CSF leak after pediatric endoscopic endonasal expanded approaches: a series review.

Purpose: Endoscopic endonasal approaches in the pediatric population pose specific challenges. Management of postoperative cerebrospinal fluid [CSF] leak is probably the major concern. The purpose of the present investigation is to describe and analyze the incidence of postoperative CSF leaks in our pediatric series of endoscopic endonasal approaches.

Septal rhinopharyngeal flap: a novel technique for skull base reconstruction after endoscopic endonasal clivectomies.

Endoscopic endonasal reconstruction techniques have improved CSF leak rates that were initially reported after surgery for cranial base and intradural lesions. However, wide surgical defects still pose a problem, especially if located in the clival region. The authors propose and describe a novel reconstruction technique they call a septal rhinopharyngeal flap (SRF) specifically designed to address this issue.

Endonasal Odontoidectomy in Basilar Invagination.

 The endoscopic endonasal odontoidectomy (EEO) is emerging as a feasible surgical alternative to conventional microscopic transoral approach. In this article, we show EEO in the basilar invagination (BI) and describe in detail the technical aspects, advantages, and disadvantages of this approach ( Fig. 1 ).

Gangliogliomas in the pediatric population.

Background: Gangliogliomas are neoplastic lesions composed by a mixed population of neoplastic glial and dysplastic neural cells. They represent around 5% of all CNS tumors in the pediatric population. These usually are well-differentiated, slow-growing tumors, meaning that complete resection could cure most of these patients.

Impact of Multilayer Vascularized Reconstruction after Skull Base Endoscopic Endonasal Approaches.

 The use of vascularized flap to reconstruct the skull base defects has dramatically changed the postoperative cerebrospinal fluid (CSF) leak rates allowing the expansion of endoscopic skull base procedures. At present, there is insufficient scientific evidence to permit identification of the optimal reconstruction technique after the endoscopic endonasal approach (EEA).  The main purpose of this article is to establish the risk factors for failure in the reconstruction after EEA and whether the use of a surgical reconstruction protocol can improve the surgical results.

Spontaneous CSF rhinorrhea as a presenting symptom of a clival chordoma.

CSF rhinorrhea is a rare presenting symptom of a clival chordoma as these tumors do not tend to show dural invasion as a histological feature. Here we discuss the case of a 61 years old female with spontaneous rhinorrhea secondary to a clival chordoma, and the value of some specific MRI sequences in accurate identification of a tumor with such atypical presentation, enabling the surgeon to plan accordingly.

Laparoscopy-assisted placement of a ventriculobiliary shunt: a technical note.

Purpose: Hydrocephalus is a common condition in pediatric neurosurgeon's clinical practice. Peritoneal and atrial shunting is the treatment of choice in the immense majority of patients. Sometimes, there are complex cases that may need innovative solutions in order to implant the distal catheter of the shunt: in these situations, the gallbladder is a well-described option and it can be safely used.

Radiological Study of the Carotid-Clival Window and Its Application in Endoscopic Endonasal Expanded Approaches.

Background: The surgical approach to the petrous apex (PA) and petroclival junction (PCJ) remains a challenge. The carotid-clival window (CCW) represents the widest window available to approach the PCJ from a mediolateral endoscopic route. Here we define the CCW radiologically in nonpathological conditions, to establish the anatomic variability of the PCJ, relate this variability to pneumatization patterns, and evaluate some technical concerns conditioned by the CCW.

Endo ICG videoangiography: localizing the carotid artery in skull-base endonasal approaches.

Background: In this work, the applicability of ICG-VA to skull base endoscopic surgery and its capacity to locate the internal carotid artery are shown.

Methods: An adapted optical module to perform ICG-VA was used to perform endoscopic procedures. There were two intraoperative phases of interest that were used to evaluate the ICA: upon exposure of the skull base and during the intradural exploration.

Transantral endoscopic approach for the treatment of lesions affecting the maxillary nerve.

Background: Surgical approaches to skull base lesions that affect the maxillary nerve are complex, due to deep location and presence of relevant neurovascular structures surrounding this area.

Method: We propose the transantral endoscopic approach (TEA) for the treatment of lesions affecting the maxillary nerve or its vicinity. More specifically, the ones that are located anterior to the foramen rotundum.

Full endoscopic endonasal transsellar-transclival approach: the modularity concept.

Background: Endoscopic endonasal approaches (EEAs) constitute a reasonable option for the treatment of lesions that involve the sellar and clival regions.

Methods: We describe, step by step, the full EEA expanded to the middle and lower clivus for the treatment of perisellar lesions. Delimiting different modules around the sellar region is useful in establishing the best endoscopic approach for each tumor.

Indocyanine Green Videoangiography in Negative: Spinal Dural Arteriovenous Fistula.

Introduction This work reports the first indocyanine green videoangiography (IGV) in negative published with video format support. This technique, so called because its first phase is performed with occlusion of the vessel suspected of being pathologic, is used for the diagnosis of spinal arteriovenous fistula (sDAVF). Case Report The authors present the case of a 68-year-old man with an sDAVF fed by the right T7 segmentary artery.

Brain abscess as the initial presentation of a macroprolactinoma: Case report.

Macroprolactinomas may behave invasively and infiltrate the skull base, causing a subsequent thinning that can also lead to a bone defect and a direct route of entry for pathogens. We describe the case of a 34-year-old male admitted to hospital with fever (38°C), headache, stiffness in the neck, diplopia and neurological impairment. Brain magnetic resonance imaging showed two bilateral abscesses in the fronto-parietal areas with intracranial venous sinus thrombosis and a pituitary adenoma that extended from the suprasellar region, eroding the sellar floor into the sphenoid sinus.

Indocyanine green videoangiography methodological variations: review.

Indocyanine green videoangiography (ICGVA) procedures have become widespread within the spectrum of microsurgical techniques for neurovascular pathologies. We have conducted a review to identify and assess the impact of all of the methodological variations of conventional ICGVA applied in the field of neurovascular pathology that have been published to date in the English literature. A total of 18 studies were included in this review, identifying four primary methodological variants compared to conventional ICGVA: techniques based on the transient occlusion, intra-arterial ICG administration via catheters, use of endoscope system with a filter to collect florescence of ICG, and quantitative fluorescence analysis.

Full endoscopic endonasal expanded approach to the petroclival region: optimizing the carotid-clival window.

Background: The petroclival junction (PCJ) is a challenging skull base location from neurosurgical point of view, especially if the retrocarotid space has to be reached.

Method: In response to this challenge, this report provides a detailed full description of the endoscopic endonasal expanded approach (EEA) to the petroclival region and retrocarotid space. We present the technique step by step, introducing a critical concept about the optimization of the petroclival drilling, generating the carotid-clival window (CCW).

Full endoscopic endonasal suprapetrous approach to Meckel's cave.

Background: Meckel's cave is an anatomically complex region that can be approached surgically via several routes, namely the posterolateral, lateral, anterolateral, and, due to recent advancements, anteromedial routes, with the latter being represented by the expanded endonasal approaches.

Method: We describe in detail the surgical technique of the suprapetrous endonasal approach to Meckel's cave and highlight the main anatomical key elements involved in this approach as well as the technical aspects for avoiding surgical complications.

Conclusion: The suprapetrous endonasal approach to Meckel's cave avoids the brain tissue retraction, and thereby prevents postoperative brain edema.

Microscopic versus endoscopic pituitary surgery.

Introduction And Objective: The endoscopic techniques used in pituitary surgery have evolved greatly in recent years. Our objective in this study was to conduct a review of the systematic reviews published in the English language literature, to examine their consistency and conclusions reached following studies comparing microsurgery and endoscopic surgery in hypophyseal surgery.

Materials And Methods: We carried out a bibliographic search on MEDLINE and EMBASE electronic databases, selecting those systematic reviews and meta-analyses published from the year 2000 until January 2013, focusing on comparisons between microsurgical and endoscopic techniques.

Full endoscopic endonasal transclival approach: meningioma attached to the ventral surface of the brainstem.

Background: Intracranial meningiomas without dural attachment (MWODA) are rare entities. We present the first case published, to the best of our knowledge, regarding a MWODA attached to the ventral surface of the brainstem. This location makes the patient subsidiary to treatment through an expanded endonasal transclival approach.

[Endonasal skull base endoscopy].

Introduction And Objective: The endoscopic endonasal techniques used in skull base surgery have evolved greatly in recent years. Our study objective was to perform a qualitative systematic review of the likewise systematic reviews in published English language literature, to examine the evidence and conclusions reached in these studies comparing transcranial and endoscopic approaches in skull base surgery.

Material And Methods: We searched the references on the MEDLINE and EMBASE electronic databases selecting the systematic reviews, meta-analyses and evidence based medicine reviews on skull based pathologies published from January 2000 until January 2013.

[Sacral metastasis simulating aneurysmal bone cyst].

Cystic spinal lesions with characteristic patterns, such as the presence of haematic fluid-fluid levels (H-FFL), have been associated with many tumoral lineages, more frequently with aneurysmal bone cyst (ABC) and exceptionally with metastasis. We present the case of a 60-year-old man with the finding of a sacral cystic bone lesion with H-FFL, with initial suspicion of ABC and confirmed diagnosis of metastasis. The case presented is, to our knowledge, the second case published of spinal cystic bone metastasis with H-FFL pattern with unknown primary tumour at the time of diagnosis and the only one that received resective surgical treatment, achieving pulmonary and metastatic disease control with good quality of life after 1 year of follow up.

Primary extraosseous intradural spinal Ewing's sarcoma: report of two cases.

Two cases of primary extraosseous intradural spinal Ewing's sarcoma are reported with a review of the current literature. This rare neoplasm shares features with cerebral primitive neuroectodermal tumors, complicating a correct diagnosis. Gross total resection seems to be the main treatment, although adjuvant therapies could improve the prognosis.

Full endoscopic endonasal extreme far-medial approach: Eustachian tube transposition.

The complex anatomical relationships within the skull base have been described from an endoscopic point of view. However, systematic surgical, not just anatomical, management of the eustachian tube (ET) and the approach to the styloid and parapharyngeal spaces have not yet been described. The authors describe the full endoscopic endonasal extreme far-medial approach used in their surgical practice and show how they applied it to a case.