Peer-Review Reports

The Role of the Endoscopic Endonasal Route in the Management of Craniopharyngiomas Luigi Maria Cavallo1, Domenico Solari1, Felice Esposito1, Alessandro Villa1, Giuseppe Minniti2, Paolo Cappabianca1

Key words Craniopharyngioma - Endoscopy - Expanded endonasal approach - Transsphenoidal surgery -

Abbreviations and Acronyms CSF: Cerebrospinal fluid EEA: Endoscopic endonasal approach From the 1Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples; and 2Department of Radiation Oncology, Sant’Andrea Hospital, University Sapienza, Rome, Italy To whom correspondence should be addressed: Luigi Maria Cavallo, M.D., Ph.D. [E-mail: [email protected]] Citation: World Neurosurg. (2014) 82, 6S:S32-S40. http://dx.doi.org/10.1016/j.wneu.2014.07.023 Journal homepage: www.WORLDNEUROSURGERY.org Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2014 Elsevier Inc. All rights reserved.

- BACKGROUND:

Craniopharyngiomas represent one of the major challenges of neurosurgery. Surgical management of craniopharyngiomas classically required various transcranial approaches with the transsphenoidal route reserved for very selected cases. With the widespread use of endoscopes in endonasal surgery in the past decade, the extended endoscopic endonasal transtuberculum and transplanum approaches have been proposed as an alternative surgical route for removal of different types of suprasellar tumors, including solid craniopharyngiomas in patients with normal pituitary function and small sella.

- METHODS:

A detailed report is presented of the technique used by the authors for the endoscopic endonasal approach for the resection of craniopharyngiomas. For each type of craniopharyngioma, hints and anatomic “main landmarks” are provided throughout each step of the procedure.

- CONCLUSIONS:

The endoscopic endonasal approach offers advantages in the management of craniopharyngiomas that historically have been approached via the transsphenoidal route (i.e., purely intrasellar or intra-suprasellar infradiaphragmatic, preferably cystic lesions in patients with panhypopituitarism). Use of the “extended” endoscopic endonasal approach overcomes the limits of the transsphenoidal route to the sella enabling the management of different purely suprasellar and retrosellar cystic/solid craniopharyngiomas, regardless of the sellar size or pituitary function.

INTRODUCTION The surgical management of craniopharyngiomas is challenging. Complete removal of a craniopharyngioma has been advocated as the most effective treatment (27, 37, 59, 64, 68, 69, 72, 74). Nevertheless, despite the benign nature of craniopharyngiomas, complete surgical removal cannot always be achieved because of the frequent proximity and adhesions of the tumor to vital neurovascular structures. Additionally, craniopharyngiomas can recur even after radical resection. The surgical removal of recurrent craniopharyngioma is even more troublesome because of scar formation and new adhesions (2, 27, 37, 59, 64, 68, 69, 71, 72). Surgical resection of craniopharyngiomas historically has been performed via different microsurgical transcranial approaches (i.e., subfrontal, frontolateral, pterional) with the transsphenoidal approach, performed with either a microscope or an endoscope, classically restricted to intrasellar or intrasuprasellar subdiaphragmatic tumors (38, 54). The introduction and diffusion of the extended transsphenoidal approach

S32

www.SCIENCEDIRECT.com

foreseen by Hardy (36) and described by Weiss (70) created a new paradigm in transsphenoidal surgery opening a new corridor to the suprasellar space. The evolution of surgical techniques and technology in recent decades has decreased morbidity and increased effectiveness of transcranial and transsphenoidal approaches (20, 23, 28, 33, 39, 40, 63). The widespread use of the endoscope in sinus surgery (49, 58, 67) was brought to transsphenoidal surgery for the treatment of pituitary tumors (3, 9). The wider panoramic view offered by the endoscope increased the versatility of the transsphenoidal approach and permitted it to be expanded to different parts of the skull base, allowing the removal of different “pure” supradiaphragmatic lesions (5, 8, 10, 11, 17, 18, 20, 25, 30, 31, 41, 43-45, 48, 51, 53). Because craniopharyngiomas often are infrachiasmatic midline tumors, the endonasal route provides the advantage of accessing the tumor immediately after suprasellar dural opening, without brain

or optic nerve retraction and with direct visualization through a straight surgical route (46). Because the approach has a caudalcranial orientation and the tumors are basically infrachiasmatic, the original classification of craniopharyngiomas in relation to the chiasm (prefixed or postfixed) could result out of date Kassam et al. (45) drew attention to the relationships between infundibulum and craniopharyngiomas and proposed a new classification identifying 4 categories: type I, preinfundibular; type II, transinfundibular; type III, retroinfundibular; and type IV, isolated third ventricular (not well accessed via endonasal routes). In this article, we present the surgical nuances based on our experience with the endoscopic endonasal approach (EEA) in the treatment of craniopharyngiomas. We highlight the feasibility of this technique and evaluate its advantages and limits compared with the transcranial and transsphenoidal microscopic approaches.

WORLD NEUROSURGERY, http://dx.doi.org/10.1016/j.wneu.2014.07.023

PEER-REVIEW REPORTS LUIGI MARIA CAVALLO ET AL.

ENDOSCOPIC ENDONASAL MANAGEMENT OF CRANIOPHARYNGIOMAS

SURGICAL TECHNIQUE The EEA is a 2-surgeon, 3- or 4-hand technique performed using a rigid endoscope (0 degrees), 18 cm in length and 4 mm in diameter (KARL STORZ GmbH & Co., Tuttlingen, Germany), as the sole instrument for visualizing the surgical field. At the beginning of the procedure, the primary surgeon is placed at the right of the patient’s bed regardless of whether he or she is right-handed or left-handed, with the assistant surgeon on the left side of the patient and the scrub nurse at the level of the patient’s legs. Each surgeon looks into a dedicated monitor, adjusted in front of him or her at a personalized height and distance. Operative Nuances for Standard Craniopharyngioma Surgery Not every craniopharyngioma that is amenable for removal via the transsphenoidal route requires a so-called extended approach; some lesions can be removed by via a “standard” approach to the sellar region, as for pituitary adenomas (6, 32, 34). The indications for the endoscopic standard approach for removal of a craniopharyngioma are the same as the indications well defined several decades ago for the microsurgical transsphenoidal technique (34). This procedure is reserved for patients with enlargement of the pituitary fossa and preferably cystic extraarachnoidal infradiaphragmatic tumors (1, 16, 54, 55, 61, 66), intrasellar or with suprasellar (52) and retrosellar (38) extensions, if symmetric and well defined. It is more appropriate in patients with hypopituitarism (55). The endoscope can provide additional benefit when dealing with such lesions via a standard transsphenoidal route because retrosellar and suprasellar areas are more easily visualized, especially with angled scopes and in cases of prefixed chiasm. The endoscope allows the surgeon to verify the completeness of tumor removal, explore the inner aspect of the cyst wall, confirm removal of cyst contents, and assess the possible presence of cerebrospinal fluid (CSF) leak (Figures 1e3) (13). Operative Nuances for Extended Craniopharyngioma Surgery The bone over the sella is removed, and the planum sphenoidale is opened

Figure 1. (A and B) Preoperative magnetic resonance imaging showing an intra-suprasellar, partially cystic craniopharyngioma. The mass extends bilaterally up to the medial wall of both cavernous sinuses and upward, compressing the optic chiasm.

anteriorly to the anterior margin of the tumor, which is determined with image guidance. Complete removal of the

tuberculum sellae (i.e., the suprasellar notch (21) as seen from the endonasal perspective) including bilateral medial

Figure 2. Intraoperative photos. (A) On opening of the dura mater, the fluid component (“motor oil”) flows out and is drained. (B and C) Debulking of the solid part proceeds via curettage up to the cavernous sinus medial walls, from which tumor is peeled off. (D) After tumor removal, the sellar cavity is occupied by the suprasellar cistern, which, freed from tumor compression, has fallen. The asterisk indicates “motor oil” fluid component. T, tumor; sc, suprasellar cistern; ds, dorsum sellae.

WORLD NEUROSURGERY 82 [6S]: S32-S40, DECEMBER 2014

www.WORLDNEUROSURGERY.org

S33

PEER-REVIEW REPORTS LUIGI MARIA CAVALLO ET AL.

ENDOSCOPIC ENDONASAL MANAGEMENT OF CRANIOPHARYNGIOMAS

Figure 3. (A and B) Postoperative magnetic resonance imaging demonstrating total removal of the lesion.

opto-carotid recesses (mOCRs) is mandatory to expose the subarachnoid opticocarotid cistern to allow adequate suprasellar exposure for tumor resection. Bleeding from the superior intercavernous sinus during the removal of tuberculum sellae (10, 19, 20, 43, 45), especially in cases of suprasellar craniopharyngioma, is common. Despite the effective use of hemostatic agents, the sinus should be closed with bipolar coagulation instead of using hemoclips, which narrows the dural opening. The dura mater is incised horizontally a few millimeters above and below the superior intercavernous sinus to coagulate the sinus between the 2 tips of the bipolar forceps in its median portion. It is incised with microscissors, and the 2 resulting dural flaps are coagulated achieving their retraction and the consequential enlargement of the dural opening, which over the planum can be easily cut using a Kerrison punch. The endoscopic transsphenoidal approach to craniopharyngiomas follows the same principles and goals of the standardized microsurgical procedure: internal debulking of the solid part or cystic evacuation, followed by fine meticulous dissection from the main surrounding neurovascular structures. All dissection maneuvers are performed under direct visual control, with the opportunity of passing between a close-up and a wider panoramic view. Above all, the concept of extracapsular dissection, introduced by Laws (54), takes precedence over any other consideration.

S34

www.SCIENCEDIRECT.com

In addition, approaching the tumor from its ventral aspect, with all of the critical neurovascular structures on its dorsum and perimeter, represents a great advantage. The endoscopic technique does not differ in terms of surgical steps from conventional microsurgery. Debulking of the solid or cystic component is performed followed by capsule mobilization and extracapsular sharp dissection. The debulking phase can be performed effectively using a 2-suction technique (45). The EEA provides direct visualization of the inferior aspect of the chiasm, the infundibulum, the third ventricle, and the retrosellar and parasellar spaces, which can be dissected free from tumor. Craniopharyngiomas often are adherent to or invade the chiasm or hypothalamus, particularly in cases of recurrence (14). In these circumstances, we advise “not to force” resection to maintain nervous system tissue integrity and to preserve function (Figures 4e9). Because intraoperative CSF leakage frequently results from wider dural opening, an accurate reconstruction of the skull base defect is mandatory after lesion removal. The reconstruction should ideally be watertight to prevent postoperative CSF leak, the risk of which is higher in the EEA for craniopharyngiomas because of the large opening of the arachnoid cisterns or of the third ventricle. Conventional reconstruction techniques yield inadequate results for several reasons, including 1) the size of the defect, 2) the irregular shape of the defect owing to the short

distance between the osteodural defect and the optic nerves and carotid arteries, and 3) the wide intradural empty space lacking arachnoidal barriers. The repair should proceed as for a grade 3 on Kelly’s scale (26) to achieve 1) intradural sealing of the arachnoid, 2) watertight closure of the osteodural skull base defect, and 3) packing of the sphenoid. A thin layer of fibrin glue (TISSEEL; Baxter AG, Vienna, Austria) is positioned in the intradural space as a first barrier to CSF and to fill the dead space (7). The closure of the osteodural defect is achieved using a combination of a solid or semisolid buttress made of an easy-to-shape material such as a synthetic copolymer (LactoSorb; Walter Lorenz Surgical, Inc., Jacksonville, Florida, USA) combined with a dural substitute (Tutoplast; Tutogen Medical GmbH, Neunkirchen am Brand, Germany). A single layer of the dural substitute is positioned in the extradural space (12), covering the dural opening, and the conformed sheath of the resorbable semisolid material is overlapped and embedded in the extradural space, dragging the dural substitute in overlay position. When a watertight barrier has been achieved, multiple layers of dural substitute are placed over the reconstruction to support it, or a mucosal flap—usually a free mucoperichondrium flap harvested from the middle turbinate or from the nasal septum or a vascularized Hadad pedicled flap (35, 47)—is used to cover the posterior wall of the sphenoid sinus. Fibrin glue is used to fill the sphenoid cavity, reducing “dead spaces,” and to hold the material in place. At the end of the procedure, bipolar hemostasis is obtained over the border of sphenoidotomy, and final irrigation of the nasal cavities is performed. DISCUSSION Craniopharyngiomas are considered very difficult lesions to treat because of an extremely variable growth pattern. Definitive surgical management has not been described, and many controversies still exist in regard to surgical management. Transcranial microsurgical approaches have been historically advocated for the removal of tumors involving the suprasellar and ventricular areas. The transsphenoidal approach has been reserved for intra-suprasellar infradiaphragmatic

WORLD NEUROSURGERY, http://dx.doi.org/10.1016/j.wneu.2014.07.023

PEER-REVIEW REPORTS LUIGI MARIA CAVALLO ET AL.

ENDOSCOPIC ENDONASAL MANAGEMENT OF CRANIOPHARYNGIOMAS

Figure 4. (AeC) Preoperative magnetic resonance imaging showing a suprasellar and retrosellar cystic craniopharyngioma. The cyst extends

lesions (13, 38, 54) extending upward out of an enlarged sella turcica and only partially involving the anterior-inferior part of the third ventricle—grade IeII craniopharyngiomas according to the Samii classification (65). Also, normal pituitary function in patients was often considered a contraindication for the endonasal route. These indications, which were introduced >30 years ago, have been revised since the introduction of extended transsphenoidal approaches. The concept of accessing midline lesions via midline approaches holds inherent appeal, and several authors reported

asymmetrically upward displacing the third ventricle floor and posteriorly into the retrosellar space and interpeduncular cistern.

successful experiences with the use of such a technique (8, 24, 25, 32, 41, 50, 51, 56, 57, 70). Finally, the introduction of innovative tools such as the endoscope, image guidance technologies, and the progress of surgical techniques have increased the popularity of midline approaches. In recent years, different surgical centers throughout the world, already confident with the endoscopic endonasal management of pituitary tumors, began to perform “pure” extended endoscopic endonasal procedures intended for removal of lesions involving different areas of the skull base beyond the sella (4, 5, 8, 10, 11, 25, 30, 31,

Figure 5. Intraoperative photos. (A and B) The cyst has been opened and emptied so that its wall can dissected via curettage and suction, passing on each side of the pituitary stalk. (C) Endoscopic exploration of the retrosellar

WORLD NEUROSURGERY 82 [6S]: S32-S40, DECEMBER 2014

43, 44). The EEA provides median and binarial access and direct visualization of the suprasellar space without brain manipulation, offering some additional advantages secondary to either the surgical route or the properties of the endoscope itself. This approach provides a wider, close-up view of the surgical field that permits the identification of many surgical landmarks, allowing a safe dissection and removal of the tumor without any brain retraction and optic apparatus manipulation, even with a normal-sized sella. The risk of postoperative visual loss, which is strictly related to the integrity of the

area allows visualization of the floor of the third ventricle and wide communication between the cyst remnant and the subarachnoid space. ps, pituitary stalk; FThV, floor of the third ventricle.

www.WORLDNEUROSURGERY.org

S35

PEER-REVIEW REPORTS LUIGI MARIA CAVALLO ET AL.

ENDOSCOPIC ENDONASAL MANAGEMENT OF CRANIOPHARYNGIOMAS

Figure 6. (AeC) Early postoperative magnetic resonance imaging showing shrinkage of tumor with the cyst wall remnant in the suprasellar and retrosellar space. (DeF) A further reduction of the cyst wall size is

observed after the patient has undergone fractionated stereotactic radiotherapy.

Figure 7. (AeC) Preoperative magnetic resonance imaging showing a suprasellar, retroinfundibular partially cystic craniopharyngioma abutting into the retrosellar space.

S36

www.SCIENCEDIRECT.com

WORLD NEUROSURGERY, http://dx.doi.org/10.1016/j.wneu.2014.07.023

PEER-REVIEW REPORTS LUIGI MARIA CAVALLO ET AL.

ENDOSCOPIC ENDONASAL MANAGEMENT OF CRANIOPHARYNGIOMAS

Figure 8. Intraoperative photos. (A) Dissection maneuvers are carried out in the subchiasmatic area with a bimanual technique so that (B) tumor is debulked in a piecemeal fashion. (C) Endoscopic exploration shows the

vascularization of the optic chiasm, seems to be reduced. In 2004, Kassam (42) presented his group’s initial experience with the treatment of craniopharyngiomas via a full EEA, describing an extension of the resection to the retrochiasmatic space and prepontine cisterns. Following such preliminary experience, several authors adopted the EEA as a surgical strategy for removal of different skull base lesions including craniopharyngiomas (15, 19, 22, 53), reported pros and cons in large surgical series, and advocated the approach for recurrent or residual craniopharyngiomas (14). The EEA has flourished thanks to the strict and systematic study of the anatomy of the skull base as seen through this

retrosellar space after tumor removal. Ch, chiasm; T, tumor; FThV, floor of the third ventricle.

route. However, the technologic progress and the development and refinement of dedicated instrumentation and new approaches definitively showed its true potential, enabling its widespread use. Kassam et al. (45) introduced a new classification for craniopharyngiomas further contributing to the understanding of the anatomy the surgeon encounters when approaching such complicated lesions through an EEA. An understanding of the position of the tumor relative to the stalk and other main vital surrounding structures is critical for the surgical management of craniopharyngiomas. The endoscope itself provides advantages, including the possibility to remove the posterior clinoid safely, which can be

more difficult under a microscopic view. As described here, a skillful endoscopist is required to maintain the view in an extremely narrow corridor while the clinoidectomy is performed. This latter maneuver is required to gain adequate access to retroinfundibular tumors, achieving a straight midline corridor to the interpeduncular cistern. Nevertheless, it is not always possible to determine the position of the infundibulum preoperatively and, above all, its relationships with the tumor, especially when dealing with large tumors. However, we found that these relationships immediately become clear on surgical exposure, so that even if a preoperative prediction is inaccurate, the approach can be modified accordingly at this point.

Figure 9. (AeC) Postoperative magnetic resonance imaging demonstrating total removal of the lesion.

WORLD NEUROSURGERY 82 [6S]: S32-S40, DECEMBER 2014

www.WORLDNEUROSURGERY.org

S37

PEER-REVIEW REPORTS LUIGI MARIA CAVALLO ET AL.

Besides these considerations, when dealing with a recurrent craniopharyngioma via an EEA, further surgical features should be noted (14), as follows. If a previous transcranial approach has been performed, the endonasal route represents a naïve corridor. On one hand, the suprasellar prechiasmatic portion of the lesion could be more troublesome to manage, owing to arachnoidal adherences. On the other hand, the primary transcranial route did not allow the most inferior and posterior portion of the tumor to be reached. The EEA provides a direct access to these portions of the lesions through the subchiasmatic and intraventricular corridors, which are along the same axis of the approach. In cases in which a previous standard transsphenoidal approach has been performed, the nasal and sphenoidal steps need further refinement—that is, the steps required for an expanded endonasal approach. The bone opening starts at the level of the previous defect and is enlarged as previously described. Concerning tumor management, it is easier in the case of intra-suprasellar prechiasmatic lesions because the cisternal spaces and the arachnoidal plane are intact, whereas in the case of retrosellar or intraventricular craniopharyngioma, it might not be owing to the presence of scar tissue. Finally, in recurrent craniopharyngiomas already operated on by the extended endonasal approach, the procedure is faster because a 2-nostril corridor has already been created. The removal of the reconstruction material from the osteodural defect is the first step. Tumor removal is affected by the same problems of redo transcranial approaches, especially if recurrence of the tumor occurred where it was previously removed; the presence of a high concentration of arachnoidal adherences is expected. However, this approach still provides the most direct route on the same axis of the tumor. An eccentric extension of the tumor in the middle cranial fossa or anywhere out of the safe range for surgical instruments or encasement and tight adherence of neurovascular structures, such as one or both internal carotid arteries, the anterior communicating artery complex, the optic apparatus, or the hypothalamus, could generate a situation in which the effectiveness of the surgery is limited

S38

www.SCIENCEDIRECT.com

ENDOSCOPIC ENDONASAL MANAGEMENT OF CRANIOPHARYNGIOMAS

independently of the approach. Additionally, more limited access to the suprachiasmatic areas is provided whether the chiasm is prefixed or anteriorly displaced (10, 20). As the EEA expanded, its boundaries, problems concerning bleeding control from main vessels in such a narrow space (5), and the higher risk of postoperative CSF leak started to be the main issues of concern with this approach compared with the transcranial approaches. Nevertheless, as with advances in the exposure during the EEA, improvements in closure techniques, including the use of vascularized flaps (29, 35, 60, 73), are being developed and continuously refined. Such new strategies, combined with the use of new materials for hemostasis and dedicated instruments, seem to reduce such risks significantly (12, 47, 62).

CONCLUSIONS Craniopharyngiomas represent a surgical challenge with resection via either a transcranial or a transnasal approach using microscopy or endoscopy. The selection criteria of the classic transsphenoidal route for the management of craniopharyngiomas were postulated >30 years ago and still are valid today. However, the use of the endoscope through this corridor has enlarged its indications thanks to visual properties of the endoscope itself, which increase safety and efficacy of the approach. The extended EEA for suprasellar craniopharyngiomas avoids brain retraction, permits early exposure of the lesion, provides good visualization of the pituitary gland and stalk and the main vascular structures, and minimizes manipulation of the optic apparatus. The endoscopic technique, both standard and extended approaches, can be considered as a possible surgical treatment for craniopharyngiomas in the modern neurosurgical armamentarium. REFERENCES 1. Abe T, Ludecke DK: Transnasal surgery for infradiaphragmatic craniopharyngiomas in pediatric patients. Neurosurgery 44:957-964; discussion 964-966, 1999. 2. Caldarelli M, di Rocco C, Papacci F, Colosimo C Jr: Management of recurrent craniopharyngioma. Acta Neurochir (Wien) 140:447-454, 1998.

3. Cappabianca P, Alfieri A, de Divitiis E: Endoscopic endonasal transsphenoidal approach to the sella: towards functional endoscopic pituitary surgery (FEPS). Minim Invasive Neurosurg 41: 66-73, 1998. 4. Cappabianca P, Cavallo LM, Colao A, Del Basso De Caro M, Esposito F, Cirillo S, Lombardi G, de Divitiis E: Endoscopic endonasal transsphenoidal approach: outcome analysis of 100 consecutive procedures. Minim Invasive Neurosurg 45: 193-200, 2002. 5. Cappabianca P, Cavallo LM, Esposito F, de Divitiis O, Messina A, de Divitiis E: 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. 2nd ed. New York: Springer; 2008:152-199. 6. Cappabianca P, de Divitiis E: Endoscopy and transsphenoidal surgery. Neurosurgery 54: 1043-1048; discussion 1048-1050, 2004. 7. Cappabianca P, Esposito F, Magro F, Cavallo LM, Solari D, Stella L, de Divitiis O: Natura abhorret a vacuo—use of fibrin glue as a filler and sealant in neurosurgical “dead spaces.” Technical note. Acta Neurochir (Wien) 152:897-904, 2010. 8. Cappabianca P, Frank G, Pasquini E, de Divitiis O, Calbucci F: Extended endoscopic endonasal transsphenoidal approaches to the suprasellar region, planum sphenoidale and clivus. In: de Divitiis E, Cappabianca P, eds. Endoscopic Endonasal Transsphenoidal Surgery. New York: Springer; 2003:176-187. 9. Carrau RL, Jho HD, Ko Y: Transnasal-transsphenoidal endoscopic surgery of the pituitary gland. Laryngoscope 106:914-918, 1996. 10. Cavallo LM, de Divitiis O, Aydin S, Messina A, Esposito F, Iaconetta G, Talat K, Cappabianca P, Tschabitscher M: Extended endoscopic endonasal transsphenoidal approach to the suprasellar area: anatomic considerations—part 1. Neurosurgery 61:ONS24-ONS34, 2007. 11. Cavallo LM, Messina A, Cappabianca P, Esposito F, de Divitiis E, Gardner P, Tschabitscher M: Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations. Neurosurg Focus 19:E2, 2005. 12. Cavallo LM, Messina A, Esposito F, de Divitiis O, Dal Fabbro M, de Divitiis E, Cappabianca P: Skull base reconstruction in the extended endoscopic transsphenoidal approach for suprasellar lesions. J Neurosurg 107:713-720, 2007. 13. Cavallo LM, Prevedello D, Esposito F, Laws ER Jr, Dusick JR, Messina A, Jane JA Jr, Kelly DF, Cappabianca P: The role of the endoscope in the transsphenoidal management of cystic lesions of the sellar region. Neurosurg Rev 31:55-64; discussion 64, 2008. 14. Cavallo LM, Prevedello DM, Solari D, Gardner PA, Esposito F, Snyderman CH, Carrau RL, Kassam AB, Cappabianca P: Extended endoscopic endonasal transsphenoidal approach for residual

WORLD NEUROSURGERY, http://dx.doi.org/10.1016/j.wneu.2014.07.023

PEER-REVIEW REPORTS LUIGI MARIA CAVALLO ET AL.

or recurrent craniopharyngiomas. J Neurosurg 111: 578-589, 2009. 15. Ceylan S, Koc K, Anik I: Extended endoscopic approaches for midline skull-base lesions. Neurosurg Rev 32:309-319; discussion 318-319, 2009.

ENDOSCOPIC ENDONASAL MANAGEMENT OF CRANIOPHARYNGIOMAS

28. Fahlbusch R, Schott W: Pterional surgery of meningiomas of the tuberculum sellae and planum sphenoidale: surgical results with special consideration of ophthalmological and endocrinological outcomes. J Neurosurg 96:235-243, 2002.

16. Ciric IS, Cozzens JW: Craniopharyngiomas: transsphenoidal method of approach—for the virtuoso only? Clin Neurosurg 27:169-187, 1980.

29. Fortes FS, Carrau RL, Snyderman CH, Prevedello D, Vescan A, Mintz A, Gardner P, Kassam AB: The posterior pedicle inferior turbinate flap: a new vascularized flap for skull base reconstruction. Laryngoscope 117:1329-1332, 2007.

17. Couldwell WT, Weiss MH, Rabb C, Liu JK, Apfelbaum RI, Fukushima T: 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 55:539-550, 2004.

30. Frank G, Pasquini E, Doglietto F, Mazzatenta D, Sciaretta V, Farneti G, Calbucci F: The endoscopic extended transsphenoidal approach for craniopharyngiomas. Neurosurgery 59 (Suppl 1): ONS75-ONS83, 2006.

18. de Divitiis E, Cappabianca P, Cavallo LM: Endoscopic transsphenoidal approach: adaptability of the procedure to different sellar lesions. Neurosurgery 51:699-705; discussion 705-707, 2002. 19. de Divitiis E, Cappabianca P, Cavallo LM, Esposito F, de Divitiis O, Messina A: Extended endoscopic transsphenoidal approach for extrasellar craniopharyngiomas. Neurosurgery 61: 219-227; discussion 228, 2007. 20. de Divitiis E, Cavallo LM, Cappabianca P, Esposito F: Extended endoscopic endonasal transsphenoidal approach for the removal of suprasellar tumors: Part 2. Neurosurgery 60:46-58; discussion 58-59, 2007. 21. de Notaris M, Solari D, Cavallo LM, D’Enza AI, Ensenat J, Berenguer J, Ferrer E, Prats-Galino A, Cappabianca P: The “suprasellar notch,” or the tuberculum sellae as seen from below: definition, features, and clinical implications from an endoscopic endonasal perspective. J Neurosurg 116: 622-629, 2012. 22. Dehdashti AR, Ganna A, Witterick I, Gentili F: Expanded endoscopic endonasal approach for anterior cranial base and suprasellar lesions: indications and limitations. Neurosurgery 64: 677-687; discussion 687-689, 2009. 23. Delashaw JB Jr, Tedeschi H, Rhoton AL: Modified supraorbital craniotomy: technical note. Neurosurgery 30:954-956, 1992. 24. Dumont AS, Kanter AS, Jane JA Jr, Laws ER Jr: Extended transsphenoidal approach. Front Horm Res 34:29-45, 2006. 25. Dusick JR, Esposito F, Kelly DF, Cohan P, DeSalles A, Becker DP, Martin NA: The extended direct endonasal transsphenoidal approach for nonadenomatous suprasellar tumors. J Neurosurg 102:832-841, 2005.

31. Frank G, Pasquini E, Mazzatenta D: Extended transsphenoidal approach. J Neurosurg 95: 917-918, 2001. 32. Gardner PA, Prevedello DM, Kassam AB, Snyderman CH, Carrau RL, Mintz AH: The evolution of the endonasal approach for craniopharyngiomas. J Neurosurg 108:1043-1047, 2008. 33. Goel A, Muzumdar D, Desai KI: Tuberculum sellae meningioma: a report on management on the basis of a surgical experience with 70 patients. Neurosurgery 51:1358-1363; discussion 1363-1364, 2002. 34. Guiot G, Derome P: [Indications for transsphenoid approach in neurosurgery. 521 cases]. Ann Med Interne (Paris) 123:703-712, 1972. 35. Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH, Mintz A: A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 116:1882-1886, 2006. 36. Hardy J: Transsphenoidal J Neurosurg 34:582-594, 1971.

hypophysectomy.

37. Hoffman HJ: Surgical management of craniopharyngioma. Pediatr Neurosurg 21 (Suppl 1): 44-49, 1994. 38. Honegger J, Buchfelder M, Fahlbusch R, Daubler B, Dorr HG: Transsphenoidal microsurgery for craniopharyngioma. Surg Neurol 37: 189-196, 1992. 39. Jallo GI, Benjamin V: Tuberculum sellae meningiomas: microsurgical anatomy and surgical technique. Neurosurgery 51:1432-1439; discussion 1439-1440, 2002. 40. Jarrahy R, Cha ST, Berci G, Shahinian HK: Endoscopic transglabellar approach to the anterior fossa and paranasal sinuses. J Craniofac Surg 11:412-417, 2000.

43. Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL: Expanded endonasal approach: the rostrocaudal axis. Part I: crista galli to the sella turcica. Neurosurg Focus 19:E3, 2005. 44. Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL: Expanded endonasal approach: the rostrocaudal axis. Part II: posterior clinoids to the foramen magnum. Neurosurg Focus 19:E4, 2005. 45. Kassam AB, Gardner PA, Snyderman CH, Carrau RL, Mintz AH, Prevedello DM: Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based on the infundibulum. J Neurosurg 108:715-728, 2008. 46. Kassam AB, Prevedello DM, Thomas A, Gardner P, Mintz A, Snyderman C, Carrau R: Endoscopic endonasal pituitary transposition for a transdorsum sellae approach to the interpeduncular cistern. Neurosurgery 62:57-72; discussion 72-74, 2008. 47. Kassam AB, Thomas A, Carrau RL, Snyderman CH, Vescan A, Prevedello D, Mintz A, Gardner P: Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery 63:ONS44-ONS52; discussion ONS52-ONS53, 2008. 48. Kato T, Sawamura Y, Abe H, Nagashima M: Transsphenoidal-transtuberculum sellae approach for supradiaphragmatic tumours: technical note. Acta Neurochir (Wien) 140:715-719, 1998. 49. Kennedy DW: Functional endoscopic sinus surgery. Technique. Arch Otolaryngol 111: 643-649, 1985. 50. Kim J, Choe I, Bak K, Kim C, Kim N, Jang Y: Transsphenoidal supradiaphragmatic intradural approach: technical note. Minim Invasive Neurosurg 43:33-37, 2000. 51. Kouri JG, Chen MY, Watson JC, Oldfield EH: Resection of suprasellar tumors by using a modified transsphenoidal approach. Report of four cases. J Neurosurg 92:1028-1035, 2000. 52. Landolt AM, Zachmann M: Results of transsphenoidal extirpation of craniopharyngiomas and Rathke’s cysts. Neurosurgery 28:410-415, 1991. 53. Laufer I, Anand VK, Schwartz TH: Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions. J Neurosurg 106:400-406, 2007. 54. Laws ER Jr: Transsphenoidal microsurgery in the management of craniopharyngioma. J Neurosurg 52:661-666, 1980.

26. Esposito F, Dusick JR, Fatemi N, Kelly DF: Graded repair of cranial base defects and cerebrospinal fluid leaks in transsphenoidal surgery. Neurosurgery 60:295-303; discussion 303-304, 2007.

41. Kaptain GJ, Vincent DA, Sheehan JP, Laws ER Jr: Transsphenoidal approaches for the extracapsular resection of midline suprasellar and anterior cranial base lesions. Neurosurgery 49:94-101, 2001.

55. Laws ER Jr: Transsphenoidal removal of craniopharyngioma. Pediatr Neurosurg 21 (Suppl 1): 57-63, 1994.

27. Fahlbusch R, Honegger J, Paulus W, Huk W, Buchfelder M: Surgical treatment of craniopharyngiomas: experience with 168 patients. J Neurosurg 90:237-250, 1999.

42. Kassam A: Fully endoscopic endonasal resection of parasellar craniopharyngiomas: an early experience amd review of literature. Skull Base 12 (Suppl I) (Abstract), 2004.

56. Maira G, Anile C, Albanese A, Cabezas D, Pardi F, Vignati A: The role of transsphenoidal surgery in the treatment of craniopharyngiomas. J Neurosurg 100:445-451, 2004.

WORLD NEUROSURGERY 82 [6S]: S32-S40, DECEMBER 2014

www.WORLDNEUROSURGERY.org

S39

PEER-REVIEW REPORTS LUIGI MARIA CAVALLO ET AL.

57. Mason RB, Nieman LK, Doppman JL, Oldfield EH: Selective excision of adenomas originating in or extending into the pituitary stalk with preservation of pituitary function. J Neurosurg 87:343-351, 1997. 58. Messerklinger W: Endoscopy technique of the middle nasal meatus [author’s transl]. Arch Otorhinolaryngol 221:297-305, 1978. 59. Minamida Y, Mikami T, Hashi K, Houkin K: Surgical management of the recurrence and regrowth of craniopharyngiomas. J Neurosurg 103: 224-232, 2005.

ENDOSCOPIC ENDONASAL MANAGEMENT OF CRANIOPHARYNGIOMAS

eyebrow skin incision. Neurosurgery 57:242-255, 2005. 64. Samii M, Bini W: Surgical treatment of craniopharyngiomas. Zentralbl Neurochir 52:17-23, 1991. 65. Samii M, Samii A: Surgical management of craniopharyngiomas. In: Schmidek HH, ed. Schmidek & Sweet Operative Neurosurgical Techniques: Indications, Methods and Results. Philadelphia: Saunders; 2000:489-502. 66. Spaziante R, de Divitiis E: Drainage techniques for cystic craniopharyngiomas. Neurosurg Q 7: 183-208, 1997.

60. Oliver CL, Hackman TG, Carrau RL, Snyderman CH, Kassam AB, Prevedello DM, Gardner P: Palatal flap modifications allow pedicled reconstruction of the skull base. Laryngoscope 118:2102-2106, 2008.

67. Stammberger H, Posawetz W: Functional endoscopic sinus surgery. Concept, indications and results of the Messerklinger technique. Eur Arch Otorhinolaryngol 247:63-76, 1990.

61. Page RB: Craniopharyngioma: indications for transsphenoidal surgery. Curr Ther Endocrinol Metab 5:33-34, 1994.

68. Symon L, Sprich W: Radical excision of craniopharyngioma. Results in 20 patients. J Neurosurg 62:174-181, 1985.

62. Pinheiro-Neto CD, Prevedello DM, Carrau RL, Snyderman CH, Mintz A, Gardner P, Kassam A: Improving the design of the pedicled nasoseptal flap for skull base reconstruction: a radioanatomic study. Laryngoscope 117:1560-1569, 2007.

69. Van Effenterre R, Boch AL: Craniopharyngioma in adults and children: a study of 122 surgical cases. J Neurosurg 97:3-11, 2002.

71. Wisoff JH: Surgical management of recurrent craniopharyngiomas. Pediatr Neurosurg 21 (Suppl 1): 108-113, 1994. 72. Yasargil MG, Curcic M, Kis M, Siegenthaler G, Teddy PJ, Roth P: Total removal of craniopharyngiomas. Approaches and long-term results in 144 patients. J Neurosurg 73:3-11, 1990. 73. 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 119:13-18, 2008. 74. Zuccaro G: Radical resection of craniopharyngioma. Childs Nerv Syst 21:679-690, 2005.

Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Received 18 September 2013; accepted 25 July 2014

63. Reisch R, Perneczky A: Ten-year experience with the supraorbital subfrontal approach through an

S40

www.SCIENCEDIRECT.com

Citation: World Neurosurg. (2014) 82, 6S:S32-S40. http://dx.doi.org/10.1016/j.wneu.2014.07.023 Journal homepage: www.WORLDNEUROSURGERY.org

70. Weiss MH: The transnasal transsphenoidal approach. In: Apuzzo MLJ, ed. Surgery of the Third Ventricle. Baltimore: Williams & Wilkins; 1987:476-494.

Available online: www.sciencedirect.com 1878-8750/$ - see front matter ª 2014 Elsevier Inc. All rights reserved.

WORLD NEUROSURGERY, http://dx.doi.org/10.1016/j.wneu.2014.07.023

The role of the endoscopic endonasal route in the management of craniopharyngiomas.

Craniopharyngiomas represent one of the major challenges of neurosurgery. Surgical management of craniopharyngiomas classically required various trans...
2MB Sizes 4 Downloads 6 Views