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Direct Transcavernous Sinus Approach for Endoscopic Endonasal Resection of Intracavernous Sinus Tumors.
World Neurosurg. 2019 Aug; 128:e478-e487.WN

Abstract

OBJECTIVE

Because of its vascular supply and neurovascular contents, the cavernous sinus (CS) is a challenging area to dissect in the setting of skull base tumors with intracavernous extension or invasion. In the present study, we report the clinical outcomes of 14 patients with tumors with CS invasion that were surgically treated using a direct transcavernous sinus approach for endoscopic endonasal resection of their intracavernous sinus tumors.

METHODS

Fourteen patients had undergone surgery using a direct endoscopic endonasal transcavernous sinus approach. The pathologic entities included Knosp grade 3-4 pituitary adenomas (n = 8), meningioma (n = 3), squamous cell carcinoma (n = 2), and chondrosarcoma (n = 1). The indications, surgical technique, and outcomes are discussed.

RESULTS

Gross total resection was achieved in 11 patients (78.6%). All patients experienced resolution or improvement of symptoms. One patient experienced a transient oculomotor nerve palsy, which had resolved within 2 months postoperatively. No other complications occurred. For those tumors that had been grossly resected, no recurrence developed in any patient (mean follow-up, 40.4 ± 24.8 months; range 10-84).

CONCLUSIONS

Depending on the space created by intracavernous sinus tumors, use of the transanterior wall for the CS approach in endoscopic endonasal surgery could adequately treat most patients in our case series. This approach provided good visualization of the CS and can be used to treat tumors with favorable outcomes and a low incidence of complications in appropriately evaluated patients.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Zhang Q
Skull Base Surgery Center, Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, Peoples' Republic of China. Electronic address: 13701267977@163.com.
Wang Z
Longgang ENT Hospital, Shenzhen, Peoples' Republic of China.
Guo H
Skull Base Surgery Center, Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, Peoples' Republic of China.
Yan B
Skull Base Surgery Center, Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, Peoples' Republic of China.
Wang Z
Skull Base Surgery Center, Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, Peoples' Republic of China.
Zhao H
Longgang ENT Hospital, Shenzhen, Peoples' Republic of China.
Sahyouni R
Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA.
Kuan EC
Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA.

MeSH

AdenomaAdolescentAdultAgedCavernous SinusChondrosarcomaCranial Fossa, MiddleFemaleHumansInfratemporal FossaMaleMeningeal NeoplasmsMeningiomaMiddle AgedNasal CavityNatural Orifice Endoscopic SurgeryNeoplasm InvasivenessNeuroendoscopyPituitary NeoplasmsSkull Base NeoplasmsSquamous Cell Carcinoma of Head and NeckYoung Adult

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31048053

Citation

Zhang, Qiuhang, et al. "Direct Transcavernous Sinus Approach for Endoscopic Endonasal Resection of Intracavernous Sinus Tumors." World Neurosurgery, vol. 128, 2019, pp. e478-e487.
Zhang Q, Wang Z, Guo H, et al. Direct Transcavernous Sinus Approach for Endoscopic Endonasal Resection of Intracavernous Sinus Tumors. World Neurosurg. 2019;128:e478-e487.
Zhang, Q., Wang, Z., Guo, H., Yan, B., Wang, Z., Zhao, H., Sahyouni, R., & Kuan, E. C. (2019). Direct Transcavernous Sinus Approach for Endoscopic Endonasal Resection of Intracavernous Sinus Tumors. World Neurosurgery, 128, e478-e487. https://doi.org/10.1016/j.wneu.2019.04.182
Zhang Q, et al. Direct Transcavernous Sinus Approach for Endoscopic Endonasal Resection of Intracavernous Sinus Tumors. World Neurosurg. 2019;128:e478-e487. PubMed PMID: 31048053.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Direct Transcavernous Sinus Approach for Endoscopic Endonasal Resection of Intracavernous Sinus Tumors. AU - Zhang,Qiuhang, AU - Wang,Zaixing, AU - Guo,Hongchuan, AU - Yan,Bo, AU - Wang,Zhenlin, AU - Zhao,Hailiang, AU - Sahyouni,Ronald, AU - Kuan,Edward C, Y1 - 2019/04/30/ PY - 2019/03/03/received PY - 2019/04/20/revised PY - 2019/04/22/accepted PY - 2019/5/3/pubmed PY - 2020/1/21/medline PY - 2019/5/4/entrez KW - Cavernous sinus KW - Endoscopic endonasal surgery KW - Pituitary tumors KW - Sella and parasellar tumors KW - Skull base SP - e478 EP - e487 JF - World neurosurgery JO - World Neurosurg VL - 128 N2 - OBJECTIVE: Because of its vascular supply and neurovascular contents, the cavernous sinus (CS) is a challenging area to dissect in the setting of skull base tumors with intracavernous extension or invasion. In the present study, we report the clinical outcomes of 14 patients with tumors with CS invasion that were surgically treated using a direct transcavernous sinus approach for endoscopic endonasal resection of their intracavernous sinus tumors. METHODS: Fourteen patients had undergone surgery using a direct endoscopic endonasal transcavernous sinus approach. The pathologic entities included Knosp grade 3-4 pituitary adenomas (n = 8), meningioma (n = 3), squamous cell carcinoma (n = 2), and chondrosarcoma (n = 1). The indications, surgical technique, and outcomes are discussed. RESULTS: Gross total resection was achieved in 11 patients (78.6%). All patients experienced resolution or improvement of symptoms. One patient experienced a transient oculomotor nerve palsy, which had resolved within 2 months postoperatively. No other complications occurred. For those tumors that had been grossly resected, no recurrence developed in any patient (mean follow-up, 40.4 ± 24.8 months; range 10-84). CONCLUSIONS: Depending on the space created by intracavernous sinus tumors, use of the transanterior wall for the CS approach in endoscopic endonasal surgery could adequately treat most patients in our case series. This approach provided good visualization of the CS and can be used to treat tumors with favorable outcomes and a low incidence of complications in appropriately evaluated patients. SN - 1878-8769 UR - https://www.unboundmedicine.com/medline/citation/31048053/Direct_Transcavernous_Sinus_Approach_for_Endoscopic_Endonasal_Resection_of_Intracavernous_Sinus_Tumors_ DB - PRIME DP - Unbound Medicine ER -