Download PDF
J Neurol Surg B Skull Base 2012; 73(03): 147-156
DOI: 10.1055/s-0032-1301391
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Expanded Endoscopic Endonasal Approaches to Skull Base Meningiomas

J. Drew Prosser
1   Department of Otolaryngology, Georgia Health Sciences University, Augusta, Georgia
,
John R. Vender
1   Department of Otolaryngology, Georgia Health Sciences University, Augusta, Georgia
2   Department of Neurosurgery, Georgia Health Sciences University, Augusta, Georgia
,
Cargill H. Alleyne
2   Department of Neurosurgery, Georgia Health Sciences University, Augusta, Georgia
,
C. Arturo Solares
1   Department of Otolaryngology, Georgia Health Sciences University, Augusta, Georgia
2   Department of Neurosurgery, Georgia Health Sciences University, Augusta, Georgia
› Author Affiliations
Further Information

Publication History

05 February 2011

11 October 2011

Publication Date:
22 February 2012 (online)

    Permissions and Reprints

Abstract

Anterior cranial base meningiomas have traditionally been addressed via frontal or frontolateral approaches. However, with the advances in endoscopic endonasal treatment of pituitary lesions, the transphenoidal approach is being expanded to address lesions of the petrous ridge, anterior clinoid, clivus, sella, parasellar region, tuberculum, planum, olfactory groove, and crista galli regions. The expanded endoscopic endonasal approach (EEEA) has the advantage of limiting brain retraction and resultant brain edema, as well as minimizing manipulation of neural structures. Herein, we describe the techniques of transclival, transphenoidal, transplanum, and transcribiform resections of anterior skull base meningiomas. Selected cases are presented.

Keywords

skull base - endoscopic - endonasal - meningioma
 

  • References

  • 1 DeMonte F, AI-Mefty O. Meningiomas. In: Kaye AH, Laws ER, eds. Brain Tumors. London: Churchill Livingstone; 1995: 675-704
    Google Scholar
  • 2 Rubin G, Ben David U, Gornish M, Rappaport ZH. Meningiomas of the anterior cranial fossa floor. Review of 67 cases. Acta Neurochir (Wien) 1994; 129 (1-2) 26-30
    CrossrefPubMedGoogle Scholar
  • 3 Solero CL, Giombini S, Morello G. Suprasellar and olfactory meningiomas. Report on a series of 153 personal cases. Acta Neurochir (Wien) 1983; 67 (3-4) 181-194
    CrossrefPubMedGoogle Scholar
  • 4 Rachinger W, Grau S, Tonn JC. Different microsurgical approaches to meningiomas of the anterior cranial base. Acta Neurochir (Wien) 2010; 152 (6) 931-939
    CrossrefPubMedGoogle Scholar
  • 5 Solares CA, Ong YK, Snyderman CH. Transnasal endoscopic skull base surgery: what are the limits?. Curr Opin Otolaryngol Head Neck Surg 2010; 18 (1) 1-7
    CrossrefPubMedGoogle Scholar
  • 6 Kassam AB, Snyderman CH, Mintz A, Gardner PA, Carrau RL. Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurg Focus 2005; 19 (1) E3
    PubMedGoogle Scholar
  • 7 Gardner PA, Kassam AB, Thomas A , et al. Endoscopic endonasal resection of anterior cranial base meningiomas. Neurosurgery 2008; 63 (1) 36-52, discussion 52–54
    CrossrefPubMedGoogle Scholar
  • 8 Kassam AB, Gardner P, Snyderman CH, Mintz A, Carrau R. Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa. Neurosurg Focus 2005; 19 (1) E6
    PubMedGoogle Scholar
  • 9 Kassam AB, Snyderman CH, Mintz A, Gardner P, Carrau RL. Expanded endonasal approach: the rostrocaudal axis. Part II. Posterior clinoids to the foramen magnum. Neurosurg Focus 2005; 19 (1) E4
    CrossrefPubMedGoogle Scholar
  • 10 Weber R, Draf W, Kratzsch B, Hosemann W, Schaefer SD. Modern concepts of frontal sinus surgery. Laryngoscope 2001; 111 (1) 137-146
    CrossrefPubMedGoogle Scholar
  • 11 El-Sayed IH, Roediger FC, Goldberg AN, Parsa AT, McDermott MW. Endoscopic reconstruction of skull base defects with the nasal septal flap. Skull Base 2008; 18 (6) 385-394
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Harvey RJ, Nogueira JF, Schlosser RJ, Patel SJ, Vellutini E, Stamm AC. Closure of large skull base defects after endoscopic transnasal craniotomy. Clinical article. J Neurosurg 2009; 111 (2) 371-379
    CrossrefPubMedGoogle Scholar
  • 13 Kassam AB, Thomas A, Carrau RL , et al. Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery 2008; 63 (1, Suppl 1) ONS44-ONS52, discussion ONS52–ONS53
    CrossrefPubMedGoogle Scholar
  • 14 Hadad G, Bassagasteguy L, Carrau RL , et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 2006; 116 (10) 1882-1886
    CrossrefPubMedGoogle Scholar
  • 15 Shah RN, Surowitz JB, Patel MR , et al. Endoscopic pedicled nasoseptal flap reconstruction for pediatric skull base defects. Laryngoscope 2009; 119 (6) 1067-1075
    CrossrefPubMedGoogle Scholar
  • 16 Kang MD, Escott E, Thomas AJ , et al. The MR imaging appearance of the vascular pedicle nasoseptal flap. AJNR Am J Neuroradiol 2009; 30 (4) 781-786
    CrossrefPubMedGoogle Scholar
  • 17 Zanation AM, Snyderman CH, Carrau RL, Kassam AB, Gardner PA, Prevedello DM. Minimally invasive endoscopic pericranial flap: a new method for endonasal skull base reconstruction. Laryngoscope 2009; 119 (1) 13-18
    CrossrefPubMedGoogle Scholar
  • 18 Fortes FS, Carrau RL, Snyderman CH , et al. The posterior pedicle inferior turbinate flap: a new vascularized flap for skull base reconstruction. Laryngoscope 2007; 117 (8) 1329-1332
    CrossrefPubMedGoogle Scholar
  • 19 Harvey RJ, Sheahan PO, Schlosser RJ. Inferior turbinate pedicle flap for endoscopic skull base defect repair. Am J Rhinol Allergy 2009; 23 (5) 522-526
    CrossrefPubMedGoogle Scholar
  • 20 Prevedello DM, Barges-Coll J, Fernandez-Miranda JC , et al. Middle turbinate flap for skull base reconstruction: cadaveric feasibility study. Laryngoscope 2009; 119 (11) 2094-2098
    CrossrefPubMedGoogle Scholar
  • 21 Fortes FS, Carrau RL, Snyderman CH , et al. Transpterygoid transposition of a temporoparietal fascia flap: a new method for skull base reconstruction after endoscopic expanded endonasal approaches. Laryngoscope 2007; 117 (6) 970-976
    CrossrefPubMedGoogle Scholar
  • 22 Oliver CL, Hackman TG, Carrau RL , et al. Palatal flap modifications allow pedicled reconstruction of the skull base. Laryngoscope 2008; 118 (12) 2102-2106
    CrossrefPubMedGoogle Scholar