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Endoscopic Endonasal Transsphenoidal Approach

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Midline Skull Base Surgery

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Abstract

Clival chordomas are lesions located at the anterolateral aspect of the brainstem, involving the extradural and seldom the intradural spaces. These tumors have been historically accessed through posterolateral approaches, which offer a comfortable surgical corridor for this kind of lesions: indeed, the retrosigmoid approach is considered adequate for chordomas that involve mainly the cerebellomesencephalic and cerebellopontine cisterns (Samii A, Gerganov VM, Herold C, Hayashi N, Naka T, Mirzayan MJ, Ostertag H, Samii M (2007) Chordomas of the skull base: surgical management and outcome. J Neurosurg 107(2):319–324), whereas in the far lateral approach, it is more suitable for those mainly interested in the cerebellomedullary cistern (Liu JK, Couldwell WT (2005) Far-lateral transcondylar approach: surgical technique and its application in neurenteric cysts of the cervicomedullary junction. Report of two cases. Neurosurg Focus 19(2), E9; Wen HT, Rhoton AL Jr, Katsuta T, de Oliveira E (1997) Microsurgical anatomy of the transcondylar, supracondylar, and paracondylar extensions of the far-lateral approach. J Neurosurg 87(4):555–585).

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References

  1. Al-Mefty O, Kadri PA, Hasan DM, Isolan GR, Pravdenkova S (2008) Anterior clivectomy: surgical technique and clinical applications. J Neurosurg 109(5):783–793

    Article  PubMed  Google Scholar 

  2. Anand VK, Harkey HL, Al-Mefty O (1991) Open-door maxillotomy approach for lesions of the clivus. Skull Base Surg 1(4):217–225

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Ares C, Hug EB, Lomax AJ, Bolsi A, Timmermann B, Rutz HP, Schuller JC, Pedroni E, Goitein G (2009) Effectiveness and safety of spot scanning proton radiation therapy for chordomas and chondrosarcomas of the skull base: first long-term report. Int J Radiat Oncol Biol Phys 75(4):1111–1118

    Article  PubMed  Google Scholar 

  4. Arnold H, Sepehrnia A (1995) Extreme lateral transcondylar approach. J Neurosurg 82(2):313–314

    CAS  PubMed  Google Scholar 

  5. Cappabianca P, Cavallo LM, Esposito F, de Divitiis O, Messina A, de Divitiis E (2008) Extended endoscopic endonasal approach to the midline skull base: the evolving role of transsphenoidal surgery. In: Pickard JD, Akalan N, Di Rocco C, Dolenc VV, Lobo Antunes J, Mooij JJA, Schramm J, Sindou M (eds) Advances and technical standards in neurosurgery. Springer, Wien/New York, pp 152–199

    Google Scholar 

  6. Catton C, O'Sullivan B, Bell R, Laperriere N, Cummings B, Fornasier V, Wunder J (1996) Chordoma: long-term follow-up after radical photon irradiation. Radiother Oncol 41(1):67–72

    Article  CAS  PubMed  Google Scholar 

  7. Cavallo LM, Messina A, Cappabianca P, Esposito F, de Divitiis E, Gardner P, Tschabitscher M (2005) Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations. Neurosurg Focus 19(1), E2

    PubMed  Google Scholar 

  8. Cavallo LM, Messina A, Esposito F, de Divitiis O, Dal Fabbro M, de Divitiis E, Cappabianca P (2007) Skull base reconstruction in the extended endoscopic transsphenoidal approach for suprasellar lesions. J Neurosurg 107(4):713–720

    Article  PubMed  Google Scholar 

  9. Chanda A, Nanda A (2002) Partial labyrinthectomy petrous apicectomy approach to the petroclival region: an anatomic and technical study. Neurosurgery 51(1):147–159; discussion 159–160

    Article  PubMed  Google Scholar 

  10. Chibbaro S, Cornelius JF, Froelich S, Tigan L, Kehrli P, Debry C, Romano A, Herman P, George B, Bresson D (2014) Endoscopic endonasal approach in the management of skull base chordomas--clinical experience on a large series, technique, outcome, and pitfalls. Neurosurg Rev 37(2):217–224; discussion 224–215

    Article  PubMed  Google Scholar 

  11. Choi D, Crockard HA (2013) Evolution of transoral surgery: three decades of change in patients, pathologies, and indications. Neurosurgery 73(2):296–303; discussion 303–304

    Article  PubMed  Google Scholar 

  12. Cocke EW Jr, Robertson JH, Robertson JT, Crook JP Jr (1990) The extended maxillotomy and subtotal maxillectomy for excision of skull base tumors. Arch Otolaryngol Head Neck Surg 116(1):92–104

    Article  PubMed  Google Scholar 

  13. Couldwell WT, Weiss MH, Rabb C, Liu JK, Apfelbaum RI, Fukushima T (2004) Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases. Neurosurgery 55(3):539–550

    Article  PubMed  Google Scholar 

  14. Crockard HA, Steel T, Plowman N, Singh A, Crossman J, Revesz T, Holton JL, Cheeseman A (2001) A multidisciplinary team approach to skull base chordomas. J Neurosurg 95(2):175–183

    Article  CAS  PubMed  Google Scholar 

  15. Curtin HD, Rabinov JD, Som PM (2003) Central skull base. In: Head and neck imaging. Mosby, Saint Louis

    Google Scholar 

  16. de Divitiis E, Cappabianca P, Cavallo LM (2002) Endoscopic transsphenoidal approach: adaptability of the procedure to different sellar lesions. Neurosurgery 51(3):699–705; discussion 705–707

    PubMed  Google Scholar 

  17. Delgado TE, Garrido E, Harwick RD (1981) Labiomandibular, transoral approach to chordomas in the clivus and upper cervical spine. Neurosurgery 8(6):675–679

    Article  CAS  PubMed  Google Scholar 

  18. DeMonte F, Diaz E Jr, Callender D, Suk I (2001) Transmandibular, circumglossal, retropharyngeal approach for chordomas of the clivus and upper cervical spine. Technical note. Neurosurg Focus 10(3), E10

    Article  CAS  PubMed  Google Scholar 

  19. Doucet V, Peretti-Viton P, Figarella-Branger D, Manera L, Salamon G (1997) MRI of intracranial chordomas. Extent of tumour and contrast enhancement: criteria for differential diagnosis. Neuroradiology 39(8):571–576

    Article  CAS  PubMed  Google Scholar 

  20. Erdem E, Angtuaco EC, Van Hemert R, Park JS, Al-Mefty O (2003) Comprehensive review of intracranial chordoma. Radiographics 23(4):995–1009

    Article  PubMed  Google Scholar 

  21. Esposito F, Dusick JR, Fatemi N, Kelly DF (2007) Graded repair of cranial base defects and cerebrospinal fluid leaks in transsphenoidal surgery. Neurosurgery 60(4 Suppl 2):295–303; discussion 303–304

    PubMed  Google Scholar 

  22. Fatemi N, Dusick JR, Gorgulho AA, Mattozo CA, Moftakhar P, De Salles AA, Kelly DF (2008) Endonasal microscopic removal of clival chordomas. Surg Neurol 69(4):331–338

    Article  PubMed  Google Scholar 

  23. Fernandez-Miranda JC, Gardner PA, Snyderman CH, Devaney KO, Mendenhall WM, Suarez C, Rinaldo A, Ferlito A (2014) Clival chordomas: a pathological, surgical, and radiotherapeutic review. Head Neck 36(6):892–906

    Article  PubMed  Google Scholar 

  24. Feuvret L, Noel G, Weber DC, Pommier P, Ferrand R, De Marzi L, Dhermain F, Alapetite C, Mammar H, Boisserie G, Habrand JL, Mazeron JJ (2007) A treatment planning comparison of combined photon-proton beams versus proton beams-only for the treatment of skull base tumors. Int J Radiat Oncol Biol Phys 69(3):944–954

    Article  PubMed  Google Scholar 

  25. Frank G, Sciarretta V, Calbucci F, Farneti G, Mazzatenta D, Pasquini E (2006) The endoscopic transnasal transsphenoidal approach for the treatment of cranial base chordomas and chondrosarcomas. Neurosurgery 59(1 Suppl 1):ONS50–ONS57; discussion ONS50–ONS57

    PubMed  Google Scholar 

  26. Fraser JF, Nyquist GG, Moore N, Anand VK, Schwartz TH (2010) Endoscopic endonasal transclival resection of chordomas: operative technique, clinical outcome, and review of the literature. J Neurosurg 112(5):1061–1069

    Article  PubMed  Google Scholar 

  27. Gupta A, Harnsberger HR (2004) Chordoma, clivus. In: Diagnostic imaging. Head and neck. Amyrsis Inc, Salt Lake City

    Google Scholar 

  28. 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

    Article  PubMed  Google Scholar 

  29. Hardy J (2007) Transsphenoidal hypophysectomy. 1971. J Neurosurg 107(2):458–471

    Article  PubMed  Google Scholar 

  30. Hardy J, Vezina JL (1976) Transsphenoidal neurosurgery of intracranial neoplasm. Adv Neurol 15:261–273

    CAS  PubMed  Google Scholar 

  31. Iaconetta G, Fusco M, Cavallo LM, Cappabianca P, Samii M, Tschabitscher M (2007) The abducens nerve: microanatomic and endoscopic study. Neurosurgery 61(3 Suppl):7–14; discussion 14

    PubMed  Google Scholar 

  32. Igaki H, Tokuuye K, Okumura T, Sugahara S, Kagei K, Hata M, Ohara K, Hashimoto T, Tsuboi K, Takano S, Matsumura A, Akine Y (2004) Clinical results of proton beam therapy for skull base chordoma. Int J Radiat Oncol Biol Phys 60(4):1120–1126

    Article  PubMed  Google Scholar 

  33. James D, Crockard HA (1991) Surgical access to the base of skull and upper cervical spine by extended maxillotomy. Neurosurgery 29(3):411–416

    Article  CAS  PubMed  Google Scholar 

  34. Janecka IP, Nuss DW, Sen CN (1991) Facial translocation approach to the cranial base. Acta Neurochir Suppl 53:193–198

    Article  CAS  PubMed  Google Scholar 

  35. 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), E4

    PubMed  Google Scholar 

  36. 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 72–74

    PubMed  Google Scholar 

  37. Kassam AB, Thomas A, Carrau RL, Snyderman CH, Vescan A, Prevedello D, Mintz A, Gardner P (2008) Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery 63(1 Suppl 1):ONS44–ONS52; discussion ONS52–ONS53

    PubMed  Google Scholar 

  38. Kassam AB, Vescan AD, Carrau RL, Prevedello DM, Gardner P, Mintz AH, Snyderman CH, Rhoton AL (2008) Expanded endonasal approach: vidian canal as a landmark to the petrous internal carotid artery. J Neurosurg 108(1):177–183

    Article  PubMed  Google Scholar 

  39. Komotar RJ, Starke RM, Raper DM, Anand VK, Schwartz TH (2011) The endoscope-assisted ventral approach compared with open microscope-assisted surgery for clival chordomas. World Neurosurg 76(3–4):318–327; discussion 259–362

    Article  PubMed  Google Scholar 

  40. Koutourousiou M, Gardner PA, Tormenti MJ, Henry SL, Stefko ST, Kassam AB, Fernandez-Miranda JC, Snyderman CH (2012) Endoscopic endonasal approach for resection of cranial base chordomas: outcomes and learning curve. Neurosurgery 71(3):614–624; discussion 624–625

    Article  PubMed  Google Scholar 

  41. 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

    Article  PubMed  Google Scholar 

  42. Lanzino G, Dumont AS, Lopes MB, Laws ER Jr (2001) Skull base chordomas: overview of disease, management options, and outcome. Neurosurg Focus 10(3), E12

    Article  CAS  PubMed  Google Scholar 

  43. Laws E (1993) Clivus chordomas. In: Sekhar LN, Janecka IP (eds) Surgery of cranial base tumors. Raven, New York, pp 679–685

    Google Scholar 

  44. Leng LZ, Brown S, Anand VK, Schwartz TH (2008) “Gasket-seal” watertight closure in minimal-access endoscopic cranial base surgery. Neurosurgery 62(5 Suppl 2):ONSE342–ONSE343; discussion ONSE343

    PubMed  Google Scholar 

  45. Liu JK, Couldwell WT (2005) Far-lateral transcondylar approach: surgical technique and its application in neurenteric cysts of the cervicomedullary junction. Report of two cases. Neurosurg Focus 19(2), E9

    Article  PubMed  Google Scholar 

  46. Liu JK, Decker D, Schaefer SD, Moscatello AL, Orlandi RR, Weiss MH, Couldwell WT (2003) Zones of approach for craniofacial resection: minimizing facial incisions for resection of anterior cranial base and paranasal sinus tumors. Neurosurgery 53(5):1126–1135; discussion 1135–1137

    Article  PubMed  Google Scholar 

  47. Maira G, Pallini R, Anile C, Fernandez E, Salvinelli F, La Rocca LM, Rossi GF (1996) Surgical treatment of clival chordomas: the transsphenoidal approach revisited. J Neurosurg 85(5):784–792

    Article  CAS  PubMed  Google Scholar 

  48. Mendenhall NP, Malyapa RS, Su Z, Yeung D, Mendenhall WM, Li Z (2011) Proton therapy for head and neck cancer: rationale, potential indications, practical considerations, and current clinical evidence. Acta Oncol 50(6):763–771

    Article  PubMed  Google Scholar 

  49. 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):211–219; discussion 219–220

    PubMed  Google Scholar 

  50. Osborn AG (2012) Clival chordomas. In: Osborn's brain: imaging, pathology and anatomy. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  51. Pallini R, Maira G, Pierconti F, Falchetti ML, Alvino E, Cimino-Reale G, Fernandez E, D'Ambrosio E, Larocca LM (2003) Chordoma of the skull base: predictors of tumor recurrence. J Neurosurg 98(4):812–822

    Article  PubMed  Google Scholar 

  52. Prevedello DM, Ditzel Filho LF, Solari D, Carrau RL, Kassam AB (2010) Expanded endonasal approaches to middle cranial fossa and posterior fossa tumors. Neurosurg Clin N Am 21(4):621–635, vi

    Article  PubMed  Google Scholar 

  53. Rhoton AL Jr (2000) The cerebellar arteries. Neurosurgery 47(3 Suppl):S29–S68

    Article  PubMed  Google Scholar 

  54. Rhoton AL Jr (2002) The sellar region. Neurosurgery 51(4 Suppl):S335–S374

    PubMed  Google Scholar 

  55. Samii A, Gerganov VM, Herold C, Hayashi N, Naka T, Mirzayan MJ, Ostertag H, Samii M (2007) Chordomas of the skull base: surgical management and outcome. J Neurosurg 107(2):319–324

    Article  PubMed  Google Scholar 

  56. Sen C, Triana AI, Berglind N, Godbold J, Shrivastava RK (2010) Clival chordomas: clinical management, results, and complications in 71 patients. J Neurosurg 113(5):1059–1071

    Article  PubMed  Google Scholar 

  57. Stippler M, Gardner PA, Snyderman CH, Carrau RL, Prevedello DM, Kassam AB (2009) Endoscopic endonasal approach for clival chordomas. Neurosurgery 64(2):268–277; discussion 277–288

    Article  PubMed  Google Scholar 

  58. Swearingen B, Joseph M, Cheney M, Ojemann RG (1995) A modified transfacial approach to the clivus. Neurosurgery 36(1):101–104; discussion 104–105

    Article  CAS  PubMed  Google Scholar 

  59. Tamaki N, Nagashima T, Ehara K, Motooka Y, Barua KK (2001) Surgical approaches and strategies for skull base chordomas. Neurosurg Focus 10(3), E9

    Article  CAS  PubMed  Google Scholar 

  60. Weiss MH (1987) The transnasal transsphenoidal approach. In: Apuzzo MLJ (ed) Surgery of the third ventricle. Williams & Wilkins, Baltimore, pp 476–494

    Google Scholar 

  61. Wen HT, Rhoton AL Jr, Katsuta T, de Oliveira E (1997) Microsurgical anatomy of the transcondylar, supracondylar, and paracondylar extensions of the far-lateral approach. J Neurosurg 87(4):555–585

    Article  CAS  PubMed  Google Scholar 

  62. Yasuda M, Bresson D, Chibbaro S, Cornelius JF, Polivka M, Feuvret L, Takayasu M, George B (2012) Chordomas of the skull base and cervical spine: clinical outcomes associated with a multimodal surgical resection combined with proton-beam radiation in 40 patients. Neurosurg Rev 35(2):171–182; discussion 182–183

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli “Federico II”, Via Pansini 5, 80131, Naples, Italy

    Domenico Solari MD, PhD, Luigi Maria Cavallo MD, PhD, Chiara Caggiano MD, Rosa Maria Gerardi MD & Paolo Cappabianca MD

  2. Neuroradiology Unit, Department of Advanced Biomedical Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy

    Enrico Tedeschi MD

  3. Division of Legal Medicine, Department of Advanced Biomedical Sciences, Università degli Studi di Napoli “Federico II”, Naples, Italy

    Massimo Niola MD, PhD

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  1. Domenico Solari MD, PhD
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  2. Luigi Maria Cavallo MD, PhD
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  3. Enrico Tedeschi MD
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  7. Paolo Cappabianca MD
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Correspondence to Domenico Solari MD, PhD .

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Editors and Affiliations

  1. Div. of Neurosurgery Dept. of Neuroscien, University of Naples “Federico II” , Naples, Italy

    Paolo Cappabianca

  2. Div. of Neurosurgery Dept. of Neuroscien, University of Naples “Federico II” , Naples, Italy

    Luigi Maria Cavallo

  3. Div. of Neurosurgery Dept. of Neuroscien, University of Naples “Federico II” , Naples, Italy

    Oreste de Divitiis

  4. Div. of Neurosurgery Dept. of Neuroscien, University of Messina , Messina, Messina, Italy

    Felice Esposito

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Solari, D. et al. (2016). Endoscopic Endonasal Transsphenoidal Approach. In: Cappabianca, P., Cavallo, L., de Divitiis, O., Esposito, F. (eds) Midline Skull Base Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-21533-4_25

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