BOOK
Endoscopic Cranial Base and Pituitary Surgery, An Issue of Otolaryngologic Clinics of North America, E-Book
Raj Sindwani | Pablo F. Recinos | Troy D. Woodard
(2016)
Additional Information
Book Details
Abstract
This issue on endoscopic cranial base and pituitary surgery is led by experts in the field of Otolaryngology and Neurosurgery. Otolaryngologists/Head and Neck surgeons Dr. Raj Sindwani and Dr. Troy Woodard join with Neurosurgeon Dr. Pablo Recinos to present a comprehensive clinical approach. Topics include: Building an endoscopic skull base program (room setup and key equipment / IGS); Skull Base Anatomy (corridors, intra and extradural); Imaging in skull base surgery – CT, MRI, CT cisternogram, intraop CT; Sellar lesions / pathology; Principles of endoscopic pituitary surgery ; Reconstruction of skull base defects – free graft, pedicle, TPF, alloderm; Lumbar drain utility (role of intrathecal fluorescein); Hemostasis in Skull Base Surgery (control of smaller vessels, maneuvers to minimize bleeding – warm irrigations, HOB up, embolization); Management of ICA Injury (intraop options, late complications); Meningioma; Esthesioneuroblastoma; Cordoma; Sinonasal Malignancies of Skull Base; Craniopharyngioma; Endonasal approaches to the craniocervical junction; Medical complications of Pituitary/skull base surgery – (ie. SIADH, DI, Hypopit); Post-op management of skull base patient (postop Abx, imaging, debridements, topical irrigations, more...). Articles cover surgical procedure, surgical complications, and surgical anatomy as relevant to the clinical discussion.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Endoscopic Cranial Base and Pituitary Surgery\r | i | ||
| Copyright\r | ii | ||
| PROGRAM OBJECTIVE | iii | ||
| LEARNING OBJECTIVES | iii | ||
| ACCREDITATION | iii | ||
| DISCLOSURE OF CONFLICTS OF INTEREST | iii | ||
| UNAPPROVED/OFF-LABEL USE DISCLOSURE | iii | ||
| TO ENROLL | iv | ||
| METHOD OF PARTICIPATION | iv | ||
| CME INQUIRIES/SPECIAL NEEDS | iv | ||
| Contributors | v | ||
| EDITORS | v | ||
| AUTHORS | v | ||
| Contents | xi | ||
| Preface: Endoscopic Cranial Base and Pituitary Surgery\r | xi | ||
| Building a Successful Endoscopic Skull Base and Pituitary Surgery Practice\r | xi | ||
| Skull Base Anatomy\r | xi | ||
| Anatomy, Physiology, and Laboratory Evaluation of the Pituitary Gland\r | xi | ||
| Imaging in Endoscopic Cranial Skull Base and Pituitary Surgery\r | xii | ||
| Sellar Lesions/Pathology\r | xii | ||
| Principles of Pituitary Surgery\r | xii | ||
| Reconstruction of Skull Base Defects\r | xii | ||
| Cerebrospinal Fluid Diversion in Endoscopic Skull Base Reconstruction: An\rEvidence-Based Approach to the Use of Lumbar Drains\r | xiii | ||
| Strategies for Improving Visualization During Endoscopic Skull Base Surgery\r | xiii | ||
| An Overview of Anterior Skull Base Meningiomas and the Endoscopic Endonasal Approach\r | xiii | ||
| Endoscopic Management of Esthesioneuroblastoma\r | xiii | ||
| Endoscopic Endonasal Management of Skull Base Chordomas: Surgical Technique, Nuances, and Pitfalls\r | xiv | ||
| Sinonasal Malignancies of Anterior Skull Base: Histology-driven Treatment Strategies\r | xiv | ||
| Endoscopic Endonasal Management of Craniopharyngioma\r | xiv | ||
| Endoscopic Approaches to the Craniovertebral Junction\r | xv | ||
| Complication Avoidance in Endoscopic Skull Base Surgery\r | xv | ||
| Injury of the Internal Carotid Artery During Endoscopic Skull Base Surgery: Prevention and Management Protocol\r | xv | ||
| Comprehensive Postoperative Management After Endoscopic Skull Base Surgery\r | xv | ||
| OTOLARYNGOLOGIC CLINICS\rOF NORTH AMERICA\r | xvii | ||
| FORTHCOMING ISSUES | xvii | ||
| April 2016 | xvii | ||
| June 2016 | xvii | ||
| August 2016 | xvii | ||
| RECENT ISSUES | xvii | ||
| December 2015 | xvii | ||
| October 2015 | xvii | ||
| August 2015 | xvii | ||
| Preface: Endoscopic Cranial Base and Pituitary Surgery \r | xix | ||
| Building a Successful Endoscopic Skull Base and Pituitary Surgery Practice | 1 | ||
| Key points | 1 | ||
| INTRODUCTION | 1 | ||
| WHO | 2 | ||
| WHAT | 3 | ||
| WHEN | 5 | ||
| HOW | 5 | ||
| WHY | 6 | ||
| SUMMARY | 7 | ||
| REFERENCES | 7 | ||
| Skull Base Anatomy | 9 | ||
| Key points | 9 | ||
| INTRODUCTION | 9 | ||
| SPHENOID BONE | 10 | ||
| SPHENOID SINUS | 11 | ||
| PITUITARY GLAND | 12 | ||
| CAVERNOUS SINUS | 13 | ||
| SUPRASELLAR SPACE | 15 | ||
| ANTERIOR CRANIAL BASE | 17 | ||
| CLIVUS | 18 | ||
| SUMMARY | 20 | ||
| REFERENCES | 20 | ||
| Anatomy, Physiology, and Laboratory Evaluation of the Pituitary Gland | 21 | ||
| Key points | 21 | ||
| INTRODUCTION | 21 | ||
| BASIC ANATOMY | 22 | ||
| PHYSIOLOGY | 22 | ||
| OVERVIEW OF PITUITARY DYSFUNCTION | 23 | ||
| DIAGNOSIS OF COMMON HYPERSECRETION SYNDROMES | 25 | ||
| Acromegaly | 25 | ||
| Cushing's Disease | 25 | ||
| Prolactinoma | 26 | ||
| Hypopituitarism | 27 | ||
| Diabetes Insipidus | 28 | ||
| EVALUATION OF PITUITARY INCIDENTALOMAS | 28 | ||
| PERIOPERATIVE EVALUATION OF PITUITARY FUNCTION | 29 | ||
| SUMMARY | 30 | ||
| REFERENCES | 30 | ||
| Imaging in Endoscopic Cranial Skull Base and Pituitary Surgery | 33 | ||
| Key points | 33 | ||
| INTRODUCTION | 33 | ||
| IMAGING TECHNIQUE | 35 | ||
| ANATOMY OF ANTERIOR SKULL BASE | 36 | ||
| ANATOMY OF THE CENTRAL SKULL BASE | 39 | ||
| ANTERIOR SKULL BASE PATHOLOGY | 43 | ||
| Sinonasal Neoplasms | 43 | ||
| Squamous Cell Cancer | 44 | ||
| Adenocarcinoma | 44 | ||
| Olfactory Neuroblastoma | 44 | ||
| Olfactory Groove and Planum Sphenoidale Meningiomas | 45 | ||
| CENTRAL SKULL BASE PATHOLOGY | 45 | ||
| Pituitary Adenoma | 45 | ||
| Sellar Meningiomas | 47 | ||
| Craniopharyngioma | 47 | ||
| Chordoma | 48 | ||
| PRESURGICAL CONSIDERATIONS IN ENDOSCOPIC ENDONASAL SURGERY | 49 | ||
| Limitations for Surgical Treatment | 49 | ||
| Basic Anatomic Limits for EEA | 51 | ||
| Transcribriform | 51 | ||
| Transplanum | 52 | ||
| Transellar | 52 | ||
| Transclival | 53 | ||
| POSTOPERATIVE IMAGING OF ENDOSCOPIC ENDONASAL SURGERY | 53 | ||
| Early Postoperative | 54 | ||
| Late Postoperative | 55 | ||
| Complications | 57 | ||
| SUMMARY | 59 | ||
| REFERENCES | 59 | ||
| Sellar Lesions/Pathology | 63 | ||
| Key points | 63 | ||
| INTRODUCTION | 63 | ||
| EMBRYOLOGY OF THE PITUITARY GLAND | 65 | ||
| ANATOMICAL BOUNDARIES OF THE PITUITARY FOSSA | 65 | ||
| SIGNS AND SYMPTOMS RELATED TO SELLAR LESIONS | 66 | ||
| Endocrine Symptoms | 66 | ||
| Neurological Symptoms | 67 | ||
| Visual Symptoms | 68 | ||
| NEUROIMAGING | 68 | ||
| BIOLOGICAL WORKUP | 69 | ||
| NEOPLASTIC LESIONS | 69 | ||
| Pituitary Lesions | 69 | ||
| Anterior pituitary lesions | 69 | ||
| Benign lesions | 69 | ||
| Hyperplasia | 69 | ||
| Adenomas | 69 | ||
| Functioning adenomas | 70 | ||
| Nonfunctioning adenomas | 71 | ||
| Pituitary apoplexy | 72 | ||
| Atypical adenomas | 73 | ||
| Malignant lesions: primary pituitary carcinomas | 73 | ||
| Posterior pituitary lesions | 74 | ||
| Pituicytomas | 74 | ||
| Granular cell tumor | 74 | ||
| NONPITUITARY TUMORS | 74 | ||
| Benign Nonpituitary Tumors | 74 | ||
| Craniopharyngiomas | 74 | ||
| Chordomas, chondrosarcomas, and chondromas | 76 | ||
| Chordomas | 77 | ||
| Chondrosarcomas | 78 | ||
| Chondromas | 79 | ||
| Meningiomas | 79 | ||
| Tuberculum sellae meningioma | 79 | ||
| Cavernous sinus meningiomas | 81 | ||
| Hemangioblastomas | 81 | ||
| Malignant Nonpituitary Tumors | 81 | ||
| Metastatic lesions | 81 | ||
| Lymphomas | 82 | ||
| Germ cell tumor | 83 | ||
| DEVELOPMENTAL LESIONS | 83 | ||
| Rathke’s Cleft Cyst | 83 | ||
| Dermoid/Epidermoid Cysts | 83 | ||
| Dermoid cysts | 84 | ||
| Epidermoid | 84 | ||
| Arachnoid Cysts | 85 | ||
| Empty Sella Syndrome | 85 | ||
| INFLAMMATORY AND INFECTIOUS LESIONS | 85 | ||
| Hypophysitis | 85 | ||
| Mucocele | 87 | ||
| VASCULAR LESIONS: ANEURYSMS | 87 | ||
| Collision Sellar Lesions | 88 | ||
| REFERENCES | 88 | ||
| Principles of Pituitary Surgery | 95 | ||
| Key points | 95 | ||
| INTRODUCTION | 95 | ||
| Evolution of Transsphenoidal Surgery | 95 | ||
| PRINCIPLES OF SURGERY | 96 | ||
| Indications for Surgery | 96 | ||
| Preoperative Surgical Planning | 96 | ||
| Surgical Approach: Nasal Stage | 97 | ||
| Surgical Approach: Sphenoid Stage | 99 | ||
| Surgical Approach: Sellar Stage | 100 | ||
| Cavernous Sinus Invasion | 102 | ||
| SUMMARY | 105 | ||
| REFERENCES | 105 | ||
| Reconstruction of Skull Base Defects | 107 | ||
| Key points | 107 | ||
| INTRODUCTION | 107 | ||
| TREATMENT GOALS AND PLANNED OUTCOMES | 107 | ||
| PREOPERATIVE PLANNING AND PREPARATION | 108 | ||
| PATIENT POSITIONING | 108 | ||
| RECONSTRUCTION | 109 | ||
| Grafts | 109 | ||
| Flaps | 109 | ||
| NASOSEPTAL FLAP | 110 | ||
| ENDOSCOPIC-ASSISTED PERICRANIAL FLAP | 111 | ||
| TEMPOROPARIETAL FASCIA FLAP | 112 | ||
| MULTILAYER BOLSTER/CLOSURE | 114 | ||
| POTENTIAL COMPLICATIONS AND MANAGEMENT | 115 | ||
| OUTCOMES | 115 | ||
| REFERENCES | 116 | ||
| Cerebrospinal Fluid Diversion in Endoscopic Skull Base Reconstruction | 119 | ||
| Key points | 119 | ||
| INTRODUCTION | 120 | ||
| CEREBROSPINAL FLUID PHYSIOLOGY AND PRINCIPLES OF DIVERSION | 120 | ||
| USE OF LUMBAR DRAINS IN ENDOSCOPIC SKULL BASE SURGERY | 121 | ||
| COMPLICATIONS OF LUMBAR DRAINS | 125 | ||
| RECOMMENDATIONS | 126 | ||
| SUMMARY | 128 | ||
| REFERENCES | 128 | ||
| Strategies for Improving Visualization During Endoscopic Skull Base Surgery | 131 | ||
| Key points | 131 | ||
| INTRODUCTION | 131 | ||
| HEMOSTASIS | 132 | ||
| Preoperative Evaluation | 132 | ||
| INTRAOPERATIVE CONSIDERATIONS | 132 | ||
| Anesthetic Techniques | 132 | ||
| PATIENT POSITIONING | 133 | ||
| TOPICAL AND LOCAL VASOCONSTRICTION | 133 | ||
| IRRIGATION | 134 | ||
| CONTROL OF ARTERIAL BLEEDING | 134 | ||
| EMBOLIZATION | 134 | ||
| SURGICAL LIGATION | 136 | ||
| CONTROL OF VENOUS BLEEDING | 136 | ||
| SURGICAL TECHNIQUES | 138 | ||
| SUMMARY | 138 | ||
| REFERENCES | 138 | ||
| An Overview of Anterior Skull Base Meningiomas and the Endoscopic Endonasal Approach | 141 | ||
| Key points | 141 | ||
| EPIDEMIOLOGY | 142 | ||
| CAUSE AND PATHOPHYSIOLOGY | 142 | ||
| Meningiomas and the Female Sex | 142 | ||
| Meningiomas and History of Radiation | 142 | ||
| Genetic Predisposition of Meningiomas | 142 | ||
| Neurofibromatosis type 2 | 142 | ||
| Non–neurofibromatosis type 2 | 142 | ||
| Head Injuries and Meningiomas | 143 | ||
| CLASSIFICATION | 143 | ||
| According to Grade | 143 | ||
| According to Site | 143 | ||
| PATHOLOGY | 143 | ||
| Gross Pathology | 143 | ||
| CLINICAL PRESENTATION OF MIDLINE ANTERIOR SKULL BASE MENINGIOMAS | 144 | ||
| RADIOLOGY | 145 | ||
| MANAGEMENT | 145 | ||
| SURGICAL TREATMENT | 145 | ||
| OUTCOME AND COMPLICATIONS | 147 | ||
| RADIATION THERAPY AND RADIOSURGERY | 148 | ||
| SUMMARY | 148 | ||
| REFERENCES | 148 | ||
| Endoscopic Management of Esthesioneuroblastoma | 153 | ||
| Key points | 153 | ||
| INTRODUCTION | 153 | ||
| TREATMENT GOALS AND PLANNED OUTCOMES | 154 | ||
| PREOPERATIVE PLANNING AND PREPARATION | 155 | ||
| PATIENT POSITIONING | 156 | ||
| PROCEDURAL APPROACH | 157 | ||
| POSTOPERATIVE CARE | 158 | ||
| COMPLICATIONS | 160 | ||
| REHABILITATION AND RECOVERY | 161 | ||
| OUTCOMES | 161 | ||
| SUMMARY | 163 | ||
| REFERENCES | 163 | ||
| Endoscopic Endonasal Management of Skull Base Chordomas | 167 | ||
| Key points | 167 | ||
| INTRODUCTION | 167 | ||
| TREATMENT GOALS AND PLANNED OUTCOMES | 168 | ||
| SURGICAL TECHNIQUE AND PROCEDURE | 168 | ||
| Preoperative Planning | 168 | ||
| Radiologic evaluation | 168 | ||
| Tumor-vascular relationship | 170 | ||
| Tumor–cranial nerves relationship | 170 | ||
| Approach selection | 170 | ||
| Nasosinusal assessment | 171 | ||
| Equipments and instrumentation | 171 | ||
| Patient Preparation and Positioning | 171 | ||
| Procedural Approach | 172 | ||
| Basic anatomic considerations: the clival region | 172 | ||
| Preparing the transnasal corridor | 173 | ||
| Approaching the tumor | 173 | ||
| Reconstruction | 176 | ||
| Nuances and Pitfalls of the Technique | 176 | ||
| COMPLICATIONS AND MANAGEMENT | 177 | ||
| POSTPROCEDURAL CARE | 178 | ||
| EXPECTED OUTCOMES AND CLINICAL RESULTS IN THE LITERATURE | 178 | ||
| SUMMARY | 178 | ||
| SUPPLEMENTARY DATA | 180 | ||
| REFERENCES | 180 | ||
| Sinonasal Malignancies of Anterior Skull Base | 183 | ||
| Key points | 183 | ||
| INTRODUCTION | 184 | ||
| DIAGNOSTIC WORK-UP | 185 | ||
| MULTIDISCIPLINARY TREATMENT PROTOCOLS | 185 | ||
| Squamous Cell Carcinoma | 185 | ||
| Adenocarcinoma | 185 | ||
| Olfactory Neuroblastoma | 187 | ||
| Neuroendocrine Carcinoma: Small Cell and Large Cell Types | 187 | ||
| Sinonasal Undifferentiated Carcinoma | 187 | ||
| Hemangiopericytoma | 188 | ||
| Adenoid Cystic Carcinoma | 188 | ||
| Mesenchymal Tumors: Soft Tissue Sarcomas and Ewing Sarcoma | 188 | ||
| Hematolymphoid Tumors | 188 | ||
| Mucosal Melanoma | 189 | ||
| SURGICAL APPROACHES | 189 | ||
| Indications and Contraindications | 189 | ||
| Preparation and Patient Positioning | 189 | ||
| Surgical Techniques | 189 | ||
| Tumor origin identification | 190 | ||
| Exposure of the surgical field | 190 | ||
| Centripetal removal | 190 | ||
| Skull base removal | 191 | ||
| Intracranial work | 191 | ||
| Skull Base Reconstruction | 192 | ||
| Complications | 193 | ||
| Postoperative Care | 193 | ||
| Follow-up | 193 | ||
| OUTCOMES | 194 | ||
| Olfactory Neuroblastoma | 194 | ||
| Neuroendocrine Carcinoma | 195 | ||
| Sinonasal Undifferentiated Carcinoma | 195 | ||
| Squamous Cell Carcinoma | 195 | ||
| Adenocarcinoma | 195 | ||
| Mucosal Melanoma | 197 | ||
| OPEN ISSUES | 197 | ||
| SUMMARY | 197 | ||
| REFERENCES | 198 | ||
| Endoscopic Endonasal Management of Craniopharyngioma | 201 | ||
| Key points | 201 | ||
| INTRODUCTION | 202 | ||
| Epidemiology and Clinical Characteristics | 202 | ||
| Radiologic and Pathologic Characteristics | 203 | ||
| TREATMENT GOALS AND PLANNED OUTCOMES | 203 | ||
| PREOPERATIVE PLANNING AND PREPARATION | 204 | ||
| PATIENT POSITIONING | 204 | ||
| PROCEDURAL APPROACH | 205 | ||
| Nasal and Sinus Stage | 205 | ||
| Sellar/Suprasellar Stage | 205 | ||
| Closure Stage | 206 | ||
| POTENTIAL COMPLICATIONS | 207 | ||
| POSTPROCEDURAL CARE, REHABILITATION, AND RECOVERY | 208 | ||
| OUTCOMES AND LITERATURE REVIEW | 208 | ||
| SUMMARY | 209 | ||
| SUPPLEMENTARY DATA | 209 | ||
| REFERENCES | 209 | ||
| Endoscopic Approaches to the Craniovertebral Junction | 213 | ||
| Key points | 213 | ||
| INTRODUCTION | 214 | ||
| TREATMENT GOALS | 214 | ||
| PREOPERATIVE PLANNING | 214 | ||
| PATIENT POSITIONING | 215 | ||
| PROCEDURAL APPROACH | 215 | ||
| Nasal Approach | 215 | ||
| Endoscopic Endonasal Transclival Approach | 216 | ||
| Case Illustration | 216 | ||
| Endoscopic Endonasal Odontoidectomy Approach | 217 | ||
| Case Illustration | 218 | ||
| Reconstruction | 220 | ||
| POTENTIAL COMPLICATIONS AND MANAGEMENT | 221 | ||
| POST-PROCEDURAL CARE | 222 | ||
| REHABILITATION AND RECOVERY | 222 | ||
| Outcomes and Review of the Literature | 223 | ||
| SUMMARY | 223 | ||
| REFERENCES | 223 | ||
| Complication Avoidance in Endoscopic Skull Base Surgery | 227 | ||
| Key points | 227 | ||
| INTRODUCTION | 227 | ||
| ENDOCRINOLOGIC COMPLICATIONS | 228 | ||
| PERIOPERATIVE ANTIBIOTICS AND MENINGITIS | 229 | ||
| OTHER MEDICAL COMPLICATIONS | 229 | ||
| CRANIAL NEUROPATHIES | 230 | ||
| MANAGEMENT OF POSTOPERATIVE CEREBROSPINAL FLUID FISTULA | 231 | ||
| VASCULAR INJURY | 231 | ||
| SUMMARY | 234 | ||
| REFERENCES | 234 | ||
| Injury of the Internal Carotid Artery During Endoscopic Skull Base Surgery | 237 | ||
| Key points | 237 | ||
| INTRODUCTION | 237 | ||
| RISK FACTORS | 238 | ||
| Anatomic Risks | 239 | ||
| Pathology-Related Risks | 240 | ||
| Skills and Resource-Related Risks | 240 | ||
| High-Risk Factors | 240 | ||
| PREOPERATIVE WORK-UP | 241 | ||
| INTRAOPERATIVE | 242 | ||
| Sign-In and Time-Out Protocol | 242 | ||
| Surgical Preparations | 245 | ||
| During the Catastrophe | 246 | ||
| POSTOPERATIVE RESCUE | 248 | ||
| SUMMARY | 249 | ||
| REFERENCES | 250 | ||
| Comprehensive Postoperative Management After Endoscopic Skull Base Surgery | 253 | ||
| Key points | 253 | ||
| INTRODUCTION | 254 | ||
| INTRAOPERATIVE CONSIDERATIONS | 254 | ||
| GENERAL POSTOPERATIVE COURSE AND CARE AFTER ENDOSCOPIC SKULL BASE SURGERY | 254 | ||
| EARLY POSTOPERATIVE CARE STRATEGIES DEPENDING ON CEREBROSPINAL FLUID LEAK TYPE AND RECONSTRUCTION | 255 | ||
| POSTOPERATIVE CARE WHEN THERE IS NO CEREBROSPINAL FLUID LEAK | 256 | ||
| POSTOPERATIVE CARE WHEN THERE IS LOW-FLOW CEREBROSPINAL FLUID LEAK | 256 | ||
| POSTOPERATIVE CARE WHEN THERE IS A HIGH-FLOW CEREBROSPINAL FLUID LEAK OR A LARGE COMPLEX SKULL BASE DEFECT | 257 | ||
| SPECIAL POSTOPERATIVE CONSIDERATIONS | 258 | ||
| Postoperative Imaging | 258 | ||
| Antibiotic Prophylaxis in Endoscopic Skull Base Surgery | 258 | ||
| Role of Intranasal Balloon Catheter and Nonabsorbable Packing | 259 | ||
| Pediatric Patients | 259 | ||
| Postoperative Complications | 259 | ||
| Nasal Morbidity and Quality of Life After Endoscopic Skull Base Surgery | 260 | ||
| SUMMARY | 261 | ||
| REFERENCES | 261 | ||
| Index | 265 |