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Surgical nuances of the expanded endoscopic anterior skull base craniectomy for hyperostotic meningioma resection

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Abstract

Background

The rostral expanded endoscopic approach (EEA) to anterior cranial fossa (ACF) has several advantages over transcranial/craniofacial surgery, providing early access to the vascular supply of tumors and reducing morbidities of craniotomy especially that of brain retraction. This article presents endoscopic landmarks and nuances for a wide ACF corridor, with stepwise image-guided dissections highlighting surgical tricks and techniques to enhance surgical safety.

Methods

We describe an expanded endoscopic endonasal anterior skull base craniectomy for a recurrent large olfactory groove hyperostotic meningioma, with correlated cadaveric dissections.

Conclusion

The widening of rostral EEA can provide a safe and feasible route to access ACF. This article highlights the specific landmarks in endoscopic anatomy with reference to the angle of visualization and bayonetted instruments.

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Abbreviations

EEEa:

Expanded endoscopic endonasal approaches

ICA:

Internal carotid artery

AEA:

Anterior ethmoidal artery

ACF:

Anterior cranial fossa

FE:

Fovea ethmoidalis

PEA:

Posterior ethmoidal artery

LP:

Lamina papyracea

CSF:

Cerebrospinal fluid

IGS:

Image guidance system

ACP:

Anterior clinoid process

References

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Acknowledgments

We thank Ricardo L. Carrau, MD, for his invaluable guidance and intellectual contribution during this project.

Funding

No funding was received for this research.

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, The Ohio State University Medical Center, N-1049 Doan Hall, 410 West 10th, Avenue, Columbus, OH, 43210, USA

    Giuliano Silveira-Bertazzo & Daniel M. Prevedello

  2. Department of Neurological Surgery, McLaren Hospital, Bay Region, Bay City, MI, USA

    Sunil Manjila

  3. Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Medical Center, Columbus, OH, USA

    Nyall R. London Jr

  4. Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Nyall R. London Jr

  5. National Institute on Deafness and Other Communication Disorders, NIH, Bethesda, MD, USA

    Nyall R. London Jr

Authors
  1. Giuliano Silveira-Bertazzo
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  2. Sunil Manjila
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  3. Nyall R. London Jr
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  4. Daniel M. Prevedello
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Corresponding author

Correspondence to Daniel M. Prevedello.

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Conflict of interest

This study was performed at ALT-VISION at the Ohio State University. This laboratory receives educational support from the following companies: Carl Zeiss Microscopy, Intuitive Surgical Corp., KLS Martin Corp., Karl Storz Endoscopy, Leica Microsystems, Medtronic Corp., Stryker Corp., and Vycor Medical. Dr. Prevedello is a consultant for Stryker Corp., Medtronic Corp., and Integra; he has received an honorarium from Mizuho and royalties from KLS Martin. N. London holds stock in Navigen Pharmaceuticals currently of no value and was a consultant for Cooltech Inc., both of which are unrelated to this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ohio State University Wexner Medical Center institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Silveira-Bertazzo, G., Manjila, S., London, N.R. et al. Surgical nuances of the expanded endoscopic anterior skull base craniectomy for hyperostotic meningioma resection. Acta Neurochir 162, 1269–1274 (2020). https://doi.org/10.1007/s00701-020-04277-x

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  • DOI: https://doi.org/10.1007/s00701-020-04277-x

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