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Contributors

https://t.me/med1917

Kumar Abhinav, MBBS, FRCS (Neurosurgery)

Skull Base Research Fellow Department of Neurosurgery University of Pittsburgh Medical Center Pittsburgh, Pennsylvania, United States

Joan M. Ademá-Alcover, MD

Professor Department of Otolaryngology–Head and Neck Surgery Hospital General de Cataluña Universitat Autònoma de Barcelona Barcelona, Spain

Isam Alobid, MD, PhD

Associate Professor Head, Rhinology and Skull Base Unit Department of Otolaryngology Hospital Clinic University of Barcelona Barcelona, Spain

Muhamad A. Amine, MD, MS

Otorhinolaryngologist Department of Otolaryngology–Head and Neck Surgery Carle Foundation Hospital Urbana, Illinois, United States

Vijay K. Anand, MD

Clinical Professor of Otolaryngology Department of Otolaryngology–Head and Neck Surgery Weill Medical College of Cornell University New York, New York, United States

Paolo Battaglia, MD

Assistant Professor Division of Otorhinolaryngology Department of Biotechnology and Life Sciences Head and Neck Surgery & Forensic Dissection Research

Center (HNS & FDRC) University of Insubria ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi Varese, Italy

Angelique M. Berens, MD

Otolaryngologist Department of Otolaryngology–Head and Neck Surgery University of Washington School of Medicine Seattle, Washington, United States

Manuel Bernal-Sprekelsen, MD, PhD

Full Professor and Director Department of Otorhinolaryngology Hospital Clinic University of Barcelona Barcelona, Spain

Raewyn G. Campbell, MD

Otolaryngologist Department of Otolaryngology–Head and Neck Surgery The Ohio State University Wexner Medical Center Columbus, Ohio, United States

Gabriel Martinez Capoccioni, MD

Otorhinolaryngologist Department of Otorhinolaryngology–Head and Neck Surgery Complejo Hospitalario Universitario de Santiago Santiago, Spain

Paolo Cappabianca, MD, PhD

Professor and Chairman of Neurosurgery Head of Division of Neurosurgery School of Medicine and Surgery University of Naples Federico II Naples, Italy

Eugenio Cárdenas, MD, PhD

Consultant Neurosurgeon Department of Neurosurgery Hospital Universitario Virgen del Rocío y Virgen Macarena Sevilla, Spain

Ricardo L. Carrau, MD, FACS

Professor Department of Otolaryngology–Head & Neck Surgery Director of the Comprehensive Skull Base Surgery Program The Ohio State University Medical Center Columbus, Ohio, United States

xix

Contributors

https://t.me/med1917

Paolo Castelnuovo, MD, FRCSEd, FACS

Full Professor and Chairman Division of Otorhinolaryngology Department of Biotechnology and Life Sciences Head and Neck Surgery & Forensic Dissection Research

Center (HNS & FDRC) University of Insubria ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi Varese, Italy

Giuseppe Catapano, MD

Neurosurgeon Department of Neuroscience Neurosurgery Operative Unit “G Rummo” Hospital Benevento, Italy

Luigi Maria Cavallo, MD, PhD

Assistant Professor of Neurosurgery Division of Neurosurgery School of Medicine and Surgery Università degli Studi di Napoli Federico II Naples, Italy

Juanita M. Celix, MD, MPH

Neurosurgeon Department of Neurosurgery Aurora Neurosciences Innovation Institute Aurora St. Luke’s Medical Center Milwaukee, Wisconsin, United States

Mauricio López Chacón, MD

Consultant Otorhinolaryngology Rhinology and Skull Base Unit Department of Otolaryngology Hospital Clinic University of Barcelona Barcelona, Spain

Srikant S. Chakravarthi, MD, MSc

Neurosurgery Research Fellow Aurora Neuroscience Innovation Institute Aurora St. Luke’s Medical Center Milwaukee, Wisconsin, United States

Peng-Yuan Chang, MD

Instructor Department of Neurosurgery Neurological Institute Taipei Veterans General Hospital School of Medicine National Yang-Ming University Taipei, Taiwan

Arturo Cordero Castillo, MD

Consultant Otorhinolaryngologist Rhinology and Skull Base Unit Department of Otolaryngology Hospital Clinic University of Barcelona Barcelona, Spain

Martin Corsten, MD

Chair Department of Otolaryngology–Head and Neck Surgery Aurora Neurosciences Innovation Institute

Aurora St. Luke’s Medical Center Milwaukee, Wisconsin, United States

Iacopo Dallan, MD

Consultant Otorhinolaryngologist Second Unit of Otorhinolaryngology Azienda Ospedaliero-Universitaria Pisana Pisa, Italy

Elena D’avella, MD

Neurosurgeon Laboratory of Surgical NeuroAnatomy (LSNA) Human Anatomy and Embryology Unit Faculty of Medicine University of Barcelona Barcelona, Spain

Juan Pablo Demaría, MD

Otorhinolaryngologist Instituto de Diagnóstico y Cirugía Rosario, Argentina

Ricardo Dolci, MD

Otolaryngologist Clinica Dolci de Otorrinolaringologia São Paulo, Brazil

Contributors

https://t.me/med1917

Tomasz Dziedzic, MD, PhD

Neurosurgeon Department of Neurosurgery Medical University of Warsaw Warsaw, Poland

Joaquim Enseñat, MD, PhD

Chairman of Neurosurgery Department of Neurosurgery Hospital Clinic Faculty of Medicine University of Barcelona Barcelona, Spain

Juan C. Fernandez-Miranda, MD

Associate Professor Department of Neurosurgery University of Pittsburgh Medical Center Pittsburgh, Pennsylvania, United States

Giacomo Fiacchini, MD

Otolaryngologist First Otolaryngology–Head & Neck Surgery Unit University of Pisa Pisa, Italy

Stefano Sellari–Franceschini, MD

Otolaryngologist First ENT Unit Azienda Ospedaliero-Universitaria Pisana Pisa, Italy

Giorgio Frank, MD

Neurosurgeon Department of Neurosurgery, IRCCS Ospedale Bellaria Bologna, Italy

Melanie Fukui, MD

Neuroradiologist Radiology and Neurosurgery Department Aurora Neurosciences Innovation Institute Aurora St. Luke’s Medical Center Milwaukee, Wisconsin, United States

Elena Garcia-Garrigós, MD

Consultant Department of Radiology Hospital Universitario de Alicante Universidad Miguel Hernandez Alicante, Spain

Christos Georgalas, MD, PhD, DLO, FRCS(ORL-HNS)

Director Endoscopic Paranasal and Skull Base Surgery Hygeia Hospital Athens, Greece Academic Associate Leiden University Hospital Leiden, Netherlands

Michael Ghirelli, MD

ENT Resident ENT Department Ospedale Bellaria Bologna, Italy

Nelido Gonzalez Fernandez, MD

Maxillo-Facial Surgeon Department of Maxillo-Facial Surgery Instituto Nacional de Oncología y Radiobiología (INOR) La Habana, Cuba

Leo F.S. Ditzel Filho, MD

Neurosurgeon Department of Neurosurgical Surgery The Ohio State University Wexner Medical Center Columbus, Ohio, United States

Juan Ramón Gras-Cabrerizo, MD

Otorhinolaryngologist Department of Otolaryngology–Head and Neck Surgery Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona Barcelona, Spain

Gustavo Hadad, MD

Otorhinolaryngologist Instituto de Diagnóstico y Cirugía Rosario, Argentina

Marija Mavar Haramija, MSc

Biomedical Imaging Scientist Perspectum Diagnostics Ltd. Oxford, England

Ali Jamshidi, MD

Clinical Instructor Department of Otolaryngology–Head and Neck Surgery The Ohio State University Wexner Medical Center Columbus, Ohio, United States

xxi

Contributors

https://t.me/med1917

Ariel Kaen, MD, PhD

Consultant Neurosurgeon Department of Neurosurgery Hospital Universitario Virgen del Rocío y Virgen Macarena Sevilla, Spain

Apostolos Karligkiotis, MD

Otorhinolaryngologist Division of Otorhinolaryngology Department of Biotechnology and Life Sciences University of Insubria ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy

Pornthep Kasemsiri, MD

Assistant Professor Department of Otorhinolaryngology Faculty of Medicine Khon Kaen University Khon Kaen, Thailand

Amin Kassam, MD

Chair of Department of Neurosurgery V Vice-President of Neurosciences System Clinical Program Department of Neurosurgery Aurora Neurosciences Innovation Institute Aurora St. Luke’s Medical Center Milwaukee, Wisconsin, United States

Edward Kerr, MD

Neurosurgeon Department of Neurosurgical Surgery The Ohio State University Wexner Medical Center Columbus, Ohio, United States

Sammy Khalili, MD, MSc

Otolaryngologist Department of Otolaryngology and Head and Neck Surgery Aurora Neuroscience Innovation Institute Aurora St. Luke’s Medical Center Milwaukee, Wisconsin, United States

Almaz Kurbanov, MD

Research Fellow Department of Neurosurgery University of Cincinnati College of Medicine Cincinnati, Ohio, United States

Lili Laleva, MD

Neurosurgeon Department of Neurosurgery Tokuda Hospital Sofia, Bulgaria. Sofia, Bulgaria

Cristobal Langdon, MD

Professor Rhinology and Skull Base Unit Department of Otorhinolaryngology Hospital Clinic, University of Barcelona Barcelona, Spain

Eduardo Lehrer, MD

Otorhinolaryngologist Department of Otolaryngology–Head and Neck Surgery Hospital de l’Esperit Sant Barcelona, Spain

Juan Antonio Juanes Méndez, MD, PhD

Full Professor Department of Human Anatomy and Histology University of Salamanca Salamanca, Spain

Francesca Jaume Monroig, MD

Otorhinolaryngologist Rhinology and Skull Base Unit Department of Otorhinolaryngology Hospital Clinic de Barcelona Universitat de Barcelona Barcelona, Spain

Diego Mazzatenta, MD

Professor of Neurosurgery Department of Biomedical and Neuromotor Sciences University of Bologna Director of Center of Pituitary and Endoscopic

Skull Base Surgery IRCCS Institute of Neurological Sciences of Bologna Bologna, Italy

David K. Morrissey, MBBS (Hons)

Senior Lecturer Department of Surgery The University of Queensland Brisbane, Australia

xxii

Contributors

https://t.me/med1917

Kris S. Moe, MD, FACS

Professor and Chief Division of Facial Plastic and Reconstructive Surgery Departments of Otolaryngology and Neurological Surgery University of Washington School of Medicine Seattle, Washington, United States

Miguel Mural, MD

Neurosurgeron Hospital Nacional Profesor Alejandro Posadas Buenos Aires, Argentina

Jun Muto, MD, PhD

Neurosurgeon Department of Neurosurgery Keio University School of Medicine Tokyo, Japan

Matteo de Notaris, MD, PhD

Consultant Neurosurgeon Department of Neuroscience Neurosurgery Operative Unit “G Rummo” Hospital Benevento, Italy

Giuseppe Di Nuzzo, MD

Neurosurgeon Department of Neuroscience Neurosurgery Operative Unit “G Rummo” Hospital Benevento, Italy

Bradley A. Otto, MD

Assistant Professor Department of Otolaryngology–Head and Neck Surgery The Ohio State University Wexner Medical Center Columbus, Ohio, United States

Daniel M. Prevedello, MD, FACS

Associate Professor Department of Neurosurgical Surgery, The Ohio State University Wexner Medical Center Columbus, Ohio, United States

Ernesto Pasquini, MD

Adjunct Professor University of Bologna Head, ENT Metropolitan Unit Surgical Department “Bellaria” Hospital Ausl Bologna, Italy

Hafiz Patwa, MD

Otolaryngologist Department of Otolaryngology–Head & Neck Surgery The Ohio State University Wexner Medical Center Columbus, Ohio, United States

Alberto Prats-Galino, MD, PhD

Full Professor Laboratory of Surgical NeuroAnatomy (LSNA) Human Anatomy and Embryology Unit Faculty of Medicine University of Barcelona Barcelona, Spain

Carlos M. Rivera-Serrano, MD

Plastic & Reconstructive Surgeon Craniofacial and Reconstructive Microsurgery Fellow

Chang Gung Memorial Hospital Taipei, Taiwan

Roldán Roberto, MD

Otorhinolaryngologist Instituto de Diagnóstico y Cirugía Rosario, Argentina

Theodore H. Schwartz, MD, FACS

David and Ursel Barnes Professor of Minimally Invasive Neurosurgery Director, Anterior Skull Base and Pituitary Surgery Director, Epilepsy Research Laboratory Departments of Neurological Surgery, Otolaryngology

and Neuroscience Weill College of Medicine of Cornell University New York, New York, United States

Richard Rovin, MD

Neurosurgeon and Director of Clinical Research Department of Neurosurgery Aurora Neurosciences Innovation Institute Aurora St. Luke’s Medical Center Milwaukee, Wisconsin, United States

Vincenzo Seneca, MD

Neurosurgeon Department of Neuroscience Neurosurgery Operative Unit “G Rummo” Hospital Benevento, Italy

Nishit Shah, MD

Otolaryngologist Department of Otolaryngology Bombay Hospital and Medical Research Centre Breach Candy Hospital Mumbai, India

xxiii

Contributors

https://t.me/med1917

Domenico Solari, MD

Research Fellow in Neurosurgery Division of Neurosurgery School of Medicine and Surgery Università degli Studi di Napoli Federico II Naples, Italy

Humbert Massegur-Solench, MD

Consultant Department of Otolaryngology–Head and Neck Surgery Hospital de la Santa Creu i Sant Pau Universitat Autònoma de Barcelona Barcelona, Spain

Alberto Di Somma, MD

Resident in Neurosurgery Division of Neurosurgery School of Medicine and Surgery Università degli Studi di Napoli Federico II Naples, Italy

Teresa Somma, MD

Research Fellow in Neurosurgery Division of Neurosurgery University of Naples Federico II Naples, Italy

Michael Tsounis, MD, PhD

Consultant Otorhinolaryngologist Department of Otorhinolaryngology Health Directorate of Hellenic Police Headquarters Athens, Greece

Tsung-Hsi Tu, MD

Instructor Department of Neurosurgery Neurological Institute Taipei Veterans General Hospital School of Medicine National Yang-Ming University Taipei, Taiwan

Peter John Wormald, MD

Professor and Chairman Otolaryngology Head and Neck Surgery

Professor of Skull Base Surgery University of Adelaide Adelaide, Australia

Jau-Ching Wu, MD, PhD

Associate Professor Department of Neurosurgery Neurological Institute Taipei Veterans General Hospital School of Medicine National Yang-Ming University Taipei, Taiwan

Yu-Shu Yen, MD

Assistant Professor Department of Neurosurgery Neurological Institute Taipei Veterans General Hospital School of Medicine National Yang-Ming University Taipei, Taiwan

Lee A. Zimmer, MD, PhD

Professor Department of Otolaryngology–Head and Neck Surgery University of Cincinnati College of Medicine Cincinnati, Ohio, United States

Matteo Zoli, MD

Neurosurgeon Department of Neurosurgery, IRCCS Ospedale Bellaria Bologna, Italy

Mario Turri-Zanoni, MD

Consultant Otorhinolaryngologist Division of Otorhinolaryngology Department of Biotechnology and Life Sciences Head and Neck Surgery & Forensic Dissection Research Center (HNS & FDRC) University of Insubria ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi Varese, Italy

xxiv

Section 1

https://t.me/med1917

Introduction

1 Evolution of Skull Base Surgery:

The Multidisciplinary Team Approach 3

2 Three-Dimensional Anatomy

of the Skull Base: The Ventral Pathway 7

https://t.me/med1917

Chapter 1

https://t.me/med1917

Evolution of Skull

Base Surgery: The

Multidisciplinary

Team Approach

Evolution of Skull Base Surgery: The Multidisciplinary Team Approach

https://t.me/med1917

1 Evolution of Skull Base Surgery: The Multidisciplinary Team Approach

Francesca Jaume Monroig, Isam Alobid, Manuel Bernal-Sprekelsen

The idea to access the brain through the nose is ancient. There is evidence that during mummification procedures, Egyptian surgeons removed brain tissue transnasally.

1,2

In the fifth century BC, the Corpus Hippocraticum described for the first time the anatomy of the paranasal sinuses and their surgery.

However, the study of the nose and sinus anatomy did not improve until the Renaissance period when Leonardo Da Vinci started to describe the paranasal sinuses from cadaver dissections.

The maxillary was the sinus first operated; in 1675, Molinetti describes for the first time an opening approach to the maxillary sinus through the cheek.

In 1893 and 1897, Caldwell and Luc proposed, respectively, a radical surgery of the maxillary sinus by opening its anterior wall, which has been the gold standard of maxillary sinus surgery for many decades.

6,7

The transnasal approach of ethmoid sinus was first described by Riberi in 1838 and consolidated by others between 1893 and 1907.

In 1901, Hirschman visualized for the first time the maxillary sinus through an oroantral fistula using a cystoscope with an electric bulb. In 1902, Reichert performed a maxillary sinus surgery with an endoscopic view from an oroantral fistula and then, in 1922, Spielberg started to use antroscopes to access the maxillary sinus through the inferior meatus. Maltz coined the term “sinuscopy” in 1925.

However, the lack of antibiotics and proper instruments, the inadequate anesthesia, and the poor anatomic knowledge linked these surgeries to increased fatal complications. Mosher wrote in 1929: “… any surgery in this region could be simple, but it has proven to be one of the easiest to kill a patient.” For this reason, the endonasal approach remained in the darkness until the 1980s.

3,4

Back then, these scopes were bad in terms of optical quality, field of view, and illumination, as they were using electric bulbs. No wonder that the introduction of the microscope in sinus surgery by Heermann in 1958 stopped the expansion of the endoscopic surgery.

The revolution came with the rod optic endoscope developed by Hopkins in the 1960s, which dramatically increased the optical quality.

Thereafter, Karl Storz in Germany created angled endoscopes and later wide-angled endoscopes offering a huge field of view. When Hopkins and Storz shared their know-how, the endoscopes got cold light and, thus, the possibility of the endonasal surgery became a reality.

In 1660, Schneider realized that the mucus of the nose is produced by the mucosa lining of the paranasal sinus, and not, as had been thought until then, by the brain.

However, it was not until the 20th century that the idea to treat some nose diseases by operating the paranasal sinuses increased.

This idea started when it was described how the nose had an important function filtrating, humidifying, and warming up the air, thanks to the function of mucociliary clearance and autonomic system. Golding-Wood, in 1963, described how the glands of the nasal mucosa, as well as the vessels, have a direct parasympathetic innervation, leading to a direct increase of nasal secretions via transudation and exsudation when stimulated.

Messerklinger, in Austria, was one of the pioneers of the endoscopic assessment of the pathophysiology of the lateral nasal wall. He started to explore the function of the nose with the endoscope instead of the microscope, to identify why the sinuses were blocked or from where the mucous was draining, allowing one of his pupils, Stammberger, to develop and spread the concept of minimally invasive surgery of the paranasal sinuses, nowadays known as functional endoscopic sinus surgery.

15,16

Computed tomography was developed in 1972, while magnetic resonance imaging arrived in 1977. It took many years to introduce a preoperative scan as a routine assessment for all bony landmarks and the extension of chronic inflammatory disease, and it considerably improved the indications for endonasal surgery. Stammberger and Kennedy started to spread the Messerklinger concepts worldwide

16,17

—basically, the enlargement of narrow spaces to provide aeration and drainage of the paranasal sinuses through the natural ostia while preserving the surrounding mucosa as much as possible. MacKay and Lund established the systematic evaluation of radiologic studies before surgery, proposing a staging score (the Lund–Mackay score).

18,19

Technological development introduced specific surgical instruments, such as powered instrumentation known as shavers or microdebriders, first experience in computer-assisted sinus surgery was published by Anon et al in the 1990s.

and navigation systems. The

Apart from inflammatory diseases, benign tumors were started to be removed endoscopically. In 1990, Waitz and Wigand published a large case series of patients with inverted papilloma treated exclusively with an endonasal approach. cussion. In the mid-1990s, small juvenile angiofibromas were also approached endoscopically.

This did not happen without a lot of dis-

23–25

Meanwhile, extended angiofibromas, reaching the infratemporal fossa, the cavernous sinus, or the parapharyngeal space, are approached endoscopically.

The possibility to assess the skull base through the nose started with the closure of small iatrogenic cerebrospinal fluid (CSF) leaks by Wigand in 1981.

Today, most CSF

leaks are being closed endoscopically.

The transsphenoidal route to the pituitary was described in 1907, but it was abandoned due to technical difficulties. In the 1960s, Hardy started to perform transsphenoidal surgery using a microscope. published the first series on endoscopic pituitary surgery procedures in 1992,

and in 1996, Jho and Carrau described and standardized the procedure. and de Divitiis coined the term “functional endoscopic pituitary surgery.”

Jankowski et al

Cappabianca

Since the first interdisciplinary congress of endoscopic surgery of skull base in 2005, the number of interdisciplinary teams (mainly ENT and neurosurgery) has increased exponentially and more diseases are treated transnasally.

The initial experience with the closure of CSF leaks combined with the increasing experience in endoscopic pituitary surgery gave way to an increasing

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