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The Expanded Endonasal Approach to Skull Base Meningiomas

  • Amin Kassam
  • Martin Corsten
  • Richard Rovin

Abstract

Classic approaches to the skull base have involved either anterior, middle, or posterior fossa craniotomies, with retraction of the brain to expose the relevant intracranial anatomy, often with separate approaches from the midface or temporal bone to expose the relevant extracranial anatomy. The expanded endonasal approach (EEA) to skull base tumors was introduced as an alternative minimally invasive strategy for selected tumors in the late 1990s/early 2000s [3, 11, 12]. It offered some significant advantages in selected tumors, including the elimination of the need for skin incisions, the elimination of brain retraction, and the addition of excellent visualization of critical structures. In the early part of the experience with EEA, there was significant controversy about its safety, with critics of the approach citing the risk of infection and the possibility of cerebrospinal fluid leakage as a consequence of the procedure. However, early experience showed the safety of the procedure, especially relative to traditional skull base approaches, in selected tumors. We reported our experience in 800 consecutive patients performed by a single neurosurgeon over a decade and demonstrated the safety of the procedure for a broad range of pathologies [15]. Since then, the procedure has been adopted worldwide and has been made safer by advances in technology and reconstructive techniques. Since our original description of a modular anatomical classification system [25], expansion of the anatomic limits of the procedure has continued to increase the number of skull base tumors accessible by this approach. In this chapter, we will describe the use of EEA for skull base meningiomas, focusing on the anatomic limits of the use of EEA for these tumors, the advantages and disadvantages of EEA, and the technical nuances of the use of EEA for meningiomas.

Keywords

Skull Base Cavernous Sinus Occipital Condyle Skull Base Tumor Skull Base Meningioma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Beer-Furlan A, Evins AI, Rigante L, Anichini G, Stieg PE, Bernardo A (2014) Dual-port 2D and 3D endoscopy: expanding the limits of the endonasal approaches to midline skull base lesions with lateral extension. J Neurol Surg B Skull Base 75(3):187–197. doi: 10.1055/s-0033-1364165 PubMedCentralCrossRefPubMedGoogle Scholar
  2. 2.
    Caicedo-Granados E, Carrau R, Snyderman CH, Prevedello D, Fernandez-Miranda J, Gardner P, Kassam A (2010) Reverse rotation flap for reconstruction of donor site after vascular pedicled nasoseptal flap in skull base surgery. Laryngoscope 120(8):1550–1552. doi: 10.1002/lary.20975 CrossRefPubMedGoogle Scholar
  3. 3.
    Cavallo LM, Messina A, Gardner P, Esposito F, Kassam AB, Cappabianca P, de Divitiis E, Tschabitscher M (2005) Extended endoscopic endonasal approach to the pterygopalatine fossa: anatomical study and clinical considerations. Neurosurg Focus 19(1), E5PubMedGoogle Scholar
  4. 4.
    de Lara D, Ditzel Filho LF, Muto J, Otto BA, Carrau RL, Prevedello DM (2013) Surgical management of craniopharyngioma with third ventricle involvement. Neurosurg Focus 34(1 Suppl): Video 5. doi: 10.3171/2013.V1.FOCUS12330
  5. 5.
    Felisati G, Lenzi R, Pipolo C, Maccari A, Messina F, Revay M, Lania A, Cardia A, Lasio G (2013) Endoscopic expanded endonasal approach: preliminary experience with the new 3D endoscope. Acta Otorhinolaryngol Ital organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale 33(2):102–106Google Scholar
  6. 6.
    Fortes FS, Carrau RL, Snyderman CH, Kassam A, Prevedello D, Vescan A, Mintz A, Gardner P (2007) Transpterygoid transposition of a temporoparietal fascia flap: a new method for skull base reconstruction after endoscopic expanded endonasal approaches. Laryngoscope 117(6):970–976. doi: 10.1097/MLG.0b013e3180471482 CrossRefPubMedGoogle Scholar
  7. 7.
    Fortes FS, Carrau RL, Snyderman CH, Prevedello D, Vescan A, Mintz A, Gardner P, Kassam AB (2007) The posterior pedicle inferior turbinate flap: a new vascularized flap for skull base reconstruction. Laryngoscope 117(8):1329–1332. doi: 10.1097/mlg.0b013e318062111f CrossRefPubMedGoogle Scholar
  8. 8.
    Gardner PA, Kassam AB, Thomas A, Snyderman CH, Carrau RL, Mintz AH, Prevedello DM (2008) Endoscopic endonasal resection of anterior cranial base meningiomas. Neurosurgery 63(1):36–52; discussion 52–54. doi: 10.1227/01.NEU.0000335069.30319.1E
  9. 9.
    Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH, Mintz A (2006) A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 116(10):1882–1886. doi: 10.1097/01.mlg.0000234933.37779.e4 CrossRefPubMedGoogle Scholar
  10. 10.
    Hadad G, Rivera-Serrano CM, Bassagaisteguy LH, Carrau RL, Fernandez-Miranda J, Prevedello DM, Kassam AB (2011) Anterior pedicle lateral nasal wall flap: a novel technique for the reconstruction of anterior skull base defects. Laryngoscope 121(8):1606–1610. doi: 10.1002/lary.21889 CrossRefPubMedGoogle Scholar
  11. 11.
    Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL (2005) Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurg Focus 19(1):E3PubMedGoogle Scholar
  12. 12.
    Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL (2005) Expanded endonasal approach: the rostrocaudal axis. Part II. Posterior clinoids to the foramen magnum. Neurosurg Focus 19(1):E4PubMedGoogle Scholar
  13. 13.
    Kassam AB, Prevedello DM, Thomas A, Gardner P, Mintz A, Snyderman C, Carrau R (2008) Endoscopic endonasal pituitary transposition for a transdorsum sellae approach to the interpeduncular cistern. Neurosurgery 62(3 Suppl 1):57–72; discussion 72–54. doi: 10.1227/01.neu.0000317374.30443.23
  14. 14.
    Kassam AB, Prevedello DM, Carrau RL, Snyderman CH, Gardner P, Osawa S, Seker A, Rhoton AL Jr (2009) The front door to Meckel’s cave: an anteromedial corridor via expanded endoscopic endonasal approach- technical considerations and clinical series. Neurosurgery 64(3 Suppl):ons71–82; discussion ons82–83. doi: 10.1227/01.NEU.0000335162.36862.54
  15. 15.
    Kassam AB, Prevedello DM, Carrau RL, Snyderman CH, Thomas A, Gardner P, Zanation A, Duz B, Stefko ST, Byers K, Horowitz MB (2011) Endoscopic endonasal skull base surgery: analysis of complications in the authors’ initial 800 patients. J Neurosurg 114(6):1544–1568. doi: 10.3171/2010.10.JNS09406 CrossRefPubMedGoogle Scholar
  16. 16.
    Labib MA, Prevedello DM, Carrau R, Kerr EE, Naudy C, Abou Al-Shaar H, Corsten M, Kassam A (2014) A road map to the internal carotid artery in expanded endoscopic endonasal approaches to the ventral cranial base. Neurosurgery 10(Suppl 3):448–471; discussion 471. doi: 10.1227/NEU.0000000000000362
  17. 17.
    McLaughlin N, Ditzel Filho LF, Prevedello DM, Kelly DF, Carrau RL, Kassam AB (2012) Side-cutting aspiration device for endoscopic and microscopic tumor removal. J Neurol Surgery B Skull Base 73(1):11–20. doi: 10.1055/s-0032-1304834 CrossRefGoogle Scholar
  18. 18.
    Morera VA, Fernandez-Miranda JC, Prevedello DM, Madhok R, Barges-Coll J, Gardner P, Carrau R, Snyderman CH, Rhoton AL Jr, Kassam AB (2010) “Far-medial” expanded endonasal approach to the inferior third of the clivus: the transcondylar and transjugular tubercle approaches. Neurosurgery 66(6 Suppl Operative):211–219; discussion 219–220. doi: 10.1227/01.NEU.0000369926.01891.5D
  19. 19.
    Patel MR, Shah RN, Snyderman CH, Carrau RL, Germanwala AV, Kassam AB, Zanation AM (2010) Pericranial flap for endoscopic anterior skull-base reconstruction: clinical outcomes and radioanatomic analysis of preoperative planning. Neurosurgery 66(3):506–512 ; discussion 512. doi: 10.1227/01.NEU.0000365620.59677.FF
  20. 20.
    Prevedello DM, Barges-Coll J, Fernandez-Miranda JC, Morera V, Jacobson D, Madhok R, dos Santos MC, Zanation A, Snyderman CH, Gardner P, Kassam AB, Carrau R (2009) Middle turbinate flap for skull base reconstruction: cadaveric feasibility study. Laryngoscope 119(11):2094–2098. doi: 10.1002/lary.20226 CrossRefPubMedGoogle Scholar
  21. 21.
    Rivera-Serrano CM, Oliver C, Prevedello D, Gardner P, Snyderman C, Kassam A, Carrau RL (2010) Pedicled Facial Buccinator (FAB) flap: a new flap for reconstruction of skull base defects. The Laryngoscope 120(Suppl 4):S234. doi: 10.1002/lary.21701 CrossRefPubMedGoogle Scholar
  22. 22.
    Rivera-Serrano CM, Bassagaisteguy LH, Hadad G, Carrau RL, Kelly D, Prevedello DM, Fernandez-Miranda J, Kassam AB (2011) Posterior pedicle lateral nasal wall flap: new reconstructive technique for large defects of the skull base. Am J Rhinol Allergy 25(6):e212–e216. doi: 10.2500/ajra.2011.25.3693 CrossRefPubMedGoogle Scholar
  23. 23.
    Rivera-Serrano CM, Snyderman CH, Gardner P, Prevedello D, Wheless S, Kassam AB, Carrau RL, Germanwala A, Zanation A (2011) Nasoseptal “rescue” flap: a novel modification of the nasoseptal flap technique for pituitary surgery. Laryngoscope 121(5):990–993. doi: 10.1002/lary.21419 CrossRefPubMedGoogle Scholar
  24. 24.
    Shah RN, Leight WD, Patel MR, Surowitz JB, Wong YT, Wheless SA, Germanwala AV, Zanation AM (2011) A controlled laboratory and clinical evaluation of a three-dimensional endoscope for endonasal sinus and skull base surgery. Am J Rhinol Allergy 25(3):141–144. doi: 10.2500/ajra.2011.25.3593 CrossRefPubMedGoogle Scholar
  25. 25.
    Snyderman C, Kassam A, Carrau R, Mintz A, Gardner P, Prevedello DM (2007) Acquisition of surgical skills for endonasal skull base surgery: a training program. Laryngoscope 117(4):699–705. doi: 10.1097/MLG.0b013e318031c817 CrossRefPubMedGoogle Scholar
  26. 26.
    Zanation AM, Carrau RL, Snyderman CH, Germanwala AV, Gardner PA, Prevedello DM, Kassam AB (2009) Nasoseptal flap reconstruction of high flow intraoperative cerebral spinal fluid leaks during endoscopic skull base surgery. Am J Rhinol Allergy 23(5):518–521. doi: 10.2500/ajra.2009.23.3378 CrossRefPubMedGoogle Scholar
  27. 27.
    Zanation AM, Snyderman CH, Carrau RL, Gardner PA, Prevedello DM, Kassam AB (2009) Endoscopic endonasal surgery for petrous apex lesions. Laryngoscope 119(1):19–25. doi: 10.1002/lary.20027 CrossRefPubMedGoogle Scholar
  28. 28.
    Zanation AM, Snyderman CH, Carrau RL, Kassam AB, Gardner PA, Prevedello DM (2009) Minimally invasive endoscopic pericranial flap: a new method for endonasal skull base reconstruction. Laryngoscope 119(1):13–18. doi: 10.1002/lary.20022 CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of NeurosurgeryAurora Health CareMilwaukeeUSA
  2. 2.Department of OtolaryngologyAurora Health CareMilwaukeeUSA

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