Background: Pituitary adenoma (PA) is a common intracranial tumor and surgical treatment is considered to be the best treatment for most patients. The extended endoscopic endonasal approach (EEEA) has been used to tre...Background: Pituitary adenoma (PA) is a common intracranial tumor and surgical treatment is considered to be the best treatment for most patients. The extended endoscopic endonasal approach (EEEA) has been used to treat increasing numbers of patients with PA in recent years. We conducted this study to evaluate the safety and efficacy of this approach for PA resection. Methods: We performed a retrospective analysis of all patients who underwent an EEEA to remove PA by a binostril, four-handed technique between October 2013 and April 2016 in our department. The medical information of the patients including gender, age, tumor size, hormone level, clinical outcome, and complications were collected and analyzed.Results: From a total of 593 pituitary adenoma surgeries, 171 patients (101 male and 70 female, mean age 47.4 ± 12.8 years) underwent EEEA, including 96 with functional adenomas (56.14%) and 75 with nonfunctional adenomas (43.86%). The most common symptoms were headache and vision change. Gross total resection was achieved in 126 patients (73.68%). Common complications were hyposmia or anosmia, diabetes insipidus, hypopituitarism, postoperative cerebrospinal fluid leak, cerebral hemorrhage, and epistaxis. The mean duration of follow-up was 14.6 months (range: 6–31 months). Conclusions: The application of EEEA for PA resection by a binostril, four-handed technique provided great surgical freedom with minimal invasion, and resulted in few complications. EEEA is a secure and effective surgical method that could be used for the majority of PAs.展开更多
Objective Although intracranial and extracranial communicating meningiomas are uncommon in clinical settings,they pose a considerable challenge for surgeons.Thus,one-stage surgery should be more comprehensively explai...Objective Although intracranial and extracranial communicating meningiomas are uncommon in clinical settings,they pose a considerable challenge for surgeons.Thus,one-stage surgery should be more comprehensively explained as it is not frequently reported as a first-line treatment.Case report A 27-year-old man with a massive intracranial and extracranial communicating meningioma was admitted with nasal congestion and mild numbness on the left side of his face.A combined transcranial and endoscopic endonasal approach was performed in a single day aided by preoperative tumor embolization.The tumor was nearly completely removed without any serious complications.Follow-up revealed the disappearance of diplopia,with the patient having a normal life.Furthermore,no tumor progression was noted.Conclusion The combined transcranial and endoscopic endonasal approach is feasible for removing certain massive intracranial and extracranial communicating tumors.Hybrid techniques,such as embolization,microscopic,and endoscopic manipulation,are indispensable tools for treating such cases.展开更多
The petrous apex is a difficult to reach surgical area due to its deep position in the skull base and many vital surrounding structures.Petrous apex pathology ranges from extradural cholesterol granulomas,cholesteatom...The petrous apex is a difficult to reach surgical area due to its deep position in the skull base and many vital surrounding structures.Petrous apex pathology ranges from extradural cholesterol granulomas,cholesteatomas,asymmetric pneumatization,and osteomyelitis to intradural meningiomas and schwannomas.Certain lesions,such as cholesterol granulomas,can be managed with drainage while neoplastic lesions must be completely resected.Surgical options use open,endoscopic,and combined techniques and are categorized into anterior,lateral,and posterior approaches.The choice of approach is determined by the nature of the pathology and location relative to vital structures and extension into surrounding structures and requires thorough preoperative evaluation and discussion of surgical goals with the patient.The purpose of this state-of-the-art review is to discuss the most commonly used surgical approaches to the petrous apex,and the anatomy on which these approaches are based.展开更多
文摘Background: Pituitary adenoma (PA) is a common intracranial tumor and surgical treatment is considered to be the best treatment for most patients. The extended endoscopic endonasal approach (EEEA) has been used to treat increasing numbers of patients with PA in recent years. We conducted this study to evaluate the safety and efficacy of this approach for PA resection. Methods: We performed a retrospective analysis of all patients who underwent an EEEA to remove PA by a binostril, four-handed technique between October 2013 and April 2016 in our department. The medical information of the patients including gender, age, tumor size, hormone level, clinical outcome, and complications were collected and analyzed.Results: From a total of 593 pituitary adenoma surgeries, 171 patients (101 male and 70 female, mean age 47.4 ± 12.8 years) underwent EEEA, including 96 with functional adenomas (56.14%) and 75 with nonfunctional adenomas (43.86%). The most common symptoms were headache and vision change. Gross total resection was achieved in 126 patients (73.68%). Common complications were hyposmia or anosmia, diabetes insipidus, hypopituitarism, postoperative cerebrospinal fluid leak, cerebral hemorrhage, and epistaxis. The mean duration of follow-up was 14.6 months (range: 6–31 months). Conclusions: The application of EEEA for PA resection by a binostril, four-handed technique provided great surgical freedom with minimal invasion, and resulted in few complications. EEEA is a secure and effective surgical method that could be used for the majority of PAs.
文摘Objective Although intracranial and extracranial communicating meningiomas are uncommon in clinical settings,they pose a considerable challenge for surgeons.Thus,one-stage surgery should be more comprehensively explained as it is not frequently reported as a first-line treatment.Case report A 27-year-old man with a massive intracranial and extracranial communicating meningioma was admitted with nasal congestion and mild numbness on the left side of his face.A combined transcranial and endoscopic endonasal approach was performed in a single day aided by preoperative tumor embolization.The tumor was nearly completely removed without any serious complications.Follow-up revealed the disappearance of diplopia,with the patient having a normal life.Furthermore,no tumor progression was noted.Conclusion The combined transcranial and endoscopic endonasal approach is feasible for removing certain massive intracranial and extracranial communicating tumors.Hybrid techniques,such as embolization,microscopic,and endoscopic manipulation,are indispensable tools for treating such cases.
文摘The petrous apex is a difficult to reach surgical area due to its deep position in the skull base and many vital surrounding structures.Petrous apex pathology ranges from extradural cholesterol granulomas,cholesteatomas,asymmetric pneumatization,and osteomyelitis to intradural meningiomas and schwannomas.Certain lesions,such as cholesterol granulomas,can be managed with drainage while neoplastic lesions must be completely resected.Surgical options use open,endoscopic,and combined techniques and are categorized into anterior,lateral,and posterior approaches.The choice of approach is determined by the nature of the pathology and location relative to vital structures and extension into surrounding structures and requires thorough preoperative evaluation and discussion of surgical goals with the patient.The purpose of this state-of-the-art review is to discuss the most commonly used surgical approaches to the petrous apex,and the anatomy on which these approaches are based.
