- Orbital Tumors: Report of 70 Surgically Treated Cases. [Case Reports]
- WNWorld Neurosurg 2018; 119:e449-e458
- CONCLUSIONS: We recommend, 1) the endoscopic endonasal approach for primary orbital tumors located in the medial or inferior orbital walls without extra-orbital extension; 2) the trans-eyelid approach for tumors of the upper and upper-lateral quadrants extraconally located, and 3) the fronto-orbital approach for intraconally located tumors involving more than one quadrant.
- Salvage skull base reconstruction in the endoscopic era: Vastus lateralis free tissue transfer. [Case Reports]
- HNHead Neck 2018; 40(4):E45-E52
- CONCLUSIONS: This technique permits endoscopic endonasal inset and placement of reliable, well vascularized free tissue that may be utilized for complex, secondary reconstruction of the skull base.
- Extended maxillotomy for skull base access in contemporary management of chordomas: Rationale and technical aspect. [Case Reports]
- JCJ Clin Neurosci 2017; 39:212-215
- Minimally invasive approaches to the central skull base have been popularized over the last decade and have to a large extent displaced 'open' procedures. However, traditional skull base surgery stil…
Minimally invasive approaches to the central skull base have been popularized over the last decade and have to a large extent displaced 'open' procedures. However, traditional skull base surgery still has its role especially when dealing with a large clival chordoma where maximal surgical resection is the principal goal to maximize patient survival. In this paper, we present a case of a 25year-old male patient with chordoma in the inferior clivus which was initially debulked via a transnasal endoscopic approach. He unfortunately had a large recurrence of tumor requiring re-do resection. With the aim to achieve maximal surgical resection, we then chose the technique of a transoral approach with Le Fort 1 maxillotomy and midline palatal split. Post-operative course for the patient was uneventful and post-operative MRI confirmed significant debulking of the clival lesion. The technique employed for the surgical procedure is presented here in detail as is our experience over two decades using this technique for tumors, inflammatory lesions and congenital abnormalities at the cranio-cervical junction.
- Transnasal endoscopic partial maxillectomy: Operative nuances and proposal for a comprehensive classification system based on 1378 cases. [Journal Article]
- HNHead Neck 2017; 39(4):754-766
- CONCLUSIONS: The TEPM is a stepwise approach offering increasing access that can be tailored to different maxillary, sinonasal, and skull base pathologies with minimal morbidity for patients. © 2016 Wiley Periodicals, Inc. Head Neck 39: 754-766, 2017.
- Craniofacial Resection and Reconstruction in Patients With Recurrent Cancer Involving the Craniomaxillofacial Region. [Journal Article]
- JOJ Oral Maxillofac Surg 2017; 75(3):622-631
- CONCLUSIONS: Craniofacial resection remains an effective salvage treatment for patients with recurrent SCC and SA involving the craniomaxillofacial region. The extended vertical lower TIMF is a large, simple, and reliable flap for reconstructing major defects after a craniofacial resection.
- Effect of Incremental Endoscopic Maxillectomy on Surgical Exposure of the Pterygopalatine and Infratemporal Fossae. [Journal Article]
- JNJ Neurol Surg B Skull Base 2016; 77(1):66-74
- Objective Access to the pterygopalatine and infratemporal fossae presents a significant surgical challenge, owing to their deep-seated location and complex neurovascular anatomy. This study elucidate…
Objective Access to the pterygopalatine and infratemporal fossae presents a significant surgical challenge, owing to their deep-seated location and complex neurovascular anatomy. This study elucidates the benefits of incremental medial maxillectomies to access this region. We compared access to the medial aspect of the infratemporal fossa provided by medial maxillectomy, anteriorly extended medial maxillectomy, endoscopic Denker approach (i.e., Sturmann-Canfield approach), contralateral transseptal approach, and the sublabial anterior maxillotomy (SAM). Methods We studied 10 cadaveric specimens (20 sides) dissecting the pterygopalatine and infratemporal fossae bilaterally. Radius of access was calculated using a navigation probe aligned with the endoscopic line of sight. Area of exposure was calculated as the area removed from the posterior wall of maxillary sinus. Surgical freedom was calculated by computing the working area at the proximal end of the instrument with the distal end fixed at a target. Results The endoscopic Denker approach offered a superior area of exposure (8.46 ± 1.56 cm(2)) and superior surgical freedom. Degree of lateral access with the SAM approach was similar to that of the Denker. Conclusion Our study suggests that an anterior extension of the medial maxillectomy or a cross-court approach increases both the area of exposure and surgical freedom. Further increases can be seen upon progression to a Denker approach.
- The endonasal endoscopic harvest and anatomy of the buccal fat pad flap for closure of skull base defects. [Journal Article]
- LLaryngoscope 2015; 125(10):2247-52
- CONCLUSIONS: The BFP pedicled rotational flap is a potential alternate flap following EEA in select cases.
- Endoscopic endonasal transclival transodontoid approach for ventral decompression of the craniovertebral junction: operative technique and nuances. [Review]
- NFNeurosurg Focus 2015; 38(4):E17
- The transoral approach is considered the gold-standard surgical route for performing anterior odontoidectomy and ventral decompression of the craniovertebral junction for pathological conditions that…
The transoral approach is considered the gold-standard surgical route for performing anterior odontoidectomy and ventral decompression of the craniovertebral junction for pathological conditions that result in symptomatic cervicomedullary compression, including basilar invagination, rheumatoid pannus, platybasia with retroflexed odontoid processes, and neoplasms. Extended modifications to increase the operative corridor and exposure include the transmaxillary, extended "open-door" maxillotomy, transpalatal, and transmandibular approaches. With the advent of extended endoscopic endonasal skull base techniques, there has been increased interest in the last decade in the endoscopic endonasal transclival transodontoid approach to the craniovertebral junction. The endonasal route represents an attractive minimally invasive surgical alternative, especially in cases of irreducible basilar invagination in which the pathology is situated well above the palatine line. Angled endoscopes and instrumentation can also be used for lower-lying pathology. By avoiding the oral cavity and subsequently using a transoral retractor, the endonasal route has the advantages of avoiding complications related to tongue swelling, tracheal swelling, prolonged intubation, velopharyngeal insufficiency, dysphagia, and dysphonia. Postoperative recovery is quicker, and hospital stays are shorter. In this report, the authors describe and illustrate their method of purely endoscopic endonasal transclival odonotoidectomy for anterior decompression of the craniovertebral junction and describe various operative pearls and nuances of the technique for avoiding complications.
- Videoassisted anterior surgical approaches to the craniocervical junction: rationale and clinical results. [Review]
- ESEur Spine J 2015; 24(12):2713-23
- CONCLUSIONS: Transoral (microsurgical or video-assisted) approach with sparing of the soft palate still remains the gold standard compared to the "pure" transnasal and transcervical approaches due to the wider working channel provided by the former technique. Transnasal endoscopic approach alone appears to be superior when the CVJ lesion exceeds the upper limit of the inferior third of the clivus. Combined transnasal and transoral procedures can be tailored according to the specific pathological and radiological findings.
New Search Next
- Transnasal andtransoral approach to the clivus and the craniovertebral junction. [Journal Article]
- JNJ Neurosurg Sci 2015 Mar 04
- Endoscopy represents a useful complement to the standard microsurgical approach to the anterior cranioveretebral junction CVJ and can be used by transnasal, transoral and transcervical routes; it pro…
Endoscopy represents a useful complement to the standard microsurgical approach to the anterior cranioveretebral junction CVJ and can be used by transnasal, transoral and transcervical routes; it provides information for a better decompression with no need for soft palate splitting, hard palate resection, or extended maxillotomy. Although neuronavigation allows a better orientation on the surgical field, intraoperative fluoroscopy helps to recognize residual compression. Virtually, in normal anatomic conditions, no surgical limitations exist for endoscopically assisted transoral approach, compared with the pure endonasal and transcervical endoscopic approaches. According to the personal experience in the cadaver lab, the endoscope deserves an interesting role as "support" to the standard transoral microsurgical approach, since 30° angulated endoscopy strongly increase the surgical area exposed over the posterior pharyngeal wall and the extent of the clivus. Moreover, compared to the pure transnasal endoscopic procedure, it deserves the main role due to the wider linear and angled surgical route exposure.