Application of hybrid cranioendoscopic approaches in anterior skull base surgery.

Evan Joyce,Gretchen M Oakley,Michael Karsy,William T Couldwell,Serge Makarenko

doi:10.3171/2020.4.focusvid.19913

Abstract

Anterior skull base approaches have included endoscopic or open microsurgical approaches for intracranial pathologies. However, discussion of a combined hybrid, cranioendoscopic approach, leveraging the benefits of both techniques, has been limited. Here we describe a case of a combined endoscopic, endonasal, and open microsurgical frontotemporal approach for resection of a complex anterior skull base lesion. A 62-year-old man with a large meningioma extending intradurally through the cribiform plate and sphenoethmoidal sinuses underwent a cranioendoscopic resection. Surgical techniques, including repair of the anterior skull base defect as well as complication avoidance and the coordination of multiple surgeons, are discussed.The video can be found here: https://youtu.be/Ti9tUUdWgJc.

Highlights

0:25 Case This case demonstrates a 62-year-old man who presented with epistaxis and a nasal mass which was biopsied by an outside ear, nose, and throat specialist and found to be meningioma
0:37 Imaging As you can see on the imaging, he has a large lesion involving the anterior skull base with both intracranial and extracranial nasal components
1:28 Microsurgical resection The dura is opened, and the tumor is identified in the anterior skull base

Summary

Introduction

0:25 Case This case demonstrates a 62-year-old man who presented with epistaxis and a nasal mass which was biopsied by an outside ear, nose, and throat specialist and found to be meningioma. KEYWORDS anterior skull base; meningioma; microsurgical; endoscopic; cranioendoscopic; video 0:37 Imaging As you can see on the imaging, he has a large lesion involving the anterior skull base with both intracranial and extracranial nasal components. Given that the tumor was both intracranial and extracranial and involved the nasal sinuses, and the dura was enhancing on top of the optic nerve, we chose a combined approach—both transcranial and endoscopic transnasal.

Results

Conclusion