Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica

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Object

Transsphenoidal approaches have been used for a century for the resection of pituitary and other sellar tumors. More recently, the standard endonasal approach has been expanded to provide access to other, parasellar lesions. With the addition of the endoscope, this expansion carries significant potential for the resection of skull base lesions.

Methods

The anatomical landmarks and surgical techniques used in expanded (extended) endoscopic approaches to the rostral, anterior skull base are reviewed and presented, accompanied by case illustrations of each segment (or module) of approach. The rostral half of the anterior skull base is divided into modules of approach: sellar/parasellar, transplanum/transtuberculum, and transcribriform. Case illustrations of successful resections of lesions with each module are presented and discussed.

Conclusions

Endoscopic, expanded endonasal approaches to rostral anterior skull base lesions are feasible and hold great potential for decreased morbidity. The effectiveness and appropriate use of these techniques must be evaluated by close examination of outcomes as case series expand.

Abbreviations used in this paper:ACA = anterior cerebral artery; ACoA = anterior communicating artery; AEA = anterior ethmoidal artery; CA = carotid artery; CSF = cerebrospinal fluid; ICA = internal carotid artery; MR = magnetic resonance; OCR = opticocarotid recess; PEA = posterior ethmoidal artery; SIS = superior intercavernous sinus.

Object

Transsphenoidal approaches have been used for a century for the resection of pituitary and other sellar tumors. More recently, the standard endonasal approach has been expanded to provide access to other, parasellar lesions. With the addition of the endoscope, this expansion carries significant potential for the resection of skull base lesions.

Methods

The anatomical landmarks and surgical techniques used in expanded (extended) endoscopic approaches to the rostral, anterior skull base are reviewed and presented, accompanied by case illustrations of each segment (or module) of approach. The rostral half of the anterior skull base is divided into modules of approach: sellar/parasellar, transplanum/transtuberculum, and transcribriform. Case illustrations of successful resections of lesions with each module are presented and discussed.

Conclusions

Endoscopic, expanded endonasal approaches to rostral anterior skull base lesions are feasible and hold great potential for decreased morbidity. The effectiveness and appropriate use of these techniques must be evaluated by close examination of outcomes as case series expand.

Abbreviations used in this paper:ACA = anterior cerebral artery; ACoA = anterior communicating artery; AEA = anterior ethmoidal artery; CA = carotid artery; CSF = cerebrospinal fluid; ICA = internal carotid artery; MR = magnetic resonance; OCR = opticocarotid recess; PEA = posterior ethmoidal artery; SIS = superior intercavernous sinus.

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Article Information

Contributor Notes

Address reprint requests to: Amin B. Kassam, M.D., University of Pittsburgh School of Medicine, 203 Lothrop Street, Suite 500, Pittsburgh, Pennsylvania 15213. email: kassamab@upmc.edu.

© AANS, except where prohibited by US copyright law.

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