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Controversies in Skull Base Surgery

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In my more than 40 years of practicing skull base and vascular neurosurgery, I have found that one persistent challenge we all face is to stay current on the changing paradigms of disease management for patients with skull base disease. Obtaining the best available evidence in a field dominate...

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  • October 25, 2024
  • 328
  • 2024/2025
  • Case
  • Robert f. spetzler
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  • controversies in skull base surgery

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,
,Controversies in Skull Base Surgery




Andrew S. Little, MD
Assistant Professor
Department of Neurosurgery
Barrow Neurological Institute
St. Joseph’s Hospital and Medical Center
Phoenix, Arizona, USA

Michael A. Mooney, MD
Resident
Department of Neurosurgery
Barrow Neurological Institute
St. Joseph’s Hospital and Medical Center
Phoenix, Arizona, USA




99 illustrations

On the cover
The illustration depicts three different skull base surgical options: expanded, endoscopic
endonasal surgery, transcranial microsurgery, and radiosurgery.




Thieme
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,Executive Editor: Timothy Y. Hiscock Important note: Medicine is an ever-changing science undergo-
Managing Editor: Sarah Landis ing continual development. Research and clinical experience are
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Production Editor: Naamah Schwartz edge of proper treatment and drug therapy. Insofar as this book
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President: Brian D. Scanlan to any dosage instructions and forms of applications stated in the
book. Every user is requested to examine carefully the manufac-
Library of Congress Cataloging-in-Publication Data turers’ leaflets accompanying each drug and to check, if necessary
Names: Little, Andrew S., editor. | Mooney, Michael A. in consultation with a physician or specialist, whether the dosage
(Neurosurgeon), editor. Title: Controversies in skull base surgery schedules mentioned therein or the contraindications stated by the
/ [edited by] Andrew S. Little, Michael A. Mooney. manufacturers differ from the statements made in the present
Description: New York : Thieme, [2019] book. Such examination is particularly important with drugs that
Identifiers: LCCN 2019005266| ISBN 9781626239531 (hardcover) | are either rarely used or have been newly released on the market.
ISBN 9781626239548 (e-book) Every dosage schedule or every form of application used is entirely
Subjects: | MESH: Skull Base–surgery Classification: LCC RD529 | at the user’s own risk and responsibility. The authors and publishers
NLM WE 705 | DDC 617.5/14–dc23 LC record available at https:// request every user to report to the publishers any discrepancies or
lccn.loc.gov/2019005266 inaccuracies noticed. If errors in this work are found after publi-
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© 2019 Thieme Medical Publishers, Inc. description page.
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Thieme Publishers New York referred to in this book are in fact registered trademarks or pro-
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Barrow Neurological Institute holds copyright to all diagnostic
images, photographs, intraoperative videos, animations, and art,
including the cover art, used in this work and the accompanying
digital content, unless otherwise stated. Used with permission from
Barrow Neurological Institute, Phoenix, Arizona.

Cover design: Thieme Publishing Group
Cover art: Peter M. Lawrence, MS, CMI
Typesetting by Thomson Digital, India

Printed in The Unites States of America by
King Printing Company, Inc. 54321 This book, including all parts thereof, is legally protected by
copyright. Any use, exploitation, or commercialization outside the
ISBN 978-1-62623-953-1 narrow limits set by copyright legislation, without the publisher’s
consent, is illegal and liable to prosecution. This applies in partic-
Also available as an e-book: ular to photostat reproduction, copying, mimeographing, prepa-
eISBN 978-1-62623-954-8 ration of microfilms, and electronic data processing and storage.

,This book is dedicated to my family, whose love and support has cleared the path to
complete this project and has never failed to inspire me.
Andrew S. Little

To my wife and children for their support.
To my colleagues and mentors at Barrow Neurological Institute for their inspiration.


Michael A. Mooney

,
,Contents
Video Contents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

Foreword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii

Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix

Part I Vestibular Schwannoma

1 Controversies in the Natural History of Acoustic Neuromas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Mark E. Whitaker

2 Controversies in Radiosurgery for Acoustic Neuromas: Single-Session Therapy versus
Hypofractionated Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
David S. Xu, Colin J. Przybylowski, Andrew J. Meeusen, and Randall W. Porter

3 Management of Residual Vestibular Schwannoma After Subtotal Resection:
Observation, Repeat Surgery, or Radiosurgery? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Scott Brigeman and Kaith K. Almefty

4 Treatment Strategies for Small Intracanalicular Vestibular Schwannomas in Young
Patients with Good Hearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Daniel A. Donoho, Ben A. Strickland, Jonathan J. Russin, Rick A. Friedman, and Steven L. Giannotta

Part II Meningioma

5 Transcranial Approaches Are Preferred for Certain Tuberculum and Olfactory Groove
Meningiomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Farshad Nassiri, Suganth Suppiah, and Gelareh Zadeh

6 Endoscopic Endonasal Surgery Is the Best Treatment for Certain Anterior Fossa Skull
Base Meningiomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Douglas A. Hardesty, Alaa S. Montaser, Alexandre B. Todeschini, Ricardo L. Carrau, and Daniel M. Prevedello

7 Controversies in the Management of Petroclival Meningiomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Robert S. Heller and Carl B. Heilman

8 Does Embolization Have a Role to Play in the Treatment of Skull Base
Meningiomas? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Colin J. Przybylowski, Jacob F. Baranoski, Rami O. Almefty, Dale Ding, Andrew F. Ducruet,
and Felipe C. Albuquerque

9 The Role of Radiotherapy for Atypical and Anaplastic Meningiomas . . . . . . . . . . . . . . . . . . . . . . . 48
Brooke K. Leachman, Stephanie E. Weiss, and Leland Rogers

10 Emerging Chemotherapy and Targeted Therapy for Aggressive Meningiomas . . . . . . . . . . . . 58
Yoko Fujita, Ben K. Hendricks, and Nader Sanai




v

, Contents


Part III Pituitary Adenoma

11 The Role of Transsphenoidal Surgery Following Nondiagnostic Inferior Petrosal Sinus
Sampling in Cushing Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Pamela S. Jones and Brooke Swearingen

12 Pharmacotherapy Options After Failed Surgery for Cushing Disease . . . . . . . . . . . . . . . . . . . . . . . . 70
Kevin C. J. Yuen

13 Primary Medical Therapy for Acromegaly, Ready for Prime Time? .......................... 78
Elana V. Varlamov, Winnie Liu, Shirley McCartney, Justin S. Cetas, and Maria Fleseriu

14 The Role of Radiosurgery for Pituitary Adenomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Gabriella Paisan, Ching-Jen Chen, and Jason Sheehan

15 Exploration of the Cavernous Sinus Is Effective During Transsphenoidal Surgery for
Pituitary Adenoma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Engelbert J. Knosp and Alexander S.G. Micko

16 Surgery versus Medical Management: First-Line Treatment for Pituitary Apoplexy . . . . . . . 96
Garni Barkhoudarian, Sheri Palejwala, and Daniel F. Kelly

17 Alternative Treatment Strategies for Atypical and Aggressive Pituitary Adenomas . . . . . . . 102
Gregory K. Hong

Part IV Craniopharyngioma

18 Controversies in Radical Resection versus Subtotal Resection with Radiation in
Craniopharyngioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Taylor J. Abel and James T. Rutka

19 The Role of Open and Endoscopic Approaches to Craniopharyngiomas .................... 116
Neil Majmundar, Jean Anderson Eloy, and James K. Liu

20 The Molecular Pathogenesis of Craniopharyngioma and Potential Therapeutic Targets . . 125
Douglas A. Hardesty

Part V Rathke Cleft Cyst and Other Sellar Lesions

21 Resection versus Cyst Fenestration: The Best Treatment for Rathke Cleft Cysts ........... 131

22 Headache in Patients with Rathke Cleft Cysts ................................................. 137
Justin L. Hoskin, Kevin C. J. Yuen, and Kerry L. Knievel

23 Rathke Cleft Cyst Surgery: Indications, Outcomes, and Complications ..................... 141
David L. Penn and Edward R. Laws Jr.

24 Controversies in the Management of Histiocytosis and Xanthogranulomas ............... 147
Christina E. Sarris and Ruth E. Bristol

Part VI Other Cranial Tumors

25 Surgical Approach Selection for Skull Base Chordoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Paul A. Gardner, Ahmed Jorge, Juan C. Fernandez-Miranda, Eric W. Wang, and Carl H. Snyderman



vi

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