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Minimal Access Skull Base Surgery: Open and Endoscopic Assisted Approaches
Kofi Boahene, Alfredo Quiñones-Hinojosa
SECTION 1: GENERAL
1:
1 The ‘Dilemma’ of Modern Skull Base Surgery: Selecting the Correct Approach
HISTORICAL PERSPECTIVE
EVOLUTION OF MODERN SKULL BASE TECHNIQUES
UNDERSTANDING THE GOALS OF SURGERY
UNDERSTANDING THE EXTENT OF SKULL BASE INVOLVEMENT
QOL EXPECTATIONS
SUMMARY
2:
Imaging of the Skull Base
INTRODUCTION
IMAGING TECHNIQUES
ANTERIOR SKULL BASE
Imaging Features of Common Diseases
CENTRAL SKULL BASE
Imaging Features of Common Diseases
3:
Surgical Pathology of the Skull Base
INTRODUCTION
SPECIFIC ENTITIES
Nonneoplastic
Inflammatory Disorders
Noninflammatory Lesions
Bone Tumors and Tumor-Like Lesions
Fibrous Dysplasia
Other Benign Bone Lesions/Neoplasms
Osteosarcoma
Ewing Sarcoma
Chordoma
Chondrosarcoma
Meningioma
Nonmeningothelial Dural-Based Tumors
Solitary Fibrous Tumor and Hemangiopericytoma
Inflammatory Myofibroblastic Tumor
Melanocytic Neoplasms
Sellar Lesions
Craniopharyngioma
Hematopoietic Neoplasms
Plasmacytoma/Multiple Myeloma
Lymphoma
Histiocytoses
Head and Neck Tumors
Squamous Cell Carcinoma
Olfactory Neuroblastoma
Salivary Gland Tumors
Nerve Sheath Tumors
Miscellaneous
Metastases
4:
Anesthetic Requirements and Pearls for Skull Base Surgery
INTRODUCTION
BASIC PHARMACOLOGY AND PHARMACOKINETICS
Intravenous Drugs
Opioids
Synthetic Opioids
Induction Agents
Propofol
Barbiturates
Benzodiazepine
Etomidate
Ketamine
Neuromuscular Blocking Agents
Inhalational Anesthesia
Total Intravenous Anesthesia
Cardiovascular Monitoring
Brain Monitoring
Bispectral Index
Cerebral Oximetry
Transcranial Doppler
Neurophysiologic Monitoring
Facial Nerve Monitoring
Intraoperative Auditory Brainstem Response
Somatosensory-Evoked Potentials
Motor-Evoked Potentials
Electroencephalogram
Preoperative Evaluation (Table 4.1)
Operative Setting (Fig. 4.1)
Patient Positioning
Technical Notes
Optimization of Surgical Conditions
CONCLUSION
SECTION 2: TRANSORBITAL AND SUPRAORBITAL APPROACHES
5:
Surgical Anatomy of the Orbit for Transorbital Approaches to Anterior Skull Base Lesions
INTRODUCTION
REVIEW OF THE ORBITAL ANATOMY AND SURGICAL CORRELATION
PATIENT SELECTION
INDICATIONS FOR THE TRANSORBITAL APPROACH
TECHNICAL ASPECTS
POSTOPERATIVE MANAGEMENT
ILLUSTRATIVE CASE
Surgical Procedure
SUMMARY
VIDEO LEGEND
6:
Transorbital Approaches: Minimally Invasive Access to the Anterior Skull Base
INTRODUCTION
ANATOMY
Lid Apparatus
Osseous Anatomy
TECHNIQUE
Definitions and Terminology
The Approaches: Surgical Technique
The Upper Eyelid Approach
The Precaruncular Approach
The Lateral Retrocanthal Approach
The Transconjunctival Approach
PRINCIPLES OF THERAPEUTIC MANAGEMENT
Interdisciplinary Management
Perioperative Management
Patient Positioning
Neuronavigation
Changing to the Transcranial Approach
Lumbar Drainage
INDICATIONS
Lesions Involving the Frontal Sinus
Lesions of the Interorbital Corridor and Trochlea
Sealing Dural Defects
CLINICAL STUDIES/LITERATURE REVIEW
Sinugenic Complications
Tumors of the Frontal Sinus
Management of Dural Defects
Management of Fractures of the Anterior Skull Base
DISCUSSION
CONCLUSION
7:
Transpalpebral Orbitofrontal Approaches to Intracranial Lesions
INTRODUCTION
INDICATIONS
PREOPERATIVE EVALUATION
OPERATIVE TECHNIQUE
Patient Positioning and Preparation
Eyelid Incision and Orbitofrontal Exposure
Minicraniotomy
Management of Cranial Vault Pathology
Reconstruction
POSTOPERATIVE CARE
ILLUSTRATIVE CASE
Acknowledgment
8:
Supraorbital Craniotomy Keyhole Technique
INTRODUCTION
INDICATIONS
PREOPERATIVE EVALUATION
TECHNICAL NOTES
Positioning
Incision and Subcutaneous Dissection
Supraorbital Keyhole Craniotomy
Orbital Osteotomy
Dural Opening and Brain Relaxation
Primary Operation
Closure
POSTOPERATIVE MANAGEMENT
ILLUSTRATIVE CASE
Acknowledgment
9:
Endoscopic Decompression of the Orbital Apex
INTRODUCTION
INDICATIONS
PREOPERATIVE EVALUATION
TECHNICAL NOTES
POSTOPERATIVE MANAGEMENT
ILLUSTRATIVE CASE
SECTION 3: TRANSNASAL APPROACHES
10:
Surgical Anatomy for Endoscopic Endonasal Skull Base Surgery
INTRODUCTION
EEA MODULES TO THE VENTRAL SKULL BASE
11:
Transnasal Endoscopic Assisted Transcribriform Approach to Skull Base Lesions
INTRODUCTION
INDICATIONS
PREOPERATIVE EVALUATION
Vascular Supply
TECHNICAL NOTES
Limits
Closure of Defects
Encephaloceles
CASE ILLUSTRATION
Exposure of Tumors
MANAGEMENT OF COMPLICATIONS
POSTOPERATIVE MANAGEMENT
ILLUSTRATIVE CASES
12:
Endoscopic Endonasal Transsphenoidal and Transplanum Approach
INTRODUCTION
INDICATIONS
PREOPERATIVE EVALUATION
TECHNICAL NOTES
General Setup
Nasal Approach
Resection
Reconstruction
POSTOPERATIVE MANAGEMENT
ILLUSTRATIVE CASE
13:
Endoscopic Endonasal Transpterygoid Approaches
INTRODUCTION
INDICATIONS
PREOPERATIVE EVALUATION
SURGICAL TECHNIQUE
General Concepts
Technical Steps
POSTOPERATIVE MANAGEMENT
ILLUSTRATIVE CASES
Case 1
Case 2
14:
Transnasal Endoscopic Assisted Approach to the Mid-Cranial Base and Infratemporal Fossa
INTRODUCTION
INDICATIONS
PREOPERATIVE EVALUATION
TECHNICAL NOTES
General Setup
Nasal Approach
Resection
Reconstruction
POSTOPERATIVE MANAGEMENT
ILLUSTRATIVE CASE
15:
Endoscopic Approaches to Lesions in the Cavernous Sinus
INTRODUCTION
ANATOMIC CONSIDERATIONS
CONSIDERATIONS FOR APPROACH SELECTION
ENDOSCOPIC TRANSSPHENOIDAL APPROACH TO THE CAVERNOUS SINUS
ENDOSCOPIC TRANSPTERYGOIDAL APPROACH
RECONSTRUCTION
VASCULAR CONSIDERATIONS
ILLUSTRATIVE CASES (FIGS. 15.3 and 15.4)
SUMMARY
VIDEO LEGEND
16:
Endoscopic Management of Petrous Apex Lesions
INTRODUCTION
INDICATIONS
PREOPERATIVE EVALUATION
TECHNICAL NOTES
POSTOPERATIVE MANAGEMENT
17:
Transnasal Endoscopic Assisted Approach to the Clivus and Craniocervical Junction
INTRODUCTION
INDICATIONS
PREOPERATIVE EVALUATION
TECHNICAL NOTES
Operative Preparations
Transclival Approaches
Reconstruction
POSTOPERATIVE MANAGEMENT
ILLUSTRATIVE CASE
SECTION 4: TRANSORAL APPROACHES
18:
Endoscopic Assisted Transoral Approach to the Parapharyngeal Space
INTRODUCTION
INDICATION AND PREOPERATIVE EVALUATION
TECHNICAL NOTES
Surgical Anatomy for Transoral Approach
DRAWBACKS AND POSSIBLE LIMITATIONS
REVIEW OF LITERATURE
ILLUSTRATIVE CASE
SUMMARY
19:
Endoscopic Assisted Paramandibular Approach to Infratemporal Fossa and Parapharyngeal Spaces
INTRODUCTION
INDICATIONS
PREOPERATIVE EVALUATION AND CONSIDERATION
TECHNICAL NOTES
POSTOPERATIVE MANAGEMENT
ILLUSTRATIVE CASE
SUMMARY
20:
Evolution of Transoral Robotic-Assisted Approaches to the Skull Base
EVOLUTION FROM OPEN TO ROBOTIC TECHNIQUES
APPROACHES TO THE SKULL BASE
Transoral Only Approach (Transoral Robotic Surgery)
Technique
Advantages
Disadvantages
Combined Transoral Transnasal Procedure
Technique
Advantages
Disadvantages
Combined EEA and TORS Approach (EEA/TORS)
Technique
Advantages
Disadvantages
Cervical Transoral Robotic Surgery (C-TORS)
Technique
Advantages
Disadvantages
TORS with Suprahyoid Port
Technique
Advantages
Disadvantages
Transmaxillary Approach
Technique
Advantages
Disadvantages
Transorbital Approach
Technique
Advantages
Disadvantages
CHALLENGES AND FUTURE DIRECTIONS
ILLUSTRATIVE CASE
CONCLUSION
VIDEO LEGEND
SECTION 5: MANAGEMENT OF SELECTED SKULL BASE LESIONS
21:
Endoscopic Transsphenoidal Approach to Pituitary Lesions
INTRODUCTION
SPECIAL ANATOMY OF THE SPHENOID SINUS AND SELLA
INDICATIONS
PREOPERATIVE EVALUATION
TECHNICAL NOTES
POSTOPERATIVE MANAGEMENT
ILLUSTRATIVE CASE
22:
Endoscopic Assisted Miniorbitofrontal Craniotomy in the Management of Frontal Sinus Inverting Papilloma
INTRODUCTION
PATIENT PRESENTATION AND CLINICAL EVALUATION
SURGICAL MANAGEMENT
Technical Notes
Patient Positioning and Preparation
Endonasal Approaches
Draf IIB
Draf III
Eyelid Incision and Orbitofrontal Exposure
Minicraniotomy
POSTOPERATIVE MANAGEMENT
ILLUSTRATIVE CASE
23:
Transpalpebral Orbitocranial Approach to Olfactory Groove Meningiomas
INTRODUCTION
INDICATIONS
PREOPERATIVE EVALUATION
Presenting Symptoms
Preoperative Imaging
TECHNICAL NOTES
POSTOPERATIVE MANAGEMENT
ILLUSTRATIVE CASE
24:
Transpalpebral Orbitocranial Approach to Sellar and Suprasellar Pituitary Adenoma
INTRODUCTION
INDICATIONS
PREOPERATIVE EVALUATION
TECHNICAL NOTES
Technical Nuances when Addressing Suprasellar Expansion of Pituitary Adenomas
Limitations
POSTOPERATIVE MANAGEMENT
ILLUSTRATIVE CASE
Imaging (Figs. 24.2A to D)
Plan
Surgery
Postoperative MRI (see Figs. 24.2A to D)
Follow-Up
25:
Endoscopic Assisted Resection of Juvenile Nasal Angiofibroma
INTRODUCTION
Hormone Response
Chromosomal Abnormalities
Anatomy
PREOPERATIVE EVALUATION
Staging
Management
Imaging
Embolization
TREATMENT
SURGICAL APPROACHES
Open
Endoscopic
Nonsurgical Options: Radiation
POSTOPERATIVE MANAGEMENT/COMPLICATIONS
MORBIDITY
26:
Transnasal Endoscopic Assisted Management of Cerebrospinal Fluid Leak and Meningocele
INTRODUCTION
General
Etiology and Pathophysiology
Traumatic
Iatrogenic
Spontaneous
Other Nontraumatic
Congenital
PREOPERATIVE EVALUATION
History and Physical Examination
Laboratory Findings
Imaging
Multidetector CT
Magnetic Resonance Imaging/Magnetic Resonance Cisternography
Other Imaging
Signs of Elevated ICP
INDICATIONS FOR SURGICAL REPAIR
TECHNICAL NOTES
Operative Setup
Intrathecal Fluorescein
CSF Leak Repair
Repair Technique
Site-Specific Surgical Technique
POSTOPERATIVE MANAGEMENT
27:
Transorbital Endoscopic Assisted Management of Cerebrospinal Fluid Leak
INTRODUCTION
INDICATIONS
PREOPERATIVE EVALUATION
TECHNICAL NOTES
TIPS TO PREVENT APPROACH-RELATED COMPLICATIONS
POSTOPERATIVE MANAGEMENT
ILLUSTRATIVE CASE
28:
Endoscopic Management of Clival Chordoma
INTRODUCTION
PREOPERATIVE EVALUATION
TECHNICAL NOTES
Surgical Anatomy
Surgical Technique
POSTOPERATIVE EVALUATION
CLINICAL STUDIES
29:
Minicraniotomy Management of Superior Canal Dehiscence
INTRODUCTION
PRESENTATION AND CLINICAL EVALUATION
SURGICAL MANAGEMENT
SURGICAL TECHNIQUE
POSTOPERATIVE MANAGEMENT
OUTCOMES
CONCLUSION
ILLUSTRATIVE CASE
SECTION 6: SKULL BASE RECONSTRUCTION AND POSTOPERATIVE MANAGEMENT
30:
30 Skull Base Reconstruction
INTRODUCTION
PREOPERATIVE EVALUATION AND INDICATIONS
TREATMENT ALGORITHM
ENDOSCOPIC SKULL BASE RECONSTRUCTION
Vascularized Tissue
Nasoseptal Flap
Surgical Technique
Middle Turbinate Flap
Surgical Technique
Inferior Turbinate Flap
Surgical Technique
Posterior Pedicled Inferior Turbinate Flap
Anterior Pedicled Inferior Turbinate Flap
Anteriorly Based Lateral Nasal Wall Flap
Surgical Technique
Pericranial Flap
Surgical Technique
Transpterygoid Transposition of a Temporoparietal Flap
Surgical Technique
Postoperative Management of Endoscopic Reconstruction
Nonvascularized Tissues
Alloplastic Materials
MICROVASCULAR FLAP RECONSTRUCTION FOR COMPLEX SKULL BASE DEFECTS
Radial Forearm Free Flap
Radial Forearm Free Flap Harvesting Technique
Rectus Free Flap
Rectus Free Flap Harvesting Technique
Flap Inset and Vessel Anastomosis Technique
ILLUSTRATIVE CASE
31:
Management of Complications Associated with Endoscopic Assisted Skull Base Surgery
HISTORY AND ADVANCES IN ENDOSCOPIC APPROACHES
INTRACRANIAL COMPLICATIONS
Cerebrospinal Fluid Leak
Diagnosis of Postoperative CSF Leak
Treatment of Postoperative CSF Leak
Prevention of Postoperative CSF Leak
Tension Pneumocephalus
Meningitis
Air Embolism
Internal Carotid Artery Injury
Intracranial Bleeding
Cavernous Sinus Cranial Nerve Injury
Optic Nerve Injury
ENDOCRINOLOGIC COMPLICATIONS
INTRANASAL COMPLICATIONS
Postoperative Sinusitis
Mucocele and Encephalocele
Postoperative Anosmia
Epistaxis
INTRAORBITAL COMPLICATIONS
Vision Loss
Extraocular Muscle Damage
CONCLUSION
INDEX
TOC
Index
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