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Endoscopic endonasal approach to primitive Meckel’s cave tumors: a clinical series

  • Original Article - Tumor - Other
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Abstract

Introduction

Recently, an alternative endoscopic endonasal approach to Meckel’s cave (MC) tumors has been proposed. To date, few studies have evaluated the results of this route. The aim of our study was to evaluate long-term surgical and clinical outcome associated with this technique in a cohort of patients with intrinsic MC tumors.

Methods

All patients with MC tumors treated at out institution by endoscopic endonasal approach (EEA) between 2002 and 2016 were included. Patients underwent brain MRI, CT angiography, and neurological evaluation before surgery. Complications were considered based on the surgical records. All examinations were repeated after 3 and 12 months, then annually. The median follow-up was of 44.1 months (range 16–210).

Results

The series included 8 patients (4 F): 5 neuromas, 1 meningioma, 1 chondrosarcoma, and 1 epidermoid cyst. The median age at treatment was 54.5 years (range 21–70). Three tumors presented with a posterior fossa extension. Radical removal of the MC portion of the tumor was achieved in 7 out of 8 cases. Two patients developed a permanent and transitory deficit of the sixth cranial nerve, respectively. No tumor recurrence was observed at follow-up.

Conclusion

In this preliminary series, the EEA appeared an effective and safe approach to MC tumors. The technique could be advantageous to treat tumors located in the antero-medial aspects of MC displacing the trigeminal structures posteriorly and laterally. A favorable index of an adequate working space for this approach is represented by the ICA medialization, while tumor extension to the posterior fossa represents the main limitation to radical removal of this route.

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References

  1. Akay A, Göde S, Çağli MS (2017) Neuronavigation-guided endoscopic endonasal excision of schwannoma-like chordoma of the Meckel’s cave: a case report. Turk Neurosurg. https://doi.org/10.5137/1019-5149.JTN.20825-17.0

  2. Barges-Coll J, Fernandez-Miranda JC, Prevedello DM, Gardner P, Morera V, Madhok R, Carrau RL, Snyderman CH, Rhoton AL Jr, Kassam AB (2010) Avoiding injury to the abducens nerve during expanded endonasal endoscopic surgery: anatomic and clinical case studies. Neurosurgery 67(1):144–154

    Article  Google Scholar 

  3. Cavallo LM, Messina A, Gardner P, Esposito F, Kassam AB, Cappabianca P, de Divitiis E, Tschabitscher M (2005) Extended endoscopic endonasal approach to the pterygopalatine fossa: anatomical study and clinical considerations. Neurosurg Focus 19(1):E5

    PubMed  Google Scholar 

  4. Cebula H, Kurbanov A, Zimmer LA, Poczos P, Leach JL, De Battista JC, Froelich S, Theodosopoulos PV, Keller JT (2014) Endoscopic, endonasal variability in the anatomy of the internal carotid artery. World Neurosurg 82(6):e759–e764

    Article  Google Scholar 

  5. Dolci RL, Upadhyay S, Ditzel Filho LF, Fiore ME, Buohliqah L, Lazarini PR, Prevedello DM, Carrau RL (2016) Endoscopic endonasal study of the cavernous sinus and quadrangular space: anatomic relationships. Head Neck 38(Suppl 1):E1680–E1687

    Article  Google Scholar 

  6. Dolci RL, Ditzel Filho LF, Goulart CR, Upadhyay S, Buohliqah L, Lazarini PR, Prevedello DM, Carrau RL (2018) Anatomical nuances of the internal carotid artery in relation to the quadrangular space. J Neurosurg 128(1):174–181

  7. Hardesty DA, Montaser AS, Carrau RL, Prevedello DM (2018) Limits of endoscopic endonasal transpterygoid approach to cavernous sinus and Meckel’s cave. J Neurosurg Sci 62(3):332–338

    PubMed  Google Scholar 

  8. Jouanneau E, Simon E, Jacquesson T, Sindou M, Tringali S, Messerer M, Berhouma M (2014) The endoscopic endonasal approach to the Meckel’s cave tumors: surgical technique and indications. World Neurosurg 82(6 Suppl):S155–S161

    Article  Google Scholar 

  9. Kasemsiri P, Solares CA, Carrau RL, Prosser JD, Prevedello DM, Otto BA, Old M, Kassam AB (2013) Endoscopic endonasal transpterygoid approaches: anatomical landmarks for planning the surgical corridor. Laryngoscope 123(4):811–815

    Article  Google Scholar 

  10. Kasliwal MK, Anand VK, Lavi E, Schwartz TH (2010) Endoscopic management of a rare case of nasal glioma in Meckel’s cave in an adult: case report. Minim Invasive Neurosurg 53(4):191–193

    Article  CAS  Google Scholar 

  11. Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL (2005) Expanded endonasal approach: the rostrocaudal axis. Part II. Posterior clinoids to the foramen magnum. Neurosurg Focus 19(1):E4

    PubMed  Google Scholar 

  12. Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL (2005) Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurg Focus 19(1):E3

    PubMed  Google Scholar 

  13. Kassam AB, Gardner P, Snyderman C, Mintz A, Carrau R (2005) Expanded endonasal approach: fully endoscopic, completely transnasal approach to the middle third of the clivus, petrous bone, middle cranial fossa, and infratemporal fossa. Neurosurg Focus 19(1):E6

    PubMed  Google Scholar 

  14. Kassam AB, Prevedello DM, Carrau RL, Snyderman CH, Gardner P, Osawa S, Seker A, Rhoton AL Jr (2009) The front door to Meckel’s cave: an anteromedial corridor via expanded endoscopic endonasal approach- technical considerations and clinical series. Neurosurgery 64(3 Suppl):ons71–ons82

    PubMed  Google Scholar 

  15. Marcati E, Andaluz N, Froelich SC, Zimmer LA, Leach JL, Fernandez-Miranda JC, Kurbanov A, Keller JT (2017) Paratrigeminal, paraclival, precavernous, or all of the above? A circumferential anatomical study of the C3-C4 transitional segment of the internal carotid artery. Oper Neurosurg (Hagerstown). https://doi.org/10.1093/ons/opx121

    Article  Google Scholar 

  16. Muto J, Kawase T, Yoshida K (2010) Meckel’s cave tumors: relation to the meninges and minimally invasive approaches for surgery: anatomic and clinical studies. Neurosurgery 67(3 Suppl Operative):ons291–ons298

    PubMed  Google Scholar 

  17. Pasquini E, Sciarretta V, Farneti G, Ippolito A, Mazzatenta D, Frank G (2002) Endoscopic endonasal approach for the treatment of benign schwannoma of the sinonasal tract and pterygopalatine fossa. Am J Rhinol 16(2):113–118

    Article  Google Scholar 

  18. Raza SM, Donaldson AM, Mehta A, Tsiouris AJ, Anand VK, Schwartz TH (2014) Surgical management of trigeminal schwannomas: defining the role for endoscopic endonasal approaches. Neurosurg Focus 37(4):E17

    Article  Google Scholar 

  19. Shin SS, Gardner PA, Stefko ST, Madhok R, Fernandez-Miranda JC, Snyderman CH (2011) Endoscopic endonasal approach for nonvestibular schwannomas. Neurosurgery 69:1046–1057

    Article  Google Scholar 

  20. Simal Julián JA, Miranda Lloret P, García Piñero A, Botella Asunción C (2014) Full endoscopic endonasal suprapetrous approach to Meckel’s cave. Acta Neurochir 156(8):1623–1626

    Article  Google Scholar 

  21. Van Rompaey J, Bush C, Khabbaz E, Vender J, Panizza B, Solares CA (2013) What is the best route to the Meckel cave? Anatomical comparison between the endoscopic endonasal approach and a lateral approach. J Neurol Surg B Skull Base 74(6):331–336

    Article  Google Scholar 

  22. Yang L, Hu L, Zhao W, Zhang H, Liu Q, Wang D (2018) Endoscopic endonasal approach for trigeminal schwannomas: our experience of 39 patients in 10 years. Eur Arch Otorhinolaryngol 275(3):735–741

    Article  Google Scholar 

  23. Zoli M, Milanese L, Bonfatti R, Sturiale C, Pasquini E, Frank G, Mazzatenta D (2016) Cavernous sinus invasion by pituitary adenomas: role of endoscopic endonasal surgery. J Neurosurg Sci 60(4):485–494

    PubMed  Google Scholar 

  24. Zoli M, Milanese L, Bonfatti R, Faustini-Fustini M, Marucci G, Tallini G, Zenesini C, Sturiale C, Frank G, Pasquini E, Mazzatenta D (2018) Clival chordomas: considerations after 16 years of endoscopic endonasal surgery. J Neurosurg 128(2):329–338

  25. Zwagerman NT, Zenonos G, Lieber S, Wang WH, Wang EW, Fernandez-Miranda JC, Snyderman CH, Gardner PA (2016) Endoscopic transnasal skull base surgery: pushing the boundaries. J Neuro-Oncol 130(2):319–330

    Article  Google Scholar 

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Acknowledgments

We thank Dr. Cecilia Baroncini for her linguistic review of the paper.

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Author notes

  1. Matteo Zoli and Stefano Ratti equally contributed to the paper and should be considered as first Authors.

Authors and Affiliations

  1. Department of Neurosurgery, DIBINEM, University of Bologna, Bologna, Italy

    Matteo Zoli, Federica Guaraldi & Diego Mazzatenta

  2. Pituitary Unit, Center for the Diagnosis and Treatment of Hypothalamus-Pituitary Disorders, IRCCS Istituto delle Scienze Neurologiche di Bologna, Via Altura, 3, 40139, Bologna, Italy

    Matteo Zoli, Federica Guaraldi, Laura Milanese, Giorgio Frank & Diego Mazzatenta

  3. Institute of Anatomy, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy

    Stefano Ratti, Anna Maria Billi, Lucia Manzoli & Lucio Cocco

  4. ENT Department, Ospedale Bellaria, Bologna, Italy

    Ernesto Pasquini

Authors
  1. Matteo Zoli
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  2. Stefano Ratti
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Correspondence to Matteo Zoli.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of our own institutional research committee (IRCCS Institute of Neurological Sciences, Bologna) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Informed consent was obtained from all individual participants included in the study.

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Zoli, M., Ratti, S., Guaraldi, F. et al. Endoscopic endonasal approach to primitive Meckel’s cave tumors: a clinical series. Acta Neurochir 160, 2349–2361 (2018). https://doi.org/10.1007/s00701-018-3708-4

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  • DOI: https://doi.org/10.1007/s00701-018-3708-4

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