Endoscopic endonasal surgery to treat intrinsic brainstem lesions: correlation between anatomy and surgery

OBJECTIVE: The endoscopic endonasal approach (EEA) has been proposed as an alternative in the surgical removal of ventral brainstem lesions. However, the feasibility and limitations of this approach to treat such pathologies are still poorly understood. This study aimed to report our experience in f...

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Autores: Topczewski, Thomaz E., Di Somma, Alberto, Culebras, Diego, Reyes, Luis, Torales, Jorge, Tercero Uribe, Ana, Langdon Montero, Cristobal, Alobid, Isam, Torné, Ramón, Roldán Ramos, Pedro, Prats Galino, Alberto, Enseñat Nora, Joaquim
Tipo de recurso: artículo
Estado:Versión aceptada para publicación
Fecha de publicación:2021
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:2445/226404
Acceso en línea:https://hdl.handle.net/2445/226404
Access Level:acceso embargado
Palabra clave:Cirurgia endoscòpica
Neurocirurgia
Cirurgia cerebral
Endoscopic surgery
Neurosurgery
Cerebral surgery
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spelling Endoscopic endonasal surgery to treat intrinsic brainstem lesions: correlation between anatomy and surgeryTopczewski, Thomaz E.Di Somma, AlbertoCulebras, DiegoReyes, LuisTorales, JorgeTercero Uribe, AnaLangdon Montero, CristobalAlobid, IsamTorné, RamónRoldán Ramos, PedroPrats Galino, AlbertoEnseñat Nora, JoaquimCirurgia endoscòpicaNeurocirurgiaCirurgia cerebralEndoscopic surgeryNeurosurgeryCerebral surgeryOBJECTIVE: The endoscopic endonasal approach (EEA) has been proposed as an alternative in the surgical removal of ventral brainstem lesions. However, the feasibility and limitations of this approach to treat such pathologies are still poorly understood. This study aimed to report our experience in five consecutive cases of intrinsic brainstem lesions that were managed via an EEA, as well as the specific anatomy of each case. METHODS: All patients were treated in a single center by a multidisciplinary surgical team between 2015 and 2019. Before surgery, a dedicated anatomical analysis of the brainstem safe entry zone was performed, and proper surgical planning was carried out. Neurophysiological monitoring was used in all cases. Anatomical dissections were performed in three human cadaveric heads using 0° and 30° endoscopes, and specific 3D reconstructions were executed using Amira 3D software. RESULTS: All lesions were located at the level of the ventral brainstem. Specifically, one mesencephalic cavernoma, two pontine ca- vernomas, one pontine gliomas, and one medullary diffuse midline glioma were reported. Cerebrospinal fluid leak was the major complication that occurred in one case (medullary diffuse midline glioma). From an anatomical standpoint, three main safe entry zones were used, namely the anterior mesencephalic zone (AMZ), the peritrigeminal zone (PTZ, used in two cases), and the olivar zone (OZ). Reviewing the literature, 17 cases of various brainstem lesions treated using an EEA were found. CONCLUSIONS: To our knowledge, this was the first preliminary clinical series of intrinsic brainstem lesions treated via an EEA presented in the literature. The EEA can be considered a valid surgical alternative to traditional transcranial approaches to treat selected intra-axial brainstem lesions located at the level of the ventral brainstem. To achieve good results, surgery must involve comprehensive anatomical knowledge, meticulous preoperative surgical planning, and intraoperative neurophysiological moni- toring.International Rhinologic Society202620212026infoinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/acceptedVersion32 p.application/pdfhttps://hdl.handle.net/2445/226404Articles publicats en revistes (Cirurgia i Especialitats Medicoquirúrgiques)reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)Ingléshttps://doi.org/10.4193/Rhin20.064Rhinology, 2021, vol. 59, num.2, p. 191-204Versió postprint del document publicat a: https://doi.org/10.4193/Rhin20.064info:eu-repo/semantics/embargoedAccessoai:recercat.cat:2445/2264042026-05-29T05:05:01Z
dc.title.none.fl_str_mv Endoscopic endonasal surgery to treat intrinsic brainstem lesions: correlation between anatomy and surgery
title Endoscopic endonasal surgery to treat intrinsic brainstem lesions: correlation between anatomy and surgery
spellingShingle Endoscopic endonasal surgery to treat intrinsic brainstem lesions: correlation between anatomy and surgery
Topczewski, Thomaz E.
Cirurgia endoscòpica
Neurocirurgia
Cirurgia cerebral
Endoscopic surgery
Neurosurgery
Cerebral surgery
title_short Endoscopic endonasal surgery to treat intrinsic brainstem lesions: correlation between anatomy and surgery
title_full Endoscopic endonasal surgery to treat intrinsic brainstem lesions: correlation between anatomy and surgery
title_fullStr Endoscopic endonasal surgery to treat intrinsic brainstem lesions: correlation between anatomy and surgery
title_full_unstemmed Endoscopic endonasal surgery to treat intrinsic brainstem lesions: correlation between anatomy and surgery
title_sort Endoscopic endonasal surgery to treat intrinsic brainstem lesions: correlation between anatomy and surgery
dc.creator.none.fl_str_mv Topczewski, Thomaz E.
Di Somma, Alberto
Culebras, Diego
Reyes, Luis
Torales, Jorge
Tercero Uribe, Ana
Langdon Montero, Cristobal
Alobid, Isam
Torné, Ramón
Roldán Ramos, Pedro
Prats Galino, Alberto
Enseñat Nora, Joaquim
author Topczewski, Thomaz E.
author_facet Topczewski, Thomaz E.
Di Somma, Alberto
Culebras, Diego
Reyes, Luis
Torales, Jorge
Tercero Uribe, Ana
Langdon Montero, Cristobal
Alobid, Isam
Torné, Ramón
Roldán Ramos, Pedro
Prats Galino, Alberto
Enseñat Nora, Joaquim
author_role author
author2 Di Somma, Alberto
Culebras, Diego
Reyes, Luis
Torales, Jorge
Tercero Uribe, Ana
Langdon Montero, Cristobal
Alobid, Isam
Torné, Ramón
Roldán Ramos, Pedro
Prats Galino, Alberto
Enseñat Nora, Joaquim
author2_role author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Cirurgia endoscòpica
Neurocirurgia
Cirurgia cerebral
Endoscopic surgery
Neurosurgery
Cerebral surgery
topic Cirurgia endoscòpica
Neurocirurgia
Cirurgia cerebral
Endoscopic surgery
Neurosurgery
Cerebral surgery
description OBJECTIVE: The endoscopic endonasal approach (EEA) has been proposed as an alternative in the surgical removal of ventral brainstem lesions. However, the feasibility and limitations of this approach to treat such pathologies are still poorly understood. This study aimed to report our experience in five consecutive cases of intrinsic brainstem lesions that were managed via an EEA, as well as the specific anatomy of each case. METHODS: All patients were treated in a single center by a multidisciplinary surgical team between 2015 and 2019. Before surgery, a dedicated anatomical analysis of the brainstem safe entry zone was performed, and proper surgical planning was carried out. Neurophysiological monitoring was used in all cases. Anatomical dissections were performed in three human cadaveric heads using 0° and 30° endoscopes, and specific 3D reconstructions were executed using Amira 3D software. RESULTS: All lesions were located at the level of the ventral brainstem. Specifically, one mesencephalic cavernoma, two pontine ca- vernomas, one pontine gliomas, and one medullary diffuse midline glioma were reported. Cerebrospinal fluid leak was the major complication that occurred in one case (medullary diffuse midline glioma). From an anatomical standpoint, three main safe entry zones were used, namely the anterior mesencephalic zone (AMZ), the peritrigeminal zone (PTZ, used in two cases), and the olivar zone (OZ). Reviewing the literature, 17 cases of various brainstem lesions treated using an EEA were found. CONCLUSIONS: To our knowledge, this was the first preliminary clinical series of intrinsic brainstem lesions treated via an EEA presented in the literature. The EEA can be considered a valid surgical alternative to traditional transcranial approaches to treat selected intra-axial brainstem lesions located at the level of the ventral brainstem. To achieve good results, surgery must involve comprehensive anatomical knowledge, meticulous preoperative surgical planning, and intraoperative neurophysiological moni- toring.
publishDate 2021
dc.date.none.fl_str_mv 2021
2026
2026
info
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/acceptedVersion
format article
status_str acceptedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/226404
url https://hdl.handle.net/2445/226404
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv https://doi.org/10.4193/Rhin20.064
Rhinology, 2021, vol. 59, num.2, p. 191-204
Versió postprint del document publicat a: https://doi.org/10.4193/Rhin20.064
dc.rights.none.fl_str_mv info:eu-repo/semantics/embargoedAccess
eu_rights_str_mv embargoedAccess
dc.format.none.fl_str_mv 32 p.
application/pdf
dc.publisher.none.fl_str_mv International Rhinologic Society
publisher.none.fl_str_mv International Rhinologic Society
dc.source.none.fl_str_mv Articles publicats en revistes (Cirurgia i Especialitats Medicoquirúrgiques)
reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.812429

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