INTRODUCTION: Interest in using the extended endonasal transsphenoidal approach for management of suprasellar lesions, with either a microscopic or endoscopic technique, has increased in recent years. The most relevant benefit is that this median approach permits the exposure and removal of suprasellar lesions without the need for brain retraction. MATERIALS AND METHODS: Fifteen human cadaver heads were dissected to evaluate the surgical key steps and the advantages and limitations of the extended endoscopic endonasal transplanum sphenoidale approach. We compared this with the transcranial microsurgical view of the suprasellar area as explored using the bilateral subfrontal microsurgical approach, and with the anatomy of the same region as obtained through the endoscopic endonasal route. RESULTS: Some anatomic conditions can prevent or hinder use of the extended endonasal approach. These include a low level of sphenoid sinus pneumatization, a small sella size with small distance between the internal carotid arteries, a wide intercavernous sinus, and a thick tuberculum sellae. Compared with the subfrontal transcranial approach, the endoscopic endonasal approach offers advantages to visualizing the subchiasmatic, retrosellar, and third ventricle areas. CONCLUSION: The endoscopic endonasal transplanum sphenoidale technique is a straight, median approach to the midline areas around the sella that provides a multiangled, close-up view of all relevant neurovascular structures. Although a lack of adequate instrumentation makes it impossible to manage all structures that are visible with the endoscope, in selected cases, the extended endoscopic endonasal approach can be considered part of the armamentarium for surgical treatment of the suprasellar area.

Extended endoscopic endonasal transsphenoidal approach to the suprasellar area: Anatomic considerations - Part I / Cavallo, LUIGI MARIA; DE DIVITIIS, Oreste; S., Aydin; Messina, Andrea; Esposito, Felice; Iaconetta, Giorgio; K., Talat; Cappabianca, Paolo; M., Tschabitscher. - In: NEUROSURGERY. - ISSN 0148-396X. - STAMPA. - 62:(2008), pp. 1202-1211. [10.1227/01.NEU.000028005.26449.2D]

Extended endoscopic endonasal transsphenoidal approach to the suprasellar area: Anatomic considerations - Part I

CAVALLO, LUIGI MARIA;DE DIVITIIS, ORESTE;MESSINA, ANDREA;ESPOSITO, FELICE;IACONETTA, GIORGIO;CAPPABIANCA, PAOLO;
2008

Abstract

INTRODUCTION: Interest in using the extended endonasal transsphenoidal approach for management of suprasellar lesions, with either a microscopic or endoscopic technique, has increased in recent years. The most relevant benefit is that this median approach permits the exposure and removal of suprasellar lesions without the need for brain retraction. MATERIALS AND METHODS: Fifteen human cadaver heads were dissected to evaluate the surgical key steps and the advantages and limitations of the extended endoscopic endonasal transplanum sphenoidale approach. We compared this with the transcranial microsurgical view of the suprasellar area as explored using the bilateral subfrontal microsurgical approach, and with the anatomy of the same region as obtained through the endoscopic endonasal route. RESULTS: Some anatomic conditions can prevent or hinder use of the extended endonasal approach. These include a low level of sphenoid sinus pneumatization, a small sella size with small distance between the internal carotid arteries, a wide intercavernous sinus, and a thick tuberculum sellae. Compared with the subfrontal transcranial approach, the endoscopic endonasal approach offers advantages to visualizing the subchiasmatic, retrosellar, and third ventricle areas. CONCLUSION: The endoscopic endonasal transplanum sphenoidale technique is a straight, median approach to the midline areas around the sella that provides a multiangled, close-up view of all relevant neurovascular structures. Although a lack of adequate instrumentation makes it impossible to manage all structures that are visible with the endoscope, in selected cases, the extended endoscopic endonasal approach can be considered part of the armamentarium for surgical treatment of the suprasellar area.
2008
Extended endoscopic endonasal transsphenoidal approach to the suprasellar area: Anatomic considerations - Part I / Cavallo, LUIGI MARIA; DE DIVITIIS, Oreste; S., Aydin; Messina, Andrea; Esposito, Felice; Iaconetta, Giorgio; K., Talat; Cappabianca, Paolo; M., Tschabitscher. - In: NEUROSURGERY. - ISSN 0148-396X. - STAMPA. - 62:(2008), pp. 1202-1211. [10.1227/01.NEU.000028005.26449.2D]
File in questo prodotto:
File Dimensione Formato  
9.pdf

accesso aperto

Tipologia: Documento in Post-print
Licenza: Accesso privato/ristretto
Dimensione 1.26 MB
Formato Adobe PDF
1.26 MB Adobe PDF Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11588/376347
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus ND
  • ???jsp.display-item.citation.isi??? ND
social impact