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Erschienen in: Neurosurgical Review 4/2015

01.10.2015 | Original Article

Anatomical features of skull base and oral cavity: a pilot study to determine the accessibility of the sella by transoral robotic-assisted surgery

verfasst von: Aymeric Amelot, Stephanie Trunet, Vincent Degos, Olivier André, Aurore Dionnet, Philippe Cornu, Stéphane Hans, Dorian Chauvet

Erschienen in: Neurosurgical Review | Ausgabe 4/2015

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Abstract

The role of transoral robotic surgery (TORS) in the skull base emerges and represents the natural progression toward miniinvasive resections in confined spaces. The accessibility of the sella via TORS has been recently described on fresh human cadavers. An anatomic study is mandatory to know if this approach would be feasible in the majority of patients regardless of their oral morphological features. From 30 skull base CT scans from patients who were asked to open their mouth as wide as they can, we measured specific dimensions of the oral cavity and the skull base, such as length of the palate, mouth opening and distance from the sella to the palate. All data were acquired on a sagittal midline plane and on a 25° rotation plane, which simulated the axis of the robotic instruments. Looking at the projection of the dental palatine line on the sella, we studied possible predictive factors of sellar accessibility and tried to bring objective data for surgical feasibility. We also proposed an angle α to study the working angle at the skull base. We observed that the maximal mouth opening was a good predictive factor of sellar accessibility by TORS (p < 0.05). The mouth aperture threshold value for a good sensitivity, over 80 %, was comparable to the mean value of mouth opening in our series, 38.9 and 39.4 mm respectively. Moreover, we showed a statistically significant increase of the working angle α at the skull base comparing the lateral access to the midline one (p < 0.05). This seemed to quantitatively demonstrate that the robotic arms placed at the labial commissure of the mouth can reach the sella. From these anatomical features and previous cadaveric dissections, we assume that TORS may be feasible on a majority of patients to remove pituitary adenomas.
Literatur
1.
Zurück zum Zitat Carrau RL, Jho HD, Ko Y (1996) Transnasal-transsphenoidal endoscopic surgery of the pituitary gland. Laryngoscope 106:914–918CrossRefPubMed Carrau RL, Jho HD, Ko Y (1996) Transnasal-transsphenoidal endoscopic surgery of the pituitary gland. Laryngoscope 106:914–918CrossRefPubMed
2.
Zurück zum Zitat Jho HD, Alfieri A (2001) Endoscopic endonasal pituitary surgery: evolution of surgical technique and equipment in 150 operations. Minim Invasive Neurosurg 44:1–12CrossRefPubMed Jho HD, Alfieri A (2001) Endoscopic endonasal pituitary surgery: evolution of surgical technique and equipment in 150 operations. Minim Invasive Neurosurg 44:1–12CrossRefPubMed
3.
Zurück zum Zitat Jho HD, Carrau RL (1997) Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg 87:44–51CrossRefPubMed Jho HD, Carrau RL (1997) Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg 87:44–51CrossRefPubMed
4.
Zurück zum Zitat 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:E6PubMed 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:E6PubMed
5.
Zurück zum Zitat Kassam AB, Gardner PA, Snyderman CH, Carrau RL, Mintz AH, Prevedello DM (2008) Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based on the infundibulum. J Neurosurg 108:715–728CrossRefPubMed Kassam AB, Gardner PA, Snyderman CH, Carrau RL, Mintz AH, Prevedello DM (2008) Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based on the infundibulum. J Neurosurg 108:715–728CrossRefPubMed
6.
Zurück zum Zitat Lega BC, Kramer DR, Newman JG, Lee JY (2011) Morphometric measurements of the anterior skull base for endoscopic transoral and transnasal approaches. Skull Base 21:65–70PubMedCentralCrossRefPubMed Lega BC, Kramer DR, Newman JG, Lee JY (2011) Morphometric measurements of the anterior skull base for endoscopic transoral and transnasal approaches. Skull Base 21:65–70PubMedCentralCrossRefPubMed
7.
Zurück zum Zitat Stippler M, Gardner PA, Snyderman CH, Carrau RL, Prevedello DM, Kassam AB (2009) Endoscopic endonasal approach for clival chordomas. Neurosurgery 64:268–277CrossRefPubMed Stippler M, Gardner PA, Snyderman CH, Carrau RL, Prevedello DM, Kassam AB (2009) Endoscopic endonasal approach for clival chordomas. Neurosurgery 64:268–277CrossRefPubMed
8.
Zurück zum Zitat Kaptain GJ, Kanter AS, Hamilton DK, Laws ER (2011) Management and implications of intraoperative cerebrospinal fluid leak in transnasoseptal transsphenoidal microsurgery. Neurosurgery 68:144–150CrossRefPubMed Kaptain GJ, Kanter AS, Hamilton DK, Laws ER (2011) Management and implications of intraoperative cerebrospinal fluid leak in transnasoseptal transsphenoidal microsurgery. Neurosurgery 68:144–150CrossRefPubMed
9.
Zurück zum Zitat Mamelak AN, Carmichael J, Bonert VH, Cooper O, Melmed S (2013) Single-surgeon fully endoscopic endonasal transsphenoidal surgery: outcomes in three-hundred consecutive cases. Pituitary 16:393–401CrossRefPubMed Mamelak AN, Carmichael J, Bonert VH, Cooper O, Melmed S (2013) Single-surgeon fully endoscopic endonasal transsphenoidal surgery: outcomes in three-hundred consecutive cases. Pituitary 16:393–401CrossRefPubMed
10.
Zurück zum Zitat Ceylan S, Koc K, Anik I (2009) Extended endoscopic approaches for midline skull-base lesions. Neurosurg Rev 32:309–319CrossRefPubMed Ceylan S, Koc K, Anik I (2009) Extended endoscopic approaches for midline skull-base lesions. Neurosurg Rev 32:309–319CrossRefPubMed
11.
Zurück zum Zitat Advincula AP, Song A (2007) The role of robotic surgery in gynecology. Curr Opin Obstet Gynecol 19:331–336CrossRefPubMed Advincula AP, Song A (2007) The role of robotic surgery in gynecology. Curr Opin Obstet Gynecol 19:331–336CrossRefPubMed
12.
Zurück zum Zitat Baek SK, Carmichael JC, Pigazzi A (2013) Robotic surgery: colon and rectum. Cancer J 19:140–146CrossRefPubMed Baek SK, Carmichael JC, Pigazzi A (2013) Robotic surgery: colon and rectum. Cancer J 19:140–146CrossRefPubMed
13.
Zurück zum Zitat Bonatti J, Schachner T, Bonaros N, Lehr EJ, Zimrin D, Griffith B (2011) Robotically assisted totally endoscopic coronary bypass surgery. Circulation 124:236–244CrossRefPubMed Bonatti J, Schachner T, Bonaros N, Lehr EJ, Zimrin D, Griffith B (2011) Robotically assisted totally endoscopic coronary bypass surgery. Circulation 124:236–244CrossRefPubMed
14.
Zurück zum Zitat Hakimi AA, Feder M, Ghavamian R (2007) Minimally invasive approaches to prostate cancer: a review of the current literature. Urol J 4:130–137PubMed Hakimi AA, Feder M, Ghavamian R (2007) Minimally invasive approaches to prostate cancer: a review of the current literature. Urol J 4:130–137PubMed
15.
Zurück zum Zitat O’Malley BW Jr, Weinstein GS, Snyder W, Hockstein NG (2006) Transoral robotic surgery (TORS) for base of tongue neoplasms. Laryngoscope 116:1465–1472CrossRefPubMed O’Malley BW Jr, Weinstein GS, Snyder W, Hockstein NG (2006) Transoral robotic surgery (TORS) for base of tongue neoplasms. Laryngoscope 116:1465–1472CrossRefPubMed
16.
Zurück zum Zitat Hans S, Badoual C, Gorphe P, Brasnu D (2012) Transoral robotic surgery for head and neck carcinomas. Eur Arch Otorhinolaryngol 269:1979–1984CrossRefPubMed Hans S, Badoual C, Gorphe P, Brasnu D (2012) Transoral robotic surgery for head and neck carcinomas. Eur Arch Otorhinolaryngol 269:1979–1984CrossRefPubMed
17.
18.
Zurück zum Zitat Agrawal A, Cavalcanti DD, Garcia-Gonzalez U, Chang SW, Crawford NR, Sonntag VK, Spetzler RF, Preul MC (2010) Comparison of extraoral and transoral approaches to the craniocervical junction: morphometric and quantitative analysis. World Neurosurg 74:178–188CrossRefPubMed Agrawal A, Cavalcanti DD, Garcia-Gonzalez U, Chang SW, Crawford NR, Sonntag VK, Spetzler RF, Preul MC (2010) Comparison of extraoral and transoral approaches to the craniocervical junction: morphometric and quantitative analysis. World Neurosurg 74:178–188CrossRefPubMed
19.
Zurück zum Zitat Hamberger CA, Hammer G, Marcusson G (1961) Experiences in transantrosphenoidal hypophysectomy. Trans Pac Coast Otoophthalmol Soc Annu Meet 42:273–286PubMed Hamberger CA, Hammer G, Marcusson G (1961) Experiences in transantrosphenoidal hypophysectomy. Trans Pac Coast Otoophthalmol Soc Annu Meet 42:273–286PubMed
20.
Zurück zum Zitat O’Malley BW Jr, Weinstein GS (2007) Robotic skull base surgery: preclinical investigations to human clinical applications. Arch Otolaryngol Head Neck Surg 133:1215–1219CrossRefPubMed O’Malley BW Jr, Weinstein GS (2007) Robotic skull base surgery: preclinical investigations to human clinical applications. Arch Otolaryngol Head Neck Surg 133:1215–1219CrossRefPubMed
21.
Zurück zum Zitat Ponnusamy K, Chewning S, Mohr C (2009) Robotic approaches to the posterior spine. Spine (Phila Pa 1976) 34:2104–2109CrossRef Ponnusamy K, Chewning S, Mohr C (2009) Robotic approaches to the posterior spine. Spine (Phila Pa 1976) 34:2104–2109CrossRef
22.
Zurück zum Zitat Lee JY, Lega B, Bhowmick D, Newman JG, O’Malley BW Jr, Weinstein GS, Grady MS, Welch WC (2010) Da Vinci robot-assisted transoral odontoidectomy for basilar invagination. ORL J Otorhinolaryngol Relat Spec 72:91–95CrossRefPubMed Lee JY, Lega B, Bhowmick D, Newman JG, O’Malley BW Jr, Weinstein GS, Grady MS, Welch WC (2010) Da Vinci robot-assisted transoral odontoidectomy for basilar invagination. ORL J Otorhinolaryngol Relat Spec 72:91–95CrossRefPubMed
23.
Zurück zum Zitat Herrmann BL, Mortsch F, Berg C, Weischer T, Mohr C, Mann K (2011) Acromegaly: a cross-sectional analysis of the oral and maxillofacial pathologies. Exp Clin Endocrinol Diabetes 119:9–14CrossRefPubMed Herrmann BL, Mortsch F, Berg C, Weischer T, Mohr C, Mann K (2011) Acromegaly: a cross-sectional analysis of the oral and maxillofacial pathologies. Exp Clin Endocrinol Diabetes 119:9–14CrossRefPubMed
24.
Zurück zum Zitat Güldner C, Pistorius SM, Diogo I, Bien S, Sesterhenn A, Werner JA (2012) Analysis of pneumatization and neurovascular structures of the sphenoid sinus using cone-beam tomography (CBT). Acta Radiol 53:214–219CrossRefPubMed Güldner C, Pistorius SM, Diogo I, Bien S, Sesterhenn A, Werner JA (2012) Analysis of pneumatization and neurovascular structures of the sphenoid sinus using cone-beam tomography (CBT). Acta Radiol 53:214–219CrossRefPubMed
Metadaten
Titel
Anatomical features of skull base and oral cavity: a pilot study to determine the accessibility of the sella by transoral robotic-assisted surgery
verfasst von
Aymeric Amelot
Stephanie Trunet
Vincent Degos
Olivier André
Aurore Dionnet
Philippe Cornu
Stéphane Hans
Dorian Chauvet
Publikationsdatum
01.10.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Neurosurgical Review / Ausgabe 4/2015
Print ISSN: 0344-5607
Elektronische ISSN: 1437-2320
DOI
https://doi.org/10.1007/s10143-015-0635-1

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