Minim Invasive Neurosurg 2004; 47(1): 1-8
DOI: 10.1055/s-2003-812538
Original Article
© Georg Thieme Verlag Stuttgart · New York

Endoscopic Endonasal Skull Base Surgery: Part 1 - The Midline Anterior Fossa Skull Base

H.-D.  Jho1 , H.-G.  Ha1
  • 1Center for Minimally Invasive Innovative Microneurosurgery, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
Further Information

Publication History

Publication Date:
18 July 2005 (online)

Abstract

Objective: An endonasal endoscopic surgery to the anterior fossa skull base was developed in cadaver dissection as a minimally invasive surgical technique and, subsequently, used in patient treatment.

Methods: Six cadaver head specimens were used. Ideal head positioning and various surgical routes were studied. To estimate the extent of surgical exposure provided by this technique, the width of the exposed anterior cranial fossa was measured between the medial margin of the orbits, the optic nerves and the carotid arteries. Three demonstrative patient cases are presented.

Results: Ideal head positioning was discovered to be at 15-degree extension of the forehead-chin line. Paraseptal, middle meatal and middle turbinectomy approaches were developed. The average width between the medial orbits was measured to be 24 mm (range 22 - 29 mm) at the crista galli level, 27 mm (range 24 - 30 mm) at the planum sphenoidale, 18 mm (range 15 - 22 mm) between the optic nerves, and 17 mm (range 13 - 21 mm) between the rostral carotid siphons. This technique, when it was applied in patient care, proved to be minimally invasive.

Conclusions: This endoscopic endonasal approach provided a direct “short-cut” access to the midline anterior fossa skull base. This technique can be used for the surgical treatment of cerebrospinal fluid (CSF) leak, meningiomas, craniopharyngiomas, pituitary adenomas, and other midline intracranial anterior skull base lesions. This is the first report in the English literature describing endonasal endoscopy for the surgical treatment of primary intracranial anterior fossa skull base lesions.

References

  • 1 Kennedy D W, Zinreich S J. The functional endoscopic approach to the inflammatory sinus disease: Current perspectives and technique modifications.  Am J Rhinol. 1988;  2 89
  • 2 Messerklinger W. Techniques for endoscopy of the middle nasal meatus.  Arch Otorhinolaryngol. 1978;  221 297
  • 3 Stammberger H. Endoscopic endonasal surgery: New concepts in treatment of recurring sinusitis: Part I: Anatomical and pathophysiological considerations.  Otolaryngol Head Neck Surg. 1986;  94 143-147
  • 4 Wigard M E. Transnasal ethmoidectomy under endoscopic control.  Rhinology. 1981;  19 7-15
  • 5 Apuzzo M LJ, Heifetz M D, Weiss M H, Kurze T. Neurosurgical endoscopy using the side-viewing telescope.  J Neurosurg. 1977;  46 398-400
  • 6 Auer L M, Holzer P, Ascher P W, Heppner F. Endoscopic neurosurgery.  Acta Neurochir (Wien). 1988;  90 1-4
  • 7 Bauer B L, Hellwig D. Intracerebral and intraspinal endoscopy. In: Schmideck HH, Sweet WH (eds), Operative neurosurgical techniques. 3rd edition. Philadelphia: Saunders 1994: pp 695-713
  • 8 Cohen A. Endoscopic ventricular surgery.  Pediatr Neurosurg. 1993;  19 127-134
  • 9 Dandy W. Cerebral ventriculoscopy.  Johns Hopkins Hosp Bull. 1922;  33 189
  • 10 Gaab M R, Schroeder H WS. Neuroendoscopic approach to intraventricular lesions.  J Neurosurg. 1998;  88 496-505
  • 11 Jho H D, Carrau R L. Endoscopic endonasal transsphenoidal surgery: Experience with 50 patients.  J Neurosurg. 1997;  87 44-51
  • 12 Lewis A I, Keiper G L, Crone K R. Endoscopic treatment of loculated hydrocephalus.  J Neurosurg. 1995;  82 780-785
  • 13 Perneczky A, Fries G. Endoscope-assisted brain surgery: Part 1 - evolution, basic concept, and current technique.  Neurosurgery. 1998;  42 219-225
  • 14 Jho H D, Carrau R L. Endoscopy assisted transsphenoidal surgery for pituitary adenoma: A technical note.  Acta Neurochir (Wien). 1996;  138 1416-1425
  • 15 Jho H D, Carrau R L, Ko Y, Daly M. Endoscopic pituitary surgery: An early experience.  Surg Neurol. 1997;  47 213-223
  • 16 Jho H D, Carrau R L, McLaughlin M L, Somaza S C. Endoscopic transsphenoidal resection of a large chordoma in the posterior fossa: A case report.  Acta Neurochir (Wien). 1997;  139 343-348
  • 17 Maltz M. New instrument: The sinuscope.  Laryngoscope. 1925;  35 805-811
  • 18 Mosher H P. The applied anatomy and the intranasal surgery of the ethmoidal labyrinth.  Trans Am Laryngol Assoc. 1912;  34 25-39
  • 19 Mosher H P. The surgical anatomy of the ethmoidal labyrinth.  Ann Otol Rhinol Laryngol. 1929;  38 869-901
  • 20 Alyea O E van. Ethmoid labyrinth: Anatomic study, with consideration of the clinical significance of its structural characteristics.  Arch Otolaryngol. 1939;  29 881-902

H.-D. Jho, M. D. Ph. D. 

Jho Institute for Minimally Invasive Neurosurgery · 7th Floor, Snyder Pavilion · Allegheny General Hospital

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Pittsburgh, PA 15212-4772

USA

Email: DrJho@DrJho.com