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Reconstructive challenges in the extended endoscopic transclival approach

Published online by Cambridge University Press:  01 April 2015

A Kamat ,
J Y K Lee ,
G H Goldstein ,
J G Newman ,
P B Storm ,
J N Palmer  and
N D Adappa
A Kamat*
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, USA
J Y K Lee
Affiliation:
Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
G H Goldstein
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, USA
J G Newman
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, USA
P B Storm
Affiliation:
Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
J N Palmer
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, USA
N D Adappa
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, USA
*
Address for correspondence: Dr Ameet Kamat, Department of Otorhinolaryngology – Head and Neck Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Ravdin 5 Philadelphia, Pennsylvania 19104, USA E-mail: drkamat@gmail.com
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Abstract

Objective:

We wanted to present our experience with the extended endoscopic approach to clival pathology, focusing on cerebrospinal fluid leak and reconstruction challenges.

Methods:

We examined a consecutive series of 37 patients undergoing the extended endoscopic approach for skull base tumours, 9 patients with clival pathology. Patients were examined for the incidence of post-operative cerebrospinal fluid leak in relation to tumour pathology, location, size, reconstruction and lumbar drain.

Results:

The overall incidence of post-operative cerebrospinal fluid leak was 10.8 per cent. Seventy-five per cent of patients who had a post-operative cerebrospinal fluid leak underwent a transclival approach (p < 0.05). All patients with clival pathology who underwent an intradural dissection had a post-operative cerebrospinal fluid leak (p < 0.05).

Conclusion:

Post-operative cerebrospinal fluid leak rates after the extended endoscopic approach have improved significantly after advancements including the vascularised nasoseptal flap. Despite this, transclival approaches continue to pose much difficulty. Further investigation is necessary to develop technical improvements that can meet the unique challenges associated with this region.

Keywords

Skull BaseCranial Fossa, PosteriorCerebrospinal Fluid LeakEndoscopyNatural Orifice Endoscopic SurgeryMinimally Invasive Surgical Procedures
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 129 , Issue 5 , May 2015 , pp. 468 - 472
Copyright
Copyright © JLO (1984) Limited 2015 

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Footnotes

Presented as a poster at the 23rd North American Skull Base Society Annual Meeting, 15–17 February 2013, Miami, Florida, USA

References

1Jho, HD. Endoscopic transsphenoidal surgery. J Neurooncol 2001;54:187–95CrossRefGoogle ScholarPubMed
2Komotar, RJ, Starke, RM, Raper, DM, Anand, VK, Schwartz, TH. Endoscopic skull base surgery: a comprehensive comparison with open transcranial approaches. Br J Neurosurg 2012;26:637–48CrossRefGoogle ScholarPubMed
3Komotar, RJ, Starke, RM, Raper, DM, Anand, VK, Schwartz, TH. The endoscope-assisted ventral approach compared with open microscope-assisted surgery for clival chordomas. World Neurosurg 2011;76:318–27CrossRefGoogle ScholarPubMed
4Fraser, JF, Nyquist, GG, Moore, N, Anand, VK, Schwartz, TH. Endoscopic endonasal transclival resection of chordomas: operative technique, clinical outcome, and review of the literature. J Neurosurg 2010;112:1061–9CrossRefGoogle ScholarPubMed
5Frank, G, Sciarretta, V, Calbucci, F, Farneti, G, Mazzatenta, D, Pasquini, E. The endoscopic transnasal transsphenoidal approach for the treatment of cranial base chordomas and chondrosarcomas. Neurosurgery 2006;59(suppl 1):ONS50–7Google ScholarPubMed
6Fraser, JF, Nyquist, GG, Moore, N, Anand, VK, Schwartz, TH. Endoscopic endonasal minimal access approach to the clivus: case series and technical nuances. Neurosurgery 2010;67(suppl operative):ONS150–8Google Scholar
7Stippler, M, Gardner, PA, Snyderman, CH, Carrau, RL, Prevedello, DM, Kassam, AB. Endoscopic endonasal approach for clival chordomas. Neurosurgery 2009;64:268–77CrossRefGoogle ScholarPubMed
8Dehdashti, AR, Karabatsou, K, Ganna, A, Witterick, I, Gentili, F. Expanded endoscopic endonasal approach for treatment of clival chordomas: early results in 12 patients. Neurosurgery 2008;63:299–307CrossRefGoogle ScholarPubMed
9Adappa, ND, Learned, KO, Palmer, JN, Newman, JG, Lee, JYK. Radiographic enhancement of the nasoseptal flap does not predict postoperative cerebrospinal fluid leaks in endoscopic skull base reconstruction. Laryngoscope 2012;122:1226–34CrossRefGoogle Scholar
10Kassam, AB, Thomas, A, Carrau, RL, Snyderman, CH, Vescan, A, Prevedello, D et al. . Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery 2008;63(suppl):ONS44–52Google ScholarPubMed
11Harvey, RJ, Parmar, P, Sacks, R, Zanation, AM. Endoscopic skull base reconstruction of large dural defects: a systematic review of published evidence. Laryngoscope 2012;122:452–9CrossRefGoogle ScholarPubMed
12Pinheiro-Neto, CD, Prevedello, DM, Carrau, RL, Synderman, CH, Mintz, A, Gardner, P et al. Improving the design of the pedicled nasoseptal flap for skull base reconstruction: a radioanatomic study. Laryngoscope 2007;117:1560–9CrossRefGoogle ScholarPubMed
13Oostra, A, van Furth, W, Georgalas, C. Extended endoscopic endonasal skull base surgery: from the sella to the anterior and posterior cranial fossa. ANZ J Surg 2012;82:122–30CrossRefGoogle Scholar
14Bohman, LE, Stein, SC, Newman, JG, Palmer, JN, Adappa, ND, Khan, A et al. Endoscopic versus open resection of tuberculum sellae meningiomas: a decision analysis. ORL J Otorhinolaryngol Relat Spec 2012;74:255–63CrossRefGoogle ScholarPubMed
15Sanborn, MR, Kramarz, MJ, Storm, PB, Adappa, ND, Palmer, JN, Lee, JY. Endoscopic, endonasal, transclival resection of a pontine cavernoma: case report. Neurosurgery 2012;71(suppl):198–203Google ScholarPubMed
16Adappa, ND, Lee, JY, Chiu, AG, Palmer, JN. Olfactory groove meningioma. Otolaryngol Clin North Am 2011;44:965–80CrossRefGoogle ScholarPubMed
17Lee, JY, Ramakrishnan, VR, Chiu, AG, Palmer, J, Gausas, RE. Endoscopic endonasal surgical resection of tumors of the medial orbital apex and wall. Clin Neurol Neurosurg 2012;114:93–8CrossRefGoogle ScholarPubMed
18Hwang, PY, Ho, CL. Neuronavigation using an image-guided endoscopic transnasal-sphenoethmoidal approach to clival chordomas. Neurosurgery 2007;61(suppl):212–17Google ScholarPubMed
19Solares, CA, Grindler, D, Luong, A, Kanowitz, SJ, Sade, B, Citardi, MJ et al. Endoscopic management of sphenoclival neoplasms: anatomical correlates and patient outcomes. Otolaryngol Head Neck Surg 2010;142:315–21CrossRefGoogle ScholarPubMed