1. Expanded transnasal approaches to the skull base in the Middle East: Where do we stand?
- Author
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Alsaleh S, Albakr A, Alromaih S, Alatar A, Alroqi AS, and Ajlan A
- Subjects
- Adenoma diagnostic imaging, Adenoma surgery, Adolescent, Adult, Aged, Astrocytoma diagnostic imaging, Astrocytoma surgery, Brain Neoplasms diagnostic imaging, Brain Neoplasms surgery, Carotid Artery Injuries epidemiology, Carotid Artery Injuries surgery, Carotid Artery, Internal, Cerebral Arteries injuries, Cerebral Ventriculitis epidemiology, Cerebrospinal Fluid Leak surgery, Child, Child, Preschool, Chordoma diagnostic imaging, Chordoma surgery, Craniopharyngioma diagnostic imaging, Craniopharyngioma surgery, Diabetes Insipidus epidemiology, Epidermal Cyst diagnostic imaging, Epidermal Cyst surgery, Female, Humans, Intraoperative Complications epidemiology, Intraoperative Complications surgery, Male, Meningeal Neoplasms diagnostic imaging, Meningeal Neoplasms surgery, Meningioma diagnostic imaging, Meningioma surgery, Meningitis epidemiology, Middle Aged, Natural Orifice Endoscopic Surgery methods, Optic Nerve Glioma diagnostic imaging, Optic Nerve Glioma surgery, Pituitary Neoplasms diagnostic imaging, Pituitary Neoplasms surgery, Postoperative Complications surgery, Reoperation, Saudi Arabia, Skull Base Neoplasms diagnostic imaging, Surgical Wound Infection epidemiology, Teratoma diagnostic imaging, Teratoma surgery, Vascular System Injuries epidemiology, Vascular System Injuries surgery, Young Adult, Cerebrospinal Fluid Leak epidemiology, Nasal Cavity, Neuroendoscopy methods, Postoperative Complications epidemiology, Skull Base Neoplasms surgery
- Abstract
Background: Endoscopic transnasal surgery has gained rapid global acceptance over the last two decades. The growing literature and understanding of anterior skull base endoscopic anatomy, in addition to new dedicated endoscopic instruments and tools, have helped to expand the use of the transnasal route in skull base surgery., Objective: Report our early experience in expanded endoscopic transnasal surgery (EETS) and approach to skull base neoplasms., Design: Descriptive, retrospective case series., Setting: Major tertiary care center., Patients and Methods: A retrospective case review was conducted at King Saud University Medical City between December 2014 and August 2019. Cases with skull base neoplasms that underwent EETS were included. EETS was defined as endoscopic surgical exposure that extended beyond the sellar margins (prechiasmatic sulcus superiorly, clival recess inferiorly, cavernous carotid lines laterally). Routine transsphenoidal pituitary neoplasms, neoplasms of sinonasal origin and meningoencephaloceles were excluded., Main Outcome Measures: Preoperative clinical assessment, imaging results, surgical approach, and hospital course were all retrieved from the patient electronic charts. Clinical follow-up, perioperative complications, and gross residual tumor rates were documented and reviewed., Sample Size and Characteristics: 45 cases of EETS, 13 males and 32 females with mean age of 39.0 (17.7) years (range 2-70 years)., Results: The series comprised a wide range of pathologies, including giant pituitary adenoma (8 cases), meningioma (23 cases), craniopharyngioma (4 cases), chordoma (4 cases), optic pathway glioma (2 cases), epidermoid neoplasms (2 cases), astrocytoma (1 case), and teratoma (1 case). For the entire series, gross total resection was achieved in 25/45 operations (55.5%). Postoperative cerebrospinal fluid leak was the most common complication observed in 9 patients (20%) which were all managed endoscopically. Major vascular complications occurred in 2 patients (4.4%) and are described. Other complications are outlined as well. No mortality was observed., Conclusions: EETS to the skull base can be done with results comparable to traditional approaches. More work is needed to expand our experience, improve outcomes, and educate the public and medical community in our region about the usefulness of this approach., Limitations: Sample size and study design., Conflict of Interest: None.
- Published
- 2020
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