Endoscope-Assisted Middle Fossa Approach: Optimizing the Surgical Corridor for the Resection of Multicompartmental Chordomas

André Beer-Furlan; Eduardo de Arnaldo Silva Vellutini; Leonardo Balsalobre; Aldo Cassol Stamm

doi:10.1055/s-0040-1702218

Endoscope-Assisted Middle Fossa Approach: Optimizing the Surgical Corridor for the Resection of Multicompartmental Chordomas

J Neurol Surg B Skull Base. 2021 Jul;82(Suppl 3):e172-e178. doi: 10.1055/s-0040-1702218. Epub 2020 Mar 6.

Authors

André Beer-Furlan^{1

2

3}, Eduardo de Arnaldo Silva Vellutini^{1

2}, Leonardo Balsalobre^{1

4}, Aldo Cassol Stamm^{1

4}

Affiliations

¹ São Paulo Skull Base Center, São Paulo, Brazil.
² DFVneuro Neurosurgical Group, São Paulo, Brazil.
³ Department of Neurological Surgery, Rush University, Chicago, United States.
⁴ Department of Otolaryngology, São Paulo ENT Center, Hospital Professor Edmundo Vasconcelos, São Paulo, Brazil.

Abstract

Background Skull base chordomas are a major therapeutic challenge. The surgical management involves selecting an approach that will offer the patient the best chance of largest/complete removal while minimizing morbidity and mortality. Methods Medical records and imaging review of two skull base chordomas involving the middle fossa and posterior fossa that were successfully treated with an endoscope-assisted middle fossa approach. Results The use of angled endoscopes provided better identification of anatomical landmarks and improved tumor resection when compared with the microscopic surgical exposure. The approach selection, anatomical landmarks, and technical aspects of the intraoperative setting of the endoscope-assisted approach are discussed. Conclusion Endoscopic assistance in the middle fossa approach is a safe and valuable tool for maximizing the reach of the surgical corridor when treating skull base chordomas.

Keywords: chordoma; endoscope-assisted approach; middle fossa; skull base chordoma; subtemporal; transcranial endoscopy.