The McConnell's Capsular Arteries and Their Relevance in Endoscopic Endonasal Approach to the Sellar Region.

Background: The McConnell's capsular arteries (MCCA) were first described in 1953. They consist of medial branches of the cavernous internal carotid artery (ICA) and are divided in anterior and inferior capsular arteries.

Objective: To highlight the anatomy of the MCCA and its importance in the surgical treatment of tuberculum sellae and planum sphenoidale tumors through an endoscopic endonasal approach.

Endoscopic endonasal pituitary gland hemi-transposition for resection of a dorsum sellae meningioma.

A 69-year-old female with incidental diagnosis of a dorsum sellae meningioma had shown significant tumor growth after initial conservative management. The procedure started with a microscopic sublabial transsphenoidal approach to the sella and the suprasellar space. Due to limitations to a safe dissection and removal of the retrosellar component, the surgery was converted to a purely endoscopic endonasal approach with left hemi-transposition of the pituitary gland, followed by drilling of the dorsum sellae and removal of the left posterior clinoid process.

A Side Door to Meckel's Cave: Anatomic Feasibility Study for the Lateral Transorbital Approach.

Background: In the last decade, endoscopic skull base surgery has significantly developed and generated a plethora of techniques and approaches for access to the cranial ventral floor. However, the exploration for the least-aggressive, maximally efficient approach continues.

Objective: To describe in detail an anatomical study, along with the technical nuances of a novel endoscopic approach to Meckel's Cave (MC) using a lateral transorbital (LTO) route.

Cerebrospinal Fluid Leak Rhinorrhea after Systemic Erlotinib Chemotherapy for Metastatic Lung Cancer: A Familiar Problem from an Unfamiliar Culprit.

Background: Cerebrospinal fluid (CSF) rhinorrhea after medical therapy for pituitary prolactinoma is a rare but well-described phenomenon. To our knowledge, no CSF leaks have been reported after targeted medical treatment of pituitary or anterior skull base metastases. We report this unusual case to raise awareness of spontaneous CSF leaks in the setting of skull base metastatic disease.

Indocyanine Green Fluorescence to Evaluate Nasoseptal Flap Viability in Endoscopic Endonasal Cranial Base Surgery.

 The pedicled nasoseptal flap (NSF) has dramatically reduced postoperative cerebrospinal fluid leakage following endoscopic endonasal approach (EEA) surgery. Although rare, its arterial supply may be damaged during harvest or may be preoperatively damaged for numerous reasons. Early recognition permits harvesting a contralateral flap before sacrificing its pedicle as part of the surgical exposure or use of an alternative flap.

Surgical Anatomy for the Endoscopic Endonasal Approach to the Ventrolateral Skull Base.

The authors describe the surgical anatomy for the endoscopic endonasal approach (EEA) to the ventrolateral skull base. The ventrolateral skull base can be divided into two segments: the upper lateral and lower lateral skull base. The upper lateral skull base includes the cavernous sinus and the orbit, while the lower lateral skull base includes the petrous apex, Meckel's cave, parapharyngeal space, infratemporal fossa, etc.

Newly Diagnosed Sellar Tumors in Patients with Cancer: A Diagnostic Challenge and Management Dilemma.

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.

Inside Vietnam's Largest Neurosurgery Department.

Cho Ray Hospital is the premier tertiary care center in Ho Chi Minh City, Vietnam's most populous city. The neurosurgical department was founded in 1958 and is currently one of the busiest in the world. Last year the department was responsible for more than 10,000 neurosurgical operations, excluding neuroendovascular cases.

Optic Canal Decompression: Comparison of 2 Surgical Techniques.

Background: The optic canal is a bony channel that connects the anterior cranial fossa and orbit and contains the optic nerve and ophthalmic artery. It can be affected by several pathologies, leading to compression of the nerve nearby or inside the canal, leading to visual impairment. The usual technique to decompress the canal is through a craniotomy, but recently endoscopic endonasal approaches (EEAs) have surfaced as an interesting alternative due to direct access to the canal without the need for manipulation of neurovascular structures.

Case report: ACTH-secreting pituitary carcinoma metastatic to the liver in a patient with a history of atypical pituitary adenoma and Cushing's disease.

Background: Pituitary carcinoma is a rare entity requiring the presence of metastasis to confirm its malignant potential. We report a case of pituitary carcinoma and discuss the diagnosis and management of this lesion in relation to the existing literature.

Case Presentation: The patient is a 51-year-old woman with Cushing's disease and intact adrenal glands who was diagnosed with metastatic pituitary carcinoma to the liver, 29 months after initial resection of an ACTH-secreting primary atypical pituitary adenoma (APA).

Periodic olfactory assessment in patients undergoing skull base surgery with preservation of the olfactory strip.

Objectives/hypothesis: Others have reported olfactory disturbances following endoscopic approaches to the skull base. However, there is a lack of consensus on the extent and duration of dysfunction. This study aimed to compare our results with previously published work and to validate the olfactory strip-sparing approach.

Anatomical nuances of the internal carotid artery in relation to the quadrangular space.

OBJECTIVE The aim of this study was to evaluate the anatomical variations of the internal carotid artery (ICA) in relation to the quadrangular space (QS) and to propose a classification system based on the results. METHODS A total of 44 human cadaveric specimens were dissected endonasally under direct endoscopic visualization. During the dissection, the anatomical variations of the ICA and their relationship with the QS were noted.

Posterior Reversible Encephalopathy Syndrome Causing Vision Loss After Endoscopic Endonasal Resection of Pituitary Adenoma.

Background: Posterior reversible encephalopathy syndrome (PRES) is characterized by headache, altered mental status, visual changes, and seizure combined with brain imaging consistent with cerebral edema without infarction. To the best of our knowledge, we report the first case of PRES after an endoscopic endonasal resection of a pituitary macroadenoma.

Case Description: A 59-year-old woman was diagnosed with a pituitary macroadenoma, for which she underwent endoscopic endonasal extracapsular resection.

Role of Leukocyte-Platelet-Rich Fibrin in Endoscopic Endonasal Skull Base Surgery Defect Reconstruction.

 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.  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.

Sinonasal Carcinomas with Neuroendocrine Features: Histopathological Differentiation and Treatment Outcomes.

 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.  Following institutional review board approval, the records of all patients with biopsy-proven sinonasal malignancies over a 5-year period were reviewed.

Comparative analysis of the anterior transpetrosal approach with the endoscopic endonasal approach to the petroclival region.

OBJECTIVE The endoscopic endonasal approach (EEA) offers direct access to midline skull base lesions, and the anterior transpetrosal approach (ATPA) stands out as a method for granting entry into the upper and middle clival areas. This study evaluated the feasibility of performing EEA for tumors located in the petroclival region in comparison with ATPA. METHODS On 8 embalmed cadaver heads, EEA to the petroclival region was performed utilizing a 4-mm endoscope with either 0° or 30° lenses, and an ATPA was performed under microscopic visualization.

Role of F-FDG PET/CT differentiating olfactory neuroblastoma from sinonasal undifferentiated carcinoma.

Objectives: The purpose of this study is to demonstrate the potential contribution of positron emission tomography (PET)/computed tomography (CT) to help differentiate olfactory neuroblastoma (ONB) from sinonasal undifferentiated carcinoma (SNUC).

Methods: Following approval by the institutional review board at the Wexner Medical Center at the Ohio State University, Columbus, Ohio, a pilot study with retrospective review of patients with biopsy-proven diagnosis of ONB s and SNUC s was conducted. Staging PET/CT scans were reviewed to document the maximum standardized uptake value (SUVmax).

Training model for control of an internal carotid artery injury during transsphenoidal surgery.

Objectives: As the adoption of endoscopic endonasal approaches (EEA) continues to proliferate, increasing numbers of internal carotid artery (ICA) injuries are reported. The objective of this study was to develop a synthetic ICA injury-training model that could mimic this clinical scenario and be portable, repeatable, reproducible, and without risk of biological contamination.

Methods: Based on computed tomography of a human head, we constructed a synthetic model using selective laser sintering with polyamide nylon and glass beads.

Endoscopic trans-sphenoidal surgery for petroclival and clival meningiomas.

Petroclival meningiomas are challenging lesions to manage independently of the selected surgical approach and are unique tumors in the type of pathological displacement of the surrounding anatomy. They also represent one of the most controversial entities with regard to approach selection, especially when deciding between an open versus endonasal route. When choosing an approach to the intradural portion of the petroclival region, the location of critical neurovascular structures relative to the lesion must be anticipated, including the abducens and trigeminal nerves.

Effect of Incremental Endoscopic Maxillectomy on Surgical Exposure of the Pterygopalatine and Infratemporal Fossae.

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.

Endoscopic endonasal study of the cavernous sinus and quadrangular space: Anatomic relationships.

Background: The quadrangular space permits an anterior entry into Meckel's cave while obviating the need for cerebral or cranial nerve retraction. This avenue is intimately associated with the cavernous sinus; thus, from this ventral perspective, it is feasible to visualize the anteromedial, anterolateral, and Parkinson triangles.

Methods: Twenty middle cranial fossae were dissected endonasally under direct endoscopic visualization.