Innovations in Skull Base Surgery
Youngest ever EEA Surgery Performed at Stanford
Virtual reality and 3-D printing prepares surgeons for complex procedures
Our team led by Dr. JFM performed the youngest ever EEA for a craniopharyngioma. This was a uniquely challenging case of a giant craniopharyngioma in a 2-year old child. While the endonasal endoscopic approach is the best approach for most craniopharyngiomas, it had never been done in a child this young. In fact, it was thought to be impossible because of the absence of pneumatization of the sphenoid sinus and the small size of the nasal cavity.
However, the combination of deep expertise, life commitment to excellence in endoscopic skull base surgery, team work, and technological developments, we were able to successfully removed this giant tumor with an excellent outcome.
We strive to continue providing the best possible for patients with craniopharyngiomas at Stanford Medicine.
2019
Description of the youngest ever craniopharyngioma treated via the endoscopic endonasal approach
Grant G, Hwang P, Fernandez-Miranda JC. Endoscopic Endonasal Surgery for Resection of Giant Craniopharyngioma in a Toddler: Multimodal Presurgical Planning, Surgical Technique, and Management of Complications. Operative Neurosurgery 2019 DOI: 10.1093/ons/opz384
---------------------------------------------------------------------------------------------------------------------------------------------
2019
Description of the use of patient-specific 3-dimensionally printed models for neurosurgical planning
Panesar SS, Magnetta M, Mukherjee D, Abhinav K, Branstetter BF, Gardner PA, Iv M, Fernandez-Miranda JC. Patient-specific 3-dimensionally printed models for neurosurgical planning and education. Neurosurg Focus. 2019 Dec 1;47(6):E12. doi: 10.3171/2019.9.FOCUS19511. PMID: 31786547
---------------------------------------------------------------------------------------------------------------------------------------------
2019
Description of the endoscopic endonasal superomedial orbitectomy, a key technical modification for achieving complete tumor resection in anterior skull base tumors such as meningiomas and sinonasal malignancies
Cárdenas Ruiz-Valdepeñas E, Kaen A, González-Martínez E, Gardner PA, Wang EW, Snyderman CH, Fernandez-Miranda JC. Endoscopic endonasal superomedial orbitectomy: How far is safe and possible? Laryngoscope. 2019 Jun 17. doi: 10.1002. PMID: 31206702
---------------------------------------------------------------------------------------------------------------------------------------------
2018
Description of the endoscopic endonasal translacerum approach, a key surgical technique for complete removal of tumors such as chordomas and chondrosarcomas that invade the petroclival region
Wang WH, Lieber S, Mathias RN, Sun X, Gardner PA, Snyderman CH, Wang EW, Fernandez-Miranda JC. The foramen lacerum: surgical anatomy and relevance for endoscopic endonasal approaches. J Neurosurg. 2018 Nov 1:1-12. doi: 10.3171/2018.6. PMID: 30544351
---------------------------------------------------------------------------------------------------------------------------------------------
2018
Description of the surgical anatomy of the superior hypophyseal artery, providing essential knowledge to preserve the vascular supply to the optic apparatus in craniopharyngioma and suprasellar meningioma surgery
Truong HQ, Najera E, Zanabria-Ortiz R, Celtikci E, Sun X, Borghei-Razavi H, Gardner PA, Fernandez-Miranda JC.Surgical anatomy of the superior hypophyseal artery and its relevance for endoscopic endonasal surgery. J Neurosurg. 2018 Jul 13:1-9. PMID: 30004277
---------------------------------------------------------------------------------------------------------------------------------------------
2018
Description of the endoscopic endonasal transoculomotor triangle approach for multilobulated adenomas, allowing for complete tumor resection with one single operation
Ferrareze Nunes C, Lieber S, Truong HQ, Zenonos G, Wang EW, Snyderman CH, Gardner PA, Fernandez-Miranda JC. Endoscopic endonasal transoculomotor triangle approach for adenomas invading the parapeduncular space: surgical anatomy, technical nuances, and case series. J Neurosurg. 2018 Apr 13:1-11. PMID: 29652231
---------------------------------------------------------------------------------------------------------------------------------------------
2018
Description of the surgical technique for removal of the medial wall of the cavernous sinus, a novel procedure that facilitates complete resection of invasive pituitary adenomas with great implications for patients with functional adenomas causing Acromegaly or Cushing’s disease
Truong HQ, Lieber S, Najera E, Alves-Belo JT, Gardner PA, Fernandez-Miranda JC. The medial wall of the cavernous sinus. Part 1: Surgical anatomy, ligaments, and surgical technique for its mobilization and/or resection. J Neurosurg. 2018 Sep 7:1-9. PMID: 30192192
Cohen-Cohen S, Gardner PA, Alves-Belo JT, Truong HQ, Snyderman CH, Wang EW, Fernandez-Miranda JC. The medial wall of the cavernous sinus. Part 2: Selective medial wall resection in 50 pituitary adenoma patients. J Neurosurg. 2018 Sep 7:1-10. PMID: 30192191
---------------------------------------------------------------------------------------------------------------------------------------------
2017
Description of the compartments of the cavernous sinus from an endonasal perspective, a novel classification that facilitates gentle and effective removal of tumors such as pituitary adenomas that invade the cavernous sinus
Fernandez-Miranda JC, Zwagerman NT, Abhinav K, Lieber S, Wang EW, Snyderman C, Gardner P. Cavernous sinus compartments from the endonasal endoscopic approach: anatomical considerations and surgical relevance to adenoma surgery. J Neurosurg. 2017 Sep 1:1-12. PMID: 28862552
---------------------------------------------------------------------------------------------------------------------------------------------
2017
Description of the endoscopic endonasal interdural middle fossa approach to the maxillary nerve, an original technique to maximize resection of perineural spread in malignant skull base tumors
Abhinav K, Panczykowski D, Wang WH, Snyderman CH, Gardner PA, Wang EW, Fernandez-Miranda JC. Endoscopic endonasal interdural middle fossa approach to the maxillary nerve: anatomical considerations and surgical relevance. Oper Neurosurg (Hagerstown). 2017 Aug;13(4):522-528. PMID: 28838109
---------------------------------------------------------------------------------------------------------------------------------------------
2016
Description of the endoscopic endonasal transclival transcondylar approach, a key technical modification for treatment of lower clivus chordomas and ventrally located foramen magnum meningiomas
Wang WH, Abhinav K, Wang E, Snyderman C, Gardner PA, Fernandez-Miranda JC. Endoscopic endonasal transclival transcondylar approach for foramen magnum meningiomas: surgical anatomy and technical note. Oper Neurosurg. 2016 Jun; 12(2):153-62. PMID: 29506094
---------------------------------------------------------------------------------------------------------------------------------------------
2015
Description of the endoscopic endonasal approach to the optic canal to allow for removal of tumors such as meningiomas than invade the medial aspect of the optic canal
Abhinav K, Acosta Y, Wang WH, Bonilla LR, Koutourousiou M, Wang E, Snyderman C, Gardner P, Fernandez-Miranda JC. Endoscopic endonasal approach to the optic canal: Anatomic considerations and surgical relevance. Neurosurgery. 2015 Sep; 11 Suppl 3:431-46. PMID: 26177488
---------------------------------------------------------------------------------------------------------------------------------------------
2014
Description of the endoscopic endonasal transcavernous posterior clinoidectomy with interdural pituitary transposition, a key surgical technique for removal of tumors such as chordomas and chondrosarcomas that invade the upper clival region
Fernandez-Miranda JC, Gardner PA, Rastelli MM Jr, Peris-Celda M, Koutourousiou M, Peace D, Snyderman CH, Rhoton AL Jr. Endoscopic endonasal transcavernous posterior clinoidectomy with interdural pituitary transposition. J Neurosurg. 2014 Jul; 121(1):91-9. PMID: 24816325
---------------------------------------------------------------------------------------------------------------------------------------------
2012
Description of the endoscopic endonasal middle clinoidectomy, a key surgical technique for approaches to tumors in the parasellar and suprasellar region such as pituitary adenomas, meningiomas and craniopharyngiomas
Fernandez-Miranda JC, Tormenti M, Latorre F, Gardner P, Snyderman C. Endoscopic endonasal middle clinoidectomy: anatomical, radiological, and technical note. Neurosurgery. 2012 Dec; 71[ONS Suppl 2]:ons233-ons239. PMID: 22806082
---------------------------------------------------------------------------------------------------------------------------------------------
2012
Description of the endoscopic endonasal transclival approach to the jugular tubercle, an essential technique for tumors such as chordomas, chondrosarcomas and meningiomas invading the lower clivus
Fernandez-Miranda JC, Morera VA, Snyderman CH, Gardner P. Endoscopic endonasal transclival approach to the jugular tubercle. Neurosurgery. 2012 Sep; 71(1 Suppl Operative):ONS146-59. PMID: 22127047
---------------------------------------------------------------------------------------------------------------------------------------------