Posts Tagged ‘endoscope’
Ahead of Print: Biomechanics of Endonasal Condylectomy
Background: Endoscopicendonasal approaches to the craniovertebral junction (CVJ) and clivus, which are increasingly performed for ventral skull base pathology, may require disruption of the occipitocondylar joint.
Objective: We studied the biomechanical implications at the CVJ of progressive unilateral condylectomy as would be performed through an endonasal exposure.
Methods: Seven upper cervical human cadaveric specimens (C0-C2) underwent nondestructive biomechanical flexibility testing during flexion-extension, axial rotation, and lateral bending at C0-C1 and C1-C2. Each specimen was tested intact, after an inferior one-third clivectomy, and after stepwise unilateral condylectomy using an anterior approach. Angular range of motion (ROM), lax zone, and stiff zone were determined and compared to the intact state.
Ahead of Print: Transventricular Endoscopic Fenestration of Intrasellar Arachnoid Cyst
Background: To manage arachnoid cysts, incorporation with the normal circulation is the single most important determinant of success. Although the postoperative CSF leakage rate is 3.9% for all cases of transsphenoidal surgery, it is 21.4% for intrasellar arachnoid cysts.
Objective: To present a safe, relatively easy, and effective treatment option for very rare intrasellar arachnoid cysts (IAC).
Methods: We performed a prospective study of intrasellar cystic lesions without a solid portion. Endoscopic exploration and fenestration were performed for all lesions under neuronavigational guidance. We analyzed presenting symptoms, endocrinological status, and magnetic resonance images (MRI).
Ahead of Print: The Medial Opticocarotid Recess
Background: The medial opticocarotid recess (MOCR) has become an important landmark for endoscopic approaches to the cranial base.
Objective: To examine the anatomy of the MOCR and outline its role as a “key landmark” for approaches to the sellar and suprasellar regions.
Methods: Ten silicone-injected, cadaveric specimens and 96 dry skulls were examined. Dissections were done endoscopically and microscopically.
Editor Choice: Extradural Endoscope-Assisted Subtemporal Posterior Clinoidectomy: A Cadaver Investigation Study
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Salma, Asem MD; Wang, Song MD; Ammirati, Mario MD, MBA
BACKGROUND: Surgical treatment of distal basilar artery aneurysms is challenging because of the narrow surgical corridor, presence of vital perforating vessels, deep location, and difficulty in obtaining proximal control.
OBJECTIVE: To investigate using a cadaver model the feasibility of performing a transcranial extradural posterior clinoidectomy via a subtemporal route between V2 and V3 using an endoscope-microscope combination.
METHODS: Fourteen dissections were performed in 14 fresh cadaver heads. A standard pterional approach with removal of the zygomatic arch was followed by a 2-stage dissection to remove the posterior clinoid process. In stage 1 (microscopic stage), the area between the second and third trigeminal divisions (V2 and V3) was exposed and the anterior half of the bone between them was drilled to the sphenoid sinus cavity inferior to the carotid sulcus. In stage 2 (endoscopic stage), the drilling was continued to the carotid sulcus. Next, the endosteal layer of the dura lining the carotid sulcus was dissected from the bone that was then removed. At the end of this stage, the dura reflection that forms the posterior part of the pituitary capsule was exposed and the base of the posterior clinoid process was removed using a high-speed drill and curet. Finally, the dura was opened to confirm the removal of the posterior clinoid process. Read the rest of this entry »
Ahead of Print: Bone Removal With a New Ultrasonic Bone Curette During Endoscopic Endonasal Approach to the Sellar-Suprasellar Area
Full article access for Neurosurgery subscribers.
Cappabianca, Paolo MD; Cavallo, Luigi M. MD, PhD; Esposito, Isabella MD; Barakat, Mohamed MD; Esposito, Felice MD, PhD
BACKGROUND: Accessing intradural lesions via an extended endoscopic endonasal approach requires a relatively large bony removal over the skull base.
OBJECTIVE: We describe the Sonopet ultrasonic bone curette with a new dedicated endonasal hand-piece.
MATERIALS AND METHODS: We used this ancillary device in 27 nonconsecutive endonasal procedures for different skull base lesions (18 standard pituitary operations and 9 extended approaches for either meningiomas or craniopharyngiomas).
