Neurosurgery clinics of North America
-
Neurosurg. Clin. N. Am. · Oct 2010
Review Historical ArticleTranscranial minimally invasive neurosurgery for tumors.
This article considers common minimally invasive craniotomy approaches and the role of neuroendoscopy in the removal of extra-axial and intra-axial brain tumors, excluding those of the ventricle. The use of a keyhole craniotomy combined with a carefully selected trajectory can help avoid the disadvantages associated with a standard craniotomy. ⋯ Endoscopy can also be used as a surgical adjunct to improve tumor resection and to help protect neurovascular structures. Complications associated with minimally invasive tumor neurosurgery have been similar to those associated with conventional neurosurgical approaches, and available outcomes are promising.
-
Neurosurg. Clin. N. Am. · Oct 2010
ReviewMaking the transition from microsurgery to endoscopic trans-sphenoidal pituitary neurosurgery.
This article reviews the published experience of others and introduces the authors' insights into the development of an endoscopic pituitary program. While initially challenging, this transition to endoscopic trans-sphenoidal pituitary surgery can yield rewards in the form of superior visualization and potentially more complete tumor resections. With increasing cumulative experience with the endoscopic transsphenoidal technique for pituitary surgery, the improved visualization and less steep learning curve will facilitate more widespread acceptance of endoscopic pituitary surgery as a valid alternative to the trans-septal trans-sphenoidal microscopic approach to pituitary tumors. ⋯ The collaboration between otolaryngologists and neurosurgeons is important for further developing successful endoscopic trans-sphenoidal pituitary surgery and improving care for patients. Objective evidence is needed to validate whether the improved visualization results in superior patient outcomes and reduced clinical complications, and if this technique can be reasonably taught in a controlled, supervised setting in residency training programs. Additional outcomes data are needed to evaluate long-term outcomes and define the boundaries of endoscopic trans-sphenoidal pituitary surgery.
-
Neurosurg. Clin. N. Am. · Oct 2010
ReviewExpanded endonasal approaches to middle cranial fossa and posterior fossa tumors.
Skull base lesions that involve the middle and posterior cerebral fossae have been historically managed through extensive transcranial approaches. The development of endoscopic endonasal techniques during the past decade has made possible a vast array of alternative routes to the ventral skull base, providing the ability to expose lesions in difficult-to-access regions of the cranial base in a less invasive manner. In this review, the authors detail the endoscopic surgical anatomy and the operative nuances of the expanded endoscopic endonasal approaches to tumors of the middle and posterior cranial fossae. These techniques offer excellent exposure of the targeted regions yielding optimal resections, while avoiding the morbidity associated with transcranial surgical approaches.
-
Neurosurg. Clin. N. Am. · Oct 2010
ReviewMinimally invasive surgery (endonasal) for anterior fossa and sellar tumors.
The primary goal of any surgical approach is to adequately visualize and treat the pathologic condition with minimal disruption to adjacent normal anatomy. The work of several researchers has revealed the promise of minimally invasive endonasal neurosurgery and paved the way for broader applications of the technology. This article discusses the current state of minimally invasive endonasal techniques to address the pathologic conditions of the anterior cranial fossa and parasellar region.
-
Neurosurg. Clin. N. Am. · Oct 2010
ReviewApplication of technology for minimally invasive neurosurgery.
Minimally invasive neurosurgery has developed from technological innovations, including endoscopy, instrumentation, neuroimaging, stereotaxy, and others. This article highlights current technologies for minimally invasive cranial neurosurgery.