Transsphenoidal Approaches for the Extracapsular Resection of Midline Suprasellar and Anterior Cranial Base Lesions

Abstract

Gross total extracapsular resection of midline suprasellar tumors via a transsphenoidal approach is possible but is associated with a higher risk of complications than is standard transsphenoidal surgery.

Surgical management of selected pituitary macroadenomas using extended endoscopic endonasal transsphenoidal approach: Early experience

“…[26] The surgical options for these tumors, thus, remain limited to either staged transsphenoidal resections after residual tumor descends into the sella, or transcranial removal, or combined/staged transsphenoidal-transcranial approaches. [27][28][29][30] The extended endonasal transsphenoidal approach has recently been used in the surgical treatment of a variety of midline skull base tumors, [11,[13][14][15][16][17][18][19][20][21] including craniopharyngiomas, Rathke cleft cysts, and meningiomas. However, this approach is not commonly used for removal of pituitary adenomas and only a few reports are available in the literature.…”

“…However, this approach is not commonly used for removal of pituitary adenomas and only a few reports are available in the literature. [11,13,31,32] Recently, we employed the extended endoscopic endonasal transsphenoidal approach (EEEA) as described above in detail, in a subgroup of patients who had pituitary macroadenomas with dumbbell (hour-glass) configuration, firm or fibrous consistency, complete suprasellar location, larger subfrontal extension, or recurrent tumors after previous surgery/radiation. The advantages of EEEA are many and are mainly because of the wider exposure that it provides after removal of SF and the bone of the TS and PS.…”

“…With growing experience in the endoscopic surgery for various skull base lesions, it has now become possible to remove a wide variety of anterior and middle fossa tumors safely and more effectively. [11,[13][14][15][16][17][18][19][20][21] Since past few years, we have employed the endoscopic endonasal transsphenoidal approach with extension to the tuberculum sellae (TS) and planum sphenoidale (PS) for removal of meningiomas, craniopharyngiomas, suprasellar cysts, and selected pituitary macroadenomas [ Figure 1]. In this report, we present our surgical technique and early experience with the extended endoscopic endonasal approach (EEEA) for the management of pituitary adenomas.…”

Endoscopic endonasal transplanum transtuberculum approach for retrochiasmatic craniopharyngiomas: Operative nuances

“…The technique of extended transsphenoidal microsurgical approach, which involves removal of the tuberculum sellae and planum sphenoidale (PD), and first described by Weiss [27] in 1987, has the advantage of providing direct visualization and access to the lesions located in the suprasellar and supradiaphragmatic regions. [28][29][30][31][32] With advances in endoscopic technology, surgery for craniopharyngiomas has undergone a revolutionary transformation in the past few years. Increased experience in transnasal surgery has led to the introduction of the endoscopic approach in the surgical management of tumors at locations other than the sellar cavity.…”

“…Increased experience in transnasal surgery has led to the introduction of the endoscopic approach in the surgical management of tumors at locations other than the sellar cavity. [15,[27][28][29][30][32][33][34][35][36][37][38][39][40] The pure extended (transtuberculum transplanum) endoscopic endonasal approach is a more recent modification in the endoscopic approaches and provides a direct midline exposure for access to the retrochiasmatic craniopharyngiomas. [31,36,[41][42][43][44] Recent literature suggests that for most craniopharyngiomas, the degree of resection via the endonasal endoscopic approach, in experienced hands, is comparable or superior to that obtained by the transcranial routes.…”