Internal surgery, Cavernous Sinus surgery, Humans, Models, Anatomic, Neuroendoscopy education, Sphenoid Sinus surgery, Nasal Cavity surgery, Neurosurgical Procedures education, Neurosurgical Procedures methods, Skull Base surgery
- Abstract
Mastery of the expanded endoscopic endonasal approach (EEA) requires anatomical knowledge and surgical skills; the learning curve for this technique is steep. To a great degree, these skills can be gained by cadaveric dissections; however, ethical, religious, and legal considerations may interfere with this paradigm in different regions of the world. We assessed an artificial cranial base model for the surgical simulation of EEA and compared its usefulness with that of cadaveric specimens. The model is made of both polyamide nylon and glass beads using a selective laser sintering (SLS) technique to reflect CT-DICOM data of the patient's head. It features several artificial cranial base structures such as the dura mater, venous sinuses, cavernous sinuses, internal carotid arteries, and cranial nerves. Under endoscopic view, the model was dissected through the nostrils using a high-speed drill and other endonasal surgical instruments. Anatomical structures around and inside the sphenoid sinus were accurately reconstructed in the model, and several important surgical landmarks, including the medial and lateral optico-carotid recesses and vidian canals, were observed. The bone was removed with a high-speed drill until it was eggshell thin and the dura mater was preserved, a technique very similar to that applied in patients during endonasal cranial base approaches. The model allowed simulation of almost all sagittal and coronal plane EEA modules. SLS modeling is a useful tool for acquiring the anatomical knowledge and surgical expertise for performing EEA while avoiding the ethical, religious, and infection-related problems inherent with use of cadaveric specimens.
- Published
- 2015
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36. Advantages and limitations of endoscopic endonasal approaches to the skull base.
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Kasemsiri P, Carrau RL, Ditzel Filho LF, Prevedello DM, Otto BA, Old M, de Lara D, and Kassam AB
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- Endoscopy education, Endoscopy instrumentation, Humans, Neurosurgical Procedures education, Neurosurgical Procedures instrumentation, Skull Base anatomy & histology, Treatment Outcome, Endoscopy methods, Nasal Cavity surgery, Neurosurgical Procedures methods, Skull Base surgery
- Abstract
Background: The anatomy of the skull base is extremely complex with an abundance of critical neurovascular bundles and their corresponding foramina as well as the insertions and origins of multiple masticatory and craniocervical muscles. These anatomic intricacies increase the difficulty of surgery within this area., Methods: Advantages and disadvantages of endoscopic endonasal approaches (EEAs) based on the authors' sequential learning and experience are described., Results: EEAs offer the advantages of using preexistent air spaces that enable accessing various areas of the skull base, while avoiding external incisions or scars and obviating the need for the translocation of the maxillofacial skeleton. In addition, EEAs are well suited to preserve neurologic, visual, and masticatory functions as well as cosmesis. However, the sinonasal corridor must be expanded and optimized to access the skull base adequately, facilitate the reconstruction of the surgical defect, avoid sinonasal complications, and minimize sequelae. Important considerations can limit or indicate the approach, such as the nature of the pathology, including location, diagnosis, and vascularity; patient characteristics, including age and medical comorbidities; surgeon attributes, including training, experience, and expertise; the resultant need to reconstruct large skull base defects and feasible alternatives to do so; and institutional resources, including adjunctive services, an intensive care unit, and operating room equipment., Conclusions: EEAs are important techniques in contemporary skull base surgery. Understanding the indications for and limitations of these approaches help to maximize outcomes., (Copyright © 2014 Elsevier Inc. All rights reserved.)
- Published
- 2014
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37. Endonasal endoscopic approaches to the paramedian skull base.
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de Lara D, Ditzel Filho LF, Prevedello DM, Carrau RL, Kasemsiri P, Otto BA, and Kassam AB
- Subjects
- Endoscopy adverse effects, Humans, Nasal Cavity anatomy & histology, Neurosurgical Procedures adverse effects, Postoperative Complications epidemiology, Postoperative Complications therapy, Skull Base anatomy & histology, Endoscopy methods, Nasal Cavity surgery, Neurosurgical Procedures methods, Skull Base surgery
- Abstract
Objective: To describe the technical and anatomic nuances related to endoscopic endonasal approaches (EEAs) to the paramedian skull base., Methods: Surgical indications, limitations, and technical aspects pertaining to EEAs designed to access areas oriented in the coronal plane are systematically reviewed with special attention to caveats, pitfalls, and common complications and how to avoid them. Case examples are presented., Results: The paramedian skull base may be divided into anterior (corresponding to the orbit and its contents), middle (corresponding to the middle cranial, pterygopalatine, and infratemporal fossae), and posterior (includes the craniovertebral junction lateral to the occipital condyles and the jugular foramen) segments. EEAs to the anterior segment offer access to the intraconal orbital space and the optic canal. A transpterygoid corridor typically precedes EEAs to the middle and posterior paramedian approaches. EEAs to the middle segment provide wide exposure of the petrous apex, middle cranial fossa (including cavernous sinus and Meckel cave), and infratemporal and pterygopalatine fossae. Finally, EEAs to the posterior segment access the hypoglossal canal, occipital condyle, and jugular foramen., Conclusions: Approaches to the paramedian skull base are the most challenging and complex of all endoscopic endonasal techniques. Because of their technical complexity, it is recommended that surgeons master endoscopic endonasal anatomic approaches oriented to median structures (sagittal plane) before approaching paramedian (coronal plane) pathologies., (Copyright © 2014 Elsevier Inc. All rights reserved.)
- Published
- 2014
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38. Response.
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Prevedello DM, de Lara D, Ditzel Filho LF, Muto J, Otto BA, and Carrau RL
- Subjects
- Female, Humans, Cerebral Ventricles surgery, Craniopharyngioma surgery, Craniotomy methods, Hypophysectomy methods, Microsurgery methods, Pituitary Neoplasms surgery, Skull Base surgery, Third Ventricle surgery
- Published
- 2014
39. Supraorbital eyebrow craniotomy for removal of intraaxial frontal brain tumors: a technical note.
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Ditzel Filho LF, McLaughlin N, Bresson D, Solari D, Kassam AB, and Kelly DF
- Subjects
- Aged, Brain Neoplasms pathology, Brain Neoplasms secondary, Craniopharyngioma pathology, Craniopharyngioma surgery, Follow-Up Studies, Frontal Lobe pathology, Glioma pathology, Glioma surgery, Humans, Male, Melanoma secondary, Meningeal Neoplasms pathology, Meningeal Neoplasms surgery, Meningioma pathology, Meningioma surgery, Middle Aged, Pituitary Neoplasms pathology, Pituitary Neoplasms surgery, Retrospective Studies, Treatment Outcome, Brain Neoplasms surgery, Craniotomy methods, Frontal Lobe surgery, Melanoma surgery, Orbit surgery, Radiosurgery methods
- Abstract
Objective: To present the utility and selection criteria for the supraorbital (SO) craniotomy, an approach commonly used to remove extraaxial tumors such as meningiomas and craniopharyngiomas, to resect intraaxial frontal brain lesions., Methods: All consecutive patients who underwent a SO craniotomy for an intraaxial lesion were retrospectively analyzed for lesion location, pathology, extent of resection, operative times, length of stay, and complications., Results: During 28 months, 10 patients (mean age, 67.6 years; 7 women) underwent 11 SO procedures to resect intraaxial brain lesions. Pathologies included metastatic carcinoma (n = 7), glioma (n = 2), and radiation necrosis (n = 1). The mean distance of the shortest trajectory to the lesion was 2.4 mm. Gross total or near-total removal was achieved in 80% of the cases. Median length of hospital stay was 3 days (range, 2-6 days); it was 2 days for patients admitted electively for SO craniotomy. There were no new neurologic deficits, postoperative hematomas, or cerebrospinal fluid leaks., Conclusions: The SO "eyebrow" craniotomy is a safe and effective keyhole method to remove intraaxial frontal lobe lesions, particularly lesions of the frontal pole and orbitofrontal region, allowing for minimal disruption of normal brain parenchyma and promoting a rapid recovery and short hospital stay. Metastatic tumors and select gliomas in this area are most amenable to this approach. Deeper intraaxial tumors can also be effectively accessed via this route with excellent clinical outcomes., (Copyright © 2014 Elsevier Inc. All rights reserved.)
- Published
- 2014
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40. Anatomic comparison of the endonasal and transpetrosal approaches for interpeduncular fossa access.
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Oyama K, Prevedello DM, Ditzel Filho LF, Muto J, Gun R, Kerr EE, Otto BA, and Carrau RL
- Subjects
- Craniopharyngioma surgery, Humans, Pituitary Neoplasms surgery, Interpeduncular Nucleus surgery, Nose surgery, Sella Turcica surgery
- Abstract
Object: The interpeduncular cistern, including the retrochiasmatic area, is one of the most challenging regions to approach surgically. Various conventional approaches to this region have been described; however, only the endoscopic endonasal approach via the dorsum sellae and the transpetrosal approach provide ideal exposure with a caudal-cranial view. The authors compared these 2 approaches to clarify their limitations and intrinsic advantages for access to the interpeduncular cistern., Methods: Four fresh cadaver heads were studied. An endoscopic endonasal approach via the dorsum sellae with pituitary transposition was performed to expose the interpeduncular cistern. A transpetrosal approach was performed bilaterally, combining a retrolabyrinthine presigmoid and a subtemporal transtentorium approach. Water balloons were used to simulate space-occupying lesions. "Water balloon tumors" (WBTs), inflated to 2 different volumes (0.5 and 1.0 ml), were placed in the interpeduncular cistern to compare visualization using the 2 approaches. The distances between cranial nerve (CN) III and the posterior communicating artery (PCoA) and between CN III and the edge of the tentorium were measured through a transpetrosal approach to determine the width of surgical corridors using 0- to 6-ml WBTs in the interpeduncular cistern (n = 8)., Results: Both approaches provided adequate exposure of the interpeduncular cistern. The endoscopic endonasal approach yielded a good visualization of both CN III and the PCoA when a WBT was in the interpeduncular cistern. Visualization of the contralateral anatomical structures was impaired in the transpetrosal approach. The surgical corridor to the interpeduncular cistern via the transpetrosal approach was narrow when the WBT volume was small, but its width increased as the WBT volume increased. There was a statistically significant increase in the maximum distance between CN III and the PCoA (p = 0.047) and between CN III and the tentorium (p = 0.029) when the WBT volume was 6 ml., Conclusions: Both approaches are valid surgical options for retrochiasmatic lesions such as craniopharyngiomas. The endoscopic endonasal approach via the dorsum sellae provides a direct and wide exposure of the interpeduncular cistern with negligible neurovascular manipulation. The transpetrosal approach also allows direct access to the interpeduncular cistern without pituitary manipulation; however, the surgical corridor is narrow due to the surrounding neurovascular structures and affords poor contralateral visibility. Conversely, in the presence of large or giant tumors in the interpeduncular cistern, which widen the spaces between neurovascular structures, the transpetrosal approach becomes a superior route, whereas the endoscopic endonasal approach may provide limited freedom of movement in the lateral extension.
- Published
- 2014
- Full Text
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41. Endoscopic endonasal surgical management of chondrosarcomas with cerebellopontine angle extension.
- Author
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Mesquita Filho PM, Ditzel Filho LF, Prevedello DM, Martinez CA, Fiore ME, Dolci RL, Otto BA, and Carrau RL
- Subjects
- Adult, Aged, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Neurosurgical Procedures methods, Retrospective Studies, Cerebellopontine Angle pathology, Chondrosarcoma surgery, Endoscopy methods, Nose surgery, Skull Base Neoplasms surgery
- Abstract
Object: Skull base chondrosarcomas are slow-growing, locally invasive tumors that arise from the petroclival synchondrosis. These characteristics allow them to erode the clivus and petrous bone and slowly compress the contents of the posterior fossa progressively until the patient becomes symptomatic, typically from cranial neuropathies. Given the site of their genesis, surrounded by the petrous apex and the clival recess, these tumors can project to the middle fossa, cervical area, and posteriorly, toward the cerebellopontine angle (CPA). Expanded endoscopic endonasal approaches are versatile techniques that grant access to the petroclival synchondrosis, the core of these lesions. The ability to access multiple compartments, remove infiltrated bone, and achieve tumor resection without the need for neural retraction makes these techniques particularly appealing in the management of these complex lesions., Methods: Analysis of the authors' database yielded 19 cases of skull base chondrosarcomas; among these were 5 cases with predominant CPA involvement. The electronic medical records of the 5 patients were retrospectively reviewed for age, sex, presentation, pre- and postoperative imaging, surgical technique, pathology, and follow-up. These cases were used to illustrate the surgical nuances involved in the endonasal resection of CPA chondrosarcomas., Results: The male/female ratio was 1:4, and the patients' mean age was 55.2 ±11.2 years. All cases involved petrous bone and apex, with variable extensions to the posterior fossa and parapharyngeal space. The main clinical scenario was cranial nerve (CN) palsy, evidenced by diplopia (20%), ptosis (20%), CN VI palsy (20%), dysphagia (40%), impaired phonation (40%), hearing loss (20%), tinnitus (20%), and vertigo/dizziness (40%). Gross-total resection of the CPA component of the tumor was achieved in 4 cases (80%); near-total resection of the CPA component was performed in 1 case (20%). Two patients (40%) harbored high-grade chondrosarcomas. No patient experienced worsening neurological symptoms postoperatively. In 2 cases (40%), the symptoms were completely normalized after surgery., Conclusions: Expanded endoscopic endonasal approaches appear to be safe and effective in the resection of select skull base chondrosarcomas; those with predominant CPA involvement seem particularly amenable to resection through this technique. Further studies with larger cohorts are necessary to test these preliminary impressions and to compare their effectiveness with the results obtained with open approaches.
- Published
- 2014
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42. Surgical management of craniopharyngioma with third ventricle involvement.
- Author
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de Lara D, Ditzel Filho LF, Muto J, Otto BA, Carrau RL, and Prevedello DM
- Subjects
- Aged, Craniopharyngioma complications, Diabetes Insipidus etiology, Female, Humans, Neoplasm Invasiveness, Pituitary Neoplasms complications, Surgical Flaps, Third Ventricle pathology, Vision Disorders etiology, Vision Disorders surgery, Craniopharyngioma surgery, Hypophysectomy methods, Pituitary Neoplasms surgery, Third Ventricle surgery
- Abstract
Craniopharyngiomas are notorious for their ability to invade the hypothalamus and third ventricle. Although several transcranial approaches have been proposed for their treatment, the endonasal route provides direct access to the tumor with no need for cerebral retraction or manipulation of the optic apparatus. After the lesion is debulked, the unique angle of approach achieved with this technique enables the surgeon to perform an extra-capsular dissection and visualize the walls of the third ventricle, the foramina of Monro, and the anterior comissure. Moreover, the enhanced magnification and lighting afforded by the endoscope facilitate safe tumor removal, particularly in areas where there is loss of clear lesion delimitation and greater infiltration of the surrounding structures. Herein we present the case of a 68-year-old female patient with a 3-month history of visual deterioration accompanied by worsening headaches. Investigation with magnetic resonance imaging revealed a heterogeneous mass in the suprasellar region, extending into the third ventricle and displacing the pituitary gland and stalk inferiorly. Hormonal profile was within expected range for her age. An endonasal, fully endoscopic, transplanum transtuberculum approach was performed. Gross-total removal was achieved and pathology confirmed the diagnosis of craniopharyngioma. Postoperative recovery was marked by transient diabetes insipidus. Closure was achieved with a pedicled nasoseptal flap; despite exploration of the third ventricle, there was no cerebrospinal fluid leakage. Pituitary function was preserved. Visual function has fully recovered and the patient has been uneventfully followed since surgery. The video can be found here: http://youtu.be/it5mpofZl0Q. (http://thejns.org/doi/abs/10.3171/2013.V1.FOCUS12330)
- Published
- 2013
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43. Side-cutting aspiration device for endoscopic and microscopic tumor removal.
- Author
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McLaughlin N, Ditzel Filho LF, Prevedello DM, Kelly DF, Carrau RL, and Kassam AB
- Abstract
The authors present a unique side-cutting instrument (NICO Myriad, Indianapolis, IN) with variable aspiration designed specifically for tumor resection. The study included retrospective review of data collected from 10/2009 to 01/2011. We detail the use of the Myriad in 31 patients with the following pathologies: meningioma (n=16), chordoma (n = 3), schwannoma (n = 3), pituitary adenoma (n = 2), metastasis (n = 3), hemangioblastoma (n = 1), craniopharyngioma (n = 1), and nasopharyngeal tumors (n = 2). Surgical approaches included expanded endonasal approach (n = 19), endoscopic brain port (n = 3), supraorbital "eyebrow" craniotomy (n = 3), retrosigmoid suboccipital craniotomy (n = 3), pterional craniotomy (n = 1), extreme far lateral (n = 1), and laminectomy (n = 1). Successful tumor resection was achieved in 30 cases. Instrument failure was noted in only one extremely fibrous meningioma. The design of this instrument facilitated maneuvering through narrow corridors while providing direct visualization of the suction aperture during tumor resection. These features allowed for tumor removal without injury to adjacent neurovascular structures. The side-cutting aspiration device allows safe and effective tumor removal. Its low profile, variable aspiration, and lack of thermal heat energy are particularly useful in tumor resection through narrow corridors, such as endonasal, port, and keyhole approaches. The multifunctional nature of the instrument (suction, scissors, and dissectors) minimizes multiple exchanges, facilitating tumor resection through these minimal access corridors.
- Published
- 2012
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44. Expanded endonasal approaches to middle cranial fossa and posterior fossa tumors.
- Author
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Prevedello DM, Ditzel Filho LF, Solari D, Carrau RL, and Kassam AB
- Subjects
- Cranial Fossa, Middle anatomy & histology, Cranial Fossa, Posterior anatomy & histology, Cranial Fossa, Posterior surgery, Humans, Minimally Invasive Surgical Procedures adverse effects, Nasal Cavity anatomy & histology, Neurosurgical Procedures adverse effects, Cranial Fossa, Middle surgery, Infratentorial Neoplasms surgery, Minimally Invasive Surgical Procedures methods, Nasal Cavity surgery, Neurosurgical Procedures methods, Skull Base Neoplasms surgery
- Abstract
Skull base lesions that involve the middle and posterior cerebral fossae have been historically managed through extensive transcranial approaches. The development of endoscopic endonasal techniques during the past decade has made possible a vast array of alternative routes to the ventral skull base, providing the ability to expose lesions in difficult-to-access regions of the cranial base in a less invasive manner. In this review, the authors detail the endoscopic surgical anatomy and the operative nuances of the expanded endoscopic endonasal approaches to tumors of the middle and posterior cranial fossae. These techniques offer excellent exposure of the targeted regions yielding optimal resections, while avoiding the morbidity associated with transcranial surgical approaches., (Copyright © 2010 Elsevier Inc. All rights reserved.)
- Published
- 2010
- Full Text
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