gms | German Medical Science

62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

07. - 11. Mai 2011, Hamburg

Pure endoscopic transnasal surgery to the pyramid tip

Meeting Abstract

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  • J. Lehmberg - Department of Neurosurgery, Technical University Munich
  • L.P. Berends - Department of Neurosurgery, Technical University Munich
  • B. Meyer - Department of Neurosurgery, Technical University Munich

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocP 073

DOI: 10.3205/11dgnc294, URN: urn:nbn:de:0183-11dgnc2945

Veröffentlicht: 28. April 2011

© 2011 Lehmberg et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Various microsurgical approaches to the pyramid tip offer safe resections in this area. Over the last few years, endoscopic skull base surgery has come progressively more into focus. The endoscopic transphenoidal approach was extended by bony resection of the clivus or the pyramid to reach pathologies of the pyramid tip. The aim of this report is to show the feasibility of this approach and its advantages and disadvantages.

Methods: A pure endoscopic transnasal navigated approach was used in 6 operations. Entities included chordoma, chondrosarcoma, adenoidcystic carcinoma, Rathke’s cyst, epidermoid, and cholesterol granuloma. The four hand and two nostril technique with a 4 mm endoscope at 0° to 45° was used. A thin-slice CT was used for neuronavigation, combined with CT-angiography or fusion with MR carotid artery-sensitive series; registration was achieved with surface matching.

Results: Processes at the pyramid tip can be reached endoscopically transnasally. Bony resection can be achieved only in a straight trajectory from the contralateral nostril to the medial wall of the carotid artery. Soft tissue can be resected up to the inner auditory canal and jugular foramen with angled curettes. No bleeding, csf fistula, nor new neurologic deficit was encountered.

Conclusions: The transnasal pure endoscopic approach is suitable for different pathologic processes of the pyramid tip. In this small series, the complication rate was low, only minor side effects were observed. Bony resection is limited by the course of the carotid artery. Soft tissue tumors are the candidates for this approach.