المؤلفون: Serioli, Simona, Nizzola, Mariagrazia, Plou, Pedro, De Bonis, Alessandro, Meyer, Jenna, Leonel, Luciano C. P. C., Tooley, Andrea A., Wagner, Lilly H., Bradley, Elizabeth A., Van Gompel, Jamie J., Benini, Maria Elena, Dallan, Iacopo, Peris-Celda, Maria

المصدر: Cancers; Sep2023, Vol. 15 Issue 18, p4435, 22p

مصطلحات موضوعية: ENDOSCOPIC surgery, CAVERNOUS sinus, EYE-sockets, SKULL base, COMPUTED tomography, ENDOSCOPY

مستخلص: Simple Summary: The popularity that transorbital approaches (TOAs) gained in recent years has allowed their diffusion into skull base surgery. However, for their correct application, it is essential to know the potential and the limits of this group of transorbital routes, as well as the knowledge of anatomy from this relatively new surgical perspective. In this paper, the authors illustrate step-by-step the superior eyelid transorbital approach from a macroscopic and endoscopic perspective, highlighting the main anatomical relationships to understand the application of this surgical route for the treatment of skull base pathologies. Surgical cases are provided to illustrate indications for this approach. Background: The transorbital approaches (TOAs) have acquired growing notoriety, thanks to their ability to offer alternative corridors to the skull base. However, the limited access and the unfamiliarity with this surgical perspective make recognition of key landmarks difficult, especially for less experienced surgeons. The study wants to offer a detailed description of the anatomy to comprehend the potential and limitations of TOAs. Methods: Measurements of the orbit region and the surrounding areas were performed on two hundred high-resolution CT scans and thirty-nine dry skulls. Five specimens were dissected to illustrate the TOA, and one was used to perform the extradural clinoidectomy. Three clinical cases highlighted the surgical applications. Results: A step-by-step description of the key steps of the TOA was proposed and a comparison with the transcranial anterior clinoidectomy was discussed. The mean work distance was 6.1 ± 0.4 cm, and the lateral working angle increased 20 ± 5.4° after removing the lateral orbital rim. Conclusions: TOAs are indicated in selected cases when tumor involves the lateral portion of the cavernous sinus or the middle skull base, obtaining a direct decompression of the optic nerve and avoiding excessive manipulation of the neurovascular structures. Comprehension of surgical anatomy of the orbit and its surrounding structures is essential to safely perform these approaches. [ABSTRACT FROM AUTHOR]

: Copyright of Cancers is the property of MDPI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Marshall, Camryn, Agosti, Edoardo, Peris-Celda, Maria, Pinheiro-Neto, Carlos D.

المصدر: Acta Neurochirurgica; Jul2023, Vol. 165 Issue 7, p1773-1780, 8p

مصطلحات موضوعية: ENDOSCOPIC surgery, SURGICAL excision, NASOPHARYNX tumors

مستخلص: Background: Juvenile nasopharyngeal angiofibromas (JNAs) are rare, benign, and locally invasive nasopharyngeal tumors. Endoscopic endonasal resection is effective, non-invasive, with low complication rates. Until recently, endoscopic resection was not suitable for intracranially invasive tumors. Purpose/Method: We describe resection steps of an intracranially extending JNA with a combined endoscopic endonasal and endoscopic-assisted sublabial transmaxillary approaches. Indications, advantages, and approach-specific complications are also discussed. The main surgical steps are shown in an operative video. Conclusion: Surgical excision of JNAs by a combined endoscopic endonasal and sublabial transmaxillary approaches represents a safe and effective treatment for selected intracranially invasive JNA. [ABSTRACT FROM AUTHOR]

: Copyright of Acta Neurochirurgica is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Plou, Pedro, Serioli, Simona, Leonel, Luciano C. P. C., Alexander, A. Yohan, Agosti, Edoardo, Vilany, Larissa, Graepel, Stephen, Choby, Garret, Pinheiro-Neto, Carlos D., Peris-Celda, Maria

المصدر: Cancers; May2023, Vol. 15 Issue 9, p2587, 13p

مصطلحات موضوعية: SKULL, MEDICAL cadavers, ENDOSCOPIC surgery, SURGICAL complications, CRANIOTOMY, DECISION making in clinical medicine, SKULL tumors, ENDOSCOPY

مستخلص: Simple Summary: The technical development in skull base surgery, especially to the anterior cranial fossa, has allowed for improvement in the quality of life and the long-term prognosis of patients suffering from different types of tumors that can affect this anatomical area. Applying these advanced techniques requires a thorough understanding of the skull base anatomy and surrounding structures to perform surgery without potential intraoperative complications related to the pathology itself as well as potential complications related to the surgical approach that has been chosen to treat this pathology. The purpose of this paper is to offer a comprehensive review of the surgical anatomy of the anterior skull base and the technical nuances of the surgical approaches that are more frequently used in this region. Detailed knowledge of these aspects is essential both for the choice of the surgical approach and for its correct execution when an anterior cranial fossa lesion need to be resected. The anterior cranial fossa (ACF) is a complex anatomical region that can be affected by a broad spectrum of pathology. For the surgical treatment of these lesions, many approaches have been described, each of them with different scope and potential surgical complications, often associated with significant morbidity. Traditionally, tumors involving the ACF have been operated by transcranial approaches; however, in the last two decades, endoscopic endonasal approaches (EEAs) have been gaining popularity. In this work, the authors review and describe the anatomical aspects of the ACF and the technical nuances of transcranial and endoscopic approaches for tumors located in this region. Four approaches were performed in embalmed cadaveric specimens and the key steps were documented. Four illustrative cases of ACF tumors were selected to demonstrate the clinical application of anatomical and technical knowledge, which are essential in the preoperative decision-making process. [ABSTRACT FROM AUTHOR]

: Copyright of Cancers is the property of MDPI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Lee, Daniel D.¹, Peris-Celda, Maria², Butrymowicz, Anna³, Kenning, Tyler², Pinheiro-Neto, Carlos D.³ pinheic@mail.amc.edu

المصدر: World Neurosurgery. Feb2017, Vol. 98, p303-307. 5p.

مصطلحات موضوعية: *ENDOSCOPIC surgery, *SLEEP-wake cycle, *TUMORS, *QUALITY of life, *PREOPERATIVE period, *PATIENTS

مستخلص: Objective Endoscopic endonasal transsphenoidal surgery (EETS) is a widely accepted technique for sellar tumors. Common findings during preoperative assessment include septal deviations and turbinate hypertrophy. This study evaluated quality of life changes after concurrent septoplasty and/or inferior turbinoplasty during EETS. Methods A retrospective review was performed of a prospectively collected database including all patients undergoing EETS at our institution during a 10-month period between 2015 and 2016. Patients were divided into a septoplasty/inferior turbinoplasty group and a no septoplasty/inferior turbinoplasty group. The Sino-Nasal Outcome Test (SNOT-22) was used to evaluate quality of life. Mean preoperative scores were compared with 1- and 3-month postoperative scores within each cohort. The SNOT-22 was also reorganized into 5 distinct subdomains. Average subdomain scores were calculated, and preoperative and 1- and 3-month postoperative subdomain scores were compared within each cohort. A paired Student t test was used. P values < 0.05 were considered statistically significant. Results All 24 patients met inclusion criteria by completing preoperative and postoperative SNOT-22 surveys. In the septoplasty/inferior turbinoplasty group, preoperative and 3-month postoperative scores showed a clinically significant difference ( P = 0.047). The septoplasty/inferior turbinoplasty group specifically showed a significant difference in the psychiatric and sleep SNOT-22 subdomains when comparing preoperative with 3-month postoperative scores ( P = 0.03, P = 0.01). Conclusions Patients who underwent concurrent septoplasty and/or turbinoplasty with EETS had a significantly improved quality of life compared with preoperative assessment, specifically regarding psychological and sleep symptoms. [ABSTRACT FROM AUTHOR]

المؤلفون: Peris-Celda, Maria¹, Pinheiro-Neto, Carlos D.², Scopel, Tiago F.², Fernandez-Miranda, Juan C.¹ fernandezmirandajc@upmc.edu, Gardner, Paul A.¹, Snyderman, Carl H.²

المصدر: Journal of Neurological Surgery. Part B. Skull Base. Dec2013, Vol. 74 Issue 6, p393-398. 6p.

مصطلحات موضوعية: *ENDOSCOPIC surgery, *MAXILLARY sinus surgery, *SURGICAL decompression, *SURGICAL excision, *SURGICAL & topographical anatomy

مستخلص: Objectives Infraorbital nerve (ION) decompression, excision to remove intrinsic tumors, and resection with oncological margins in malignancies with perineural invasion or dissemination are usually accomplished with an open approach. The objective is to describe the surgical anatomy, technique, and indications of the endonasal endoscopic approach (EEA) to the ION with nasolacrimal duct preservation. Design Eleven sides of formalin-fixed specimens were dissected. An anterior maxillary antrostomy was performed. The length of the ION prominence within the sinus and anatomic features of the covering bone were studied. A 45-degree endoscope visualized the infraorbital prominence endonasally. An angled dissector and dural blade allowed for dissection and resection of the ION ipsilaterally and contralaterally. Results The bone features of the ION prominence allowed for ipsilateral dissection in 10 out of 11 sides. In one case with the ION surrounded by thick cortical bone, the dissection could only be started by drilling contralaterally. The 45-degree endoscope visualized 92.2% and 100% of the length of the nerve using the ipsilateral and contralateral nostrils, respectively. Ipsilaterally, 83% of its length was resected, and 96.3% was resected contralaterally. Conclusion The ION can be approached using an ipsilateral EEA with nasolacrimal duct preservation inmost cases. The contralateral approach provides a wider angle to access the ION. This technique is primarily indicated in cases where the EEA can be used for tumor resection and oncological margins within the ION. [ABSTRACT FROM AUTHOR]

المؤلفون: Peris-Celda, Maria¹, Diogenes Pinheiro-Neto, Carlos², Funaki, Takeshi¹, Fernandez-Miranda, Juan C.³, Gardner, Paul³, Snyderman, Carl², Rhoton, Albert L.¹ rhoton@neurosurgery.ufl.edu

المصدر: Journal of Neurological Surgery. Part B. Skull Base. Dec2013, Vol. 74 Issue 6, p369-385. 17p.

مصطلحات موضوعية: *SKULL base, *ENDOSCOPIC surgery, *ANATOMICAL specimens, *THERAPEUTIC use of tomography, *SURGICAL flaps, *SELLA turcica, *CAVERNOUS sinus, *SURGERY

مستخلص: Objective Reconstruction of large clival defects after an endoscopic endonasal procedure is challenging. The objective is to analyze the morphology, indications, and limitations of the extended nasoseptal flap, which adds the nasal floor and inferior meatus mucosa, compared with the standard nasoseptal flap, for clival reconstruction. Design Twenty-seven sides of formalin-fixed anatomical specimens and 13 computed tomography (CT) scans were used. Under 0-degree endoscopic visualization, a standard flap on one side and an extended flap on the other side were performed, as well as exposure of the sella, cavernous sinus, and clival duramater. Coverage of both flaps was assessed, and they were incised and extracted for measurements. Results The extended flap has two parts: septal and inferior meatal. The extended flaps are 20 mm longer and add 774 mm² of mucosal area. They cover a clival defect from tuberculum to foramen magnumin 66.6% cases and from below the sella in 91.6%. They cover both parasellar and paraclival segments of the internal carotid arteries. The lateral inferior limits are the medial aspect of the hypoglossal canals and Eustachian tubes. CT scans can predict the need or limitation of an extended nasoseptal flap. Conclusions The nasal floor and inferior meatus mucosa adds a significant area for reconstruction of the clivus. A defect laterally beyond the hypoglossal canals is not likely covered with this variation of the flap. Preoperative CT scans are useful to guide the reconstruction techniques. [ABSTRACT FROM AUTHOR]

المؤلفون: Ramsey, Tam¹ (AUTHOR), Shastri, Karthik¹ (AUTHOR), Curran, Kent² (AUTHOR), Debiase, Carolyn¹ (AUTHOR), Peris-Celda, Maria³ (AUTHOR), Pinheiro-Neto, Carlos D.^1,3 (AUTHOR) pinheic@amc.edu

المصدر: World Neurosurgery. May2021, Vol. 149, p11-14. 4p.

مصطلحات موضوعية: *SKULL base, *ENDOSCOPIC surgery, *CEREBROSPINAL fluid, *POSTOPERATIVE period, *OPERATIVE surgery, *NASAL cannula, *PERFORATOR flaps (Surgery)

مستخلص: The pedicled nasoseptal flap (NSF) is the mainstay for endoscopic skull base reconstruction. We present a novel technique using a semirigid chondromucosal NSF that improves the reinforcement and protection of intracranial structures. Composite NSFs were performed to repair intraoperative high-flow cerebrospinal fluid leaks in 2 patients who had undergone endoscopic endonasal resection of a suprasellar mass. The surgical technique and postoperative outcomes are described. The flaps were sufficient for defect coverage, and the patients did not experience any cerebrospinal fluid leak in the immediate and delayed postoperative periods. No complications related to the composite flap had developed. The composite chondromucosal NSF is a reliable reconstruction option for select ventral cranial base reconstruction cases with the potential to improve the protection of intracranial structures. Additional surgical cases and longer follow-up are required for a better assessment of long-term outcomes. [ABSTRACT FROM AUTHOR]