Journal article
Extended endoscopic endonasal approach to clival and paraclival tumors: Indications and limits.
- Messerer M Département des neurosciences cliniques, service de neurochirurgie, centre hospitalier universitaire Vaudois, université de Lausanne, rue du Bugnon 44, 1011 Lausanne, Switzerland; Département de neurochirurgie, hôpital Kremlin-Bicêtre, université de Paris Sud, 94270 Paris, France. Electronic address: Mahmoud.messerer@chuv.ch.
- Cossu G Département des neurosciences cliniques, service de neurochirurgie, centre hospitalier universitaire Vaudois, université de Lausanne, rue du Bugnon 44, 1011 Lausanne, Switzerland.
- Pasche P Service d'otorhinolaryngologie, centre hospitalier universitaire Vaudois, université de Lausanne, UNIL, 1011 Lausanne, Switzerland.
- Ikonomidis C Service d'otorhinolaryngologie, centre hospitalier universitaire Vaudois, université de Lausanne, UNIL, 1011 Lausanne, Switzerland.
- Simon C Service d'otorhinolaryngologie, centre hospitalier universitaire Vaudois, université de Lausanne, UNIL, 1011 Lausanne, Switzerland.
- Pralong E Département des neurosciences cliniques, service de neurochirurgie, centre hospitalier universitaire Vaudois, université de Lausanne, rue du Bugnon 44, 1011 Lausanne, Switzerland.
- George M Département de neurochirurgie, hôpital Kremlin-Bicêtre, université de Paris Sud, 94270 Paris, France.
- Levivier M Département des neurosciences cliniques, service de neurochirurgie, centre hospitalier universitaire Vaudois, université de Lausanne, rue du Bugnon 44, 1011 Lausanne, Switzerland.
- Daniel RT Département des neurosciences cliniques, service de neurochirurgie, centre hospitalier universitaire Vaudois, université de Lausanne, rue du Bugnon 44, 1011 Lausanne, Switzerland.
- 2016-05-16
Published in:
- Neuro-Chirurgie. - 2016
Chirurgie de la base du crâne
Chordome
Clival chordoma
Clival meningioma
Clivus
Endoscopie
Extended endoscopic endonasal approach
Méningiome
Skull base surgery
Adult
Antineoplastic Agents
Combined Modality Therapy
Cranial Fossa, Posterior
Cranial Irradiation
Cranial Nerve Diseases
Endoscopy
Female
Humans
Male
Middle Aged
Monitoring, Intraoperative
Nasal Cavity
Postoperative Complications
Radiosurgery
Remission Induction
Retrospective Studies
Skull Base Neoplasms
Young Adult
English
OBJECTIVE
To report our experience with the Extended endoscopic endonasal approach (EEEA) for clival and paraclival tumors.
DESIGN
Retrospective analysis of a consecutive series of patients.
RESULTS
Eleven patients were considered: 3 chordomas, 3 meningiomas, 3 metastatic lesions, one chondroma and one chondrosarcoma. Gross total resection (GTR) was achieved in all chordomas and in chondromas with patients free of disease at the last follow-up. The chondrosarcoma was first operated on using a transfacial approach and endoscopy was performed for local progression with subtotal resection. The meningiomas were treated by a combination of transcranial and endoscopic approach due to their extension. The resection was subtotal and the residue treated by radiosurgery. Two patients with rhinopharyngeal carcinoma underwent palliative debulking. One metastatic melanoma that underwent GTR experienced remission. Two patients had postoperative cranial nerve palsy. No other complications were observed.
CONCLUSIONS
EEEA allows a direct access to the skull base. Through a minimal access, it limits the incidence of neurological morbidities. For midline epidural clival tumors, EEEA allows a total excision. It also offers an excellent access to the clival component of intradural lesions. A combined approach permits good tumor control with minimal complications.
To report our experience with the Extended endoscopic endonasal approach (EEEA) for clival and paraclival tumors.
DESIGN
Retrospective analysis of a consecutive series of patients.
RESULTS
Eleven patients were considered: 3 chordomas, 3 meningiomas, 3 metastatic lesions, one chondroma and one chondrosarcoma. Gross total resection (GTR) was achieved in all chordomas and in chondromas with patients free of disease at the last follow-up. The chondrosarcoma was first operated on using a transfacial approach and endoscopy was performed for local progression with subtotal resection. The meningiomas were treated by a combination of transcranial and endoscopic approach due to their extension. The resection was subtotal and the residue treated by radiosurgery. Two patients with rhinopharyngeal carcinoma underwent palliative debulking. One metastatic melanoma that underwent GTR experienced remission. Two patients had postoperative cranial nerve palsy. No other complications were observed.
CONCLUSIONS
EEEA allows a direct access to the skull base. Through a minimal access, it limits the incidence of neurological morbidities. For midline epidural clival tumors, EEEA allows a total excision. It also offers an excellent access to the clival component of intradural lesions. A combined approach permits good tumor control with minimal complications.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.neuchi.2015.12.003
- PMID 27179389
- Persistent URL
- https://folia.unifr.ch/unifr/documents/281315
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