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

Endoscopic resection of midline pathologies of the skull base

Meeting Abstract

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  • J. Kaminsky - Abteilung für Allgemeine Neurochirurgie, Neurozentrum, Universitätsklinikum Freiburg
  • M. Shah - Abteilung für Allgemeine Neurochirurgie, Neurozentrum, Universitätsklinikum Freiburg
  • M. Petrick - Abteilung für Allgemeine Neurochirurgie, Neurozentrum, Universitätsklinikum Freiburg

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.04-08

DOI: 10.3205/09dgnc134, URN: urn:nbn:de:0183-09dgnc1347

Published: May 20, 2009

© 2009 Kaminsky et al.
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Outline

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Objective: Extended indication for transnasal endoscopic approaches for the treatment of various skull base pathologies is discussed controversially. Meanwhile the transnasal endoscopic approach is established as standard procedure for primary pituitary surgery in our department. Based upon our practical knowledge we extended the indication of this approach to other skull base pathologies. Our experiences are described and discussed below.

Methods: 2 clival- and 2 petrous apex chordomas, 3 parasellar meningeomas, 3 cysts, 2 craniopharyngeomas, 1 carcinoma, 1 mucocele and 1 dermoid of the petrous apex were operated via a transnasal endoscopic approach. Prior to surgery a MRI and high resolution CT scan in some cases with additional CT-angiography were performed. Surgery was assisted by a neuronavigation system (Stryker-Leibinger, Kalamazoo, MI). In selected cases an additional intraoperative 3D-imaging was performed with a Siemens ISO-C-3D C-arm. CSF leaks were covered with free fat- and fascia-transplants and fibrin glue fixation. A temporary intranasal balloon-installation and lumbar drainage was performed in these cases.

Results: The operative resection was performed without complication in all cases. The additional information provided by the neuronavigation system and the intraoperative imaging was most helpful in cases with extensive drilling of bony structures especially in chordoma cases. A reoperation was necessary after surgery of a meningeoma and a craniopharyngeoma for treatment of a CSF-leakage.

Conclusions: The excellent visualisation provided by the endoscope allows for a precise and safe resection during the transnasal endoscopic approach. Neuronavigational guidance and intraoperative ISO-C-3D imaging contribute to an additional orientation, especially for drilling steps. Despite an accurate covering, intradural pathologies are associated with a high risk of postoperative CSF-leakage. The transnasal endoscopic approach is most suitable for the resection of extradural midline pathologies within the skull base.