gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

The expanded endonasal endoscopic approach to intradural skull base pathologies: results of the first clinical series

Meeting Abstract

  • D. Hänggi - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf
  • K. Beseoglu - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf
  • T. Hoffmann - Hals-Nasen-Ohren-Klinik, Heinrich-Heine-Universität, Düsseldorf
  • J. Schipper - Hals-Nasen-Ohren-Klinik, Heinrich-Heine-Universität, Düsseldorf
  • H.-J. Steiger - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocDI.04-01

DOI: 10.3205/09dgnc127, URN: urn:nbn:de:0183-09dgnc1270

Published: May 20, 2009

© 2009 Hänggi et al.
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Outline

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Objective: First publications have recently shown that the expanded endonasal endoscopic approach to extradural and intradural skull base pathologies is feasible and safe. The goal of the present study was to analyze the feasibility, efficacy, and safety of this approach in patients with anterior skull base tumors and anterior skull base defects performed in a single center.

Methods: In a prospective study design patients with intradural anterior skull base tumors and skull base defects treatable via the expanded endonasal endoscopic approach were included in this study. Patients with pituitary adenomas were excluded. All operations were performed fully endoscopically assisted in the four-hand technique using the Hopkins telescope (Karl Storz, Germany) and under navigation (Brainlab, Germany). In cases of a large skull base defect a vascularized nasoseptal mucosal flap was additional prepared to general principles of reconstruction. The efficacy of tumor removal and skull base reconstruction and the safety of this approach were detected in the follow-up course.

Results: So far 16 patients were enrolled in the first clinical study. In 13 cases the operation was performed due to an anterior skull base tumor (meningeoma in 10 cases, chordoma in 2 cases, metastasis in 1 case) whereas 3 operations were performed due to an anterior skull base defect (cerebrospinal fluid leak in 2 cases, congenital nasal fistula in 1 case). In 14 patients a vascularized nasoseptal mucosal flap uni- or bilateral was performed. A complete endoscopically assisted resection of the tumor was possible in 11(85%) cases; in both patients with the chordomas the resection was subtotal. A lumbar drainage for five days was applied in 12 (75%) patients for the period of five days. In one patient a cerebrospinal fluid leak required reoperation. There were no further complications.

Conclusions: In conclusion this first single center experience demonstrated, that the expanded endonasal endoscopic approach to intradural skull base pathologies is feasible, effective and save.