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The use of a three-dimensional endoscope for different skull base tumors: results of a preliminary extended endonasal surgical series

  • Clinical Article - Brain Tumors
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Abstract

Background

The evolution of skull base surgery over the past decade has been influenced by advancement in visualization technology. Recently, as a result of such improvements, three-dimensional (3-D) scopes have been widely used during endoscopic endonasal approaches. In the present study, we describe the use of 3-D stereoscopic endoscope for the treatment of a variety of skull base lesions.

Methods

From January 2010 to June 2015, a 3-D endoscopic endonasal approach (4 and 4.9 mm, 0°, and 30° rigid endoscopes) was performed in 70 patients with the following lesions: 42 large extrasellar pituitary macroadenomas, seven tuberculum sellae meningiomas, seven clivus chordomas, five craniopharyngiomas, three fibrous dysplasia of the clivus, three sinonasal malignancies, one orbital lymphangioma, one trigeminal neurinoma, one primary suprasellar lymphoma.

Results

Total tumor removal was obtained in 50 patients (71.4 %) while in 14 (20 %), subtotal removal was possible in six (8.6 %) only partial removal was achieved. Overall complications included diabetes insipidus in eight patients (11.4 %), hypopituitarism in seven patients (10 %), CSF leak in five patients (7.1 %), cranial nerve injury in two patients (2.8 %), panhypopituitarism in two patients (2.8 %), meningitis in one (1.4 %) and one postoperative central retinal artery occlusion (1.4 %). There was no mortality in the series. The mean follow-up time was 39 months (range, 6–72 months).

Conclusions

In our experience, the 3-D endoscope represents a critical development in visualization, thus enabling improved hand–eye coordination and depth perception, which are mandatory for the management of complex intradural neurovascular structures during tumor removal surgery.

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Authors and Affiliations

  1. Department of Neuroscience, “G. Rummo” Hospital, Neurosurgery Operative Unit, Via Pacevecchia n.53, 82100, Benevento, Italy

    Giuseppe Catapano, Matteo de Notaris, Giuseppe Di Nuzzo, Vincenzo Seneca & Giuseppina Iorio

  2. Unit of Otorhinolaryngology, “G. Rummo” Hospital, Benevento, Italy

    Domenico Di Maria

  3. Department of Neurosurgery, Centro Nacional de Cirugía de Mínimo Acceso, La Habana, Cuba

    Luis Alonso Fernandez

  4. Unit of Otorhinolaryngology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy

    Iacopo Dallan

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  1. Giuseppe Catapano
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Correspondence to Matteo de Notaris.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Intraoperative video showing the removal of a tuberculum sellae meningioma using a 3-D extended endoscopic endonasal transtuberculum/transplanum approach (MP4 60995 kb)

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Catapano, G., de Notaris, M., Di Maria, D. et al. The use of a three-dimensional endoscope for different skull base tumors: results of a preliminary extended endonasal surgical series. Acta Neurochir 158, 1605–1616 (2016). https://doi.org/10.1007/s00701-016-2847-8

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  • DOI: https://doi.org/10.1007/s00701-016-2847-8

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