The use of a three-dimensional endoscope for different skull base tumors: results of a preliminary extended endonasal surgical series.
The evolution of skull base surgery over the past decade has been influenced by advancement in visualization technology. Recently, as a result of such improvements, three-dimensional (3-D) scopes have been widely used during endoscopic endonasal approaches. In the present study, we describe the use of 3-D stereoscopic endoscope for the treatment of a variety of skull base lesions.



From January 2010 to June 2015, a 3-D endoscopic endonasal approach (4 and 4.9 mm, 0°, and 30° rigid endoscopes) was performed in 70 patients with the following lesions: 42 large extrasellar pituitary macroadenomas, seven tuberculum sellae meningiomas, seven clivus chordomas, five craniopharyngiomas, three fibrous dysplasia of the clivus, three sinonasal malignancies, one orbital lymphangioma, one trigeminal neurinoma, one primary suprasellar lymphoma.



Total tumor removal was obtained in 50 patients (71.4 %) while in 14 (20 %), subtotal removal was possible in six (8.6 %) only partial removal was achieved. Overall complications included diabetes insipidus in eight patients (11.4 %), hypopituitarism in seven patients (10 %), CSF leak in five patients (7.1 %), cranial nerve injury in two patients (2.8 %), panhypopituitarism in two patients (2.8 %), meningitis in one (1.4 %) and one postoperative central retinal artery occlusion (1.4 %). There was no mortality in the series. The mean follow-up time was 39 months (range, 6-72 months).



In our experience, the 3-D endoscope represents a critical development in visualization, thus enabling improved hand-eye coordination and depth perception, which are mandatory for the management of complex intradural neurovascular structures during tumor removal surgery.
Department of Neuroscience, "G. Rummo" Hospital, Neurosurgery Operative Unit, Via Pacevecchia n.53, 82100, Benevento, Italy.
Giuseppe
G
Catapano
Department of Neuroscience, "G. Rummo" Hospital, Neurosurgery Operative Unit, Via Pacevecchia n.53, 82100, Benevento, Italy. matteodenotaris@gmail.com.
Matteo
M
de Notaris
Unit of Otorhinolaryngology, "G. Rummo" Hospital, Benevento, Italy.
Domenico
D
Di Maria
Department of Neurosurgery, Centro Nacional de Cirugía de Mínimo Acceso, La Habana, Cuba.
Luis Alonso
LA
Fernandez
Department of Neuroscience, "G. Rummo" Hospital, Neurosurgery Operative Unit, Via Pacevecchia n.53, 82100, Benevento, Italy.
Giuseppe
G
Di Nuzzo
Department of Neuroscience, "G. Rummo" Hospital, Neurosurgery Operative Unit, Via Pacevecchia n.53, 82100, Benevento, Italy.
Vincenzo
V
Seneca
Department of Neuroscience, "G. Rummo" Hospital, Neurosurgery Operative Unit, Via Pacevecchia n.53, 82100, Benevento, Italy.
Giuseppina
G
Iorio
Unit of Otorhinolaryngology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Iacopo
I
Dallan
D000293:Adolescent; D000328:Adult; D000368:Aged; D003397:Craniopharyngioma / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery*; D008579:Meningioma / Q000601:surgery*; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D009666:Nose / Q000601:surgery; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D019292:Skull Base Neoplasms / Q000601:surgery*
3-D Endoscopy; Endonasal; Meningioma; Pituitary; Stereoendoscopy; Transsphenoidal