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Amin B. Kassam, Paul A. Gardner, Arlan Mintz, Carl H. Snyderman, Ricardo L. Carrau and Michael Horowitz

clip access to the proximal ICA was confirmed ( Fig. 5 ). A transplanum exposure of the paraclinoidal carotid artery in the opticocarotid cistern provided distal control ( Fig. 6 ). F ig . 3. Endoscopic view of the initial exposure after a wide sphenoidotomy was performed. PCP = paraclival carotid protuberance; pl = planum sphenoidale; tub = tuberculum sellae. F ig . 4. Endoscopic view of the left paraclival segment of the ICA exposed to obtain proximal control. CR = clival recess. F ig . 5. Endoscopic view of proximal control. Potential

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Amin B. Kassam, Paul A. Gardner, Carl H. Snyderman, Ricardo L. Carrau, Arlan H. Mintz and Daniel M. Prevedello

identified. A critical anatomical landmark is the osseous indentation or recess that is formed at the medial junction of the parasellar carotid canal (traveling vertically) and the optic canal (traveling obliquely in an anterior to posterior direction, away from the orbit). This mOCR represents the indentation or pneumatization of the middle clinoid and lateral portions of the tuberculum sellae, as viewed from the sinuses. The middle, or medial, clinoids form the lateral border of the anterior sella. 1 , 17 The prominence of the mOCR as seen from the endonasal side will

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Paul A. Gardner, Daniel M. Prevedello, Amin B. Kassam, Carl H. Snyderman, Ricardo L. Carrau and Arlan H. Mintz

. Laryngoscope 106 : 914 – 918 , 1996 6 Chakrabarti I , Amar AP , Couldwell W , Weiss MH : Long-term neurological, visual, and endocrine outcomes following transnasal resection of craniopharyngioma . J Neurosurg 102 : 650 – 657 , 2005 7 Cohen-Gadol AA , Liu JK , Laws ER Jr : Cushing's first case of transsphenoidal surgery: the launch of the pituitary surgery era . J Neurosurg 103 : 570 – 574 , 2005 8 Cook SW , Smith Z , Kelly DF : Endonasal transsphenoidal removal of tuberculum sellae meningiomas: technical note . Neurosurgery

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Luigi M. Cavallo, Daniel M. Prevedello, Domenico Solari, Paul A. Gardner, Felice Esposito, Carl H. Snyderman, Ricardo L. Carrau, Amin B. Kassam and Paolo Cappabianca

the advantage of facing the tumor immediately after the dural opening without brain retraction, and optimizes visualization of the relevant anatomy through a straight surgical route. 42 Indeed, such a corridor seems even more attractive in recurrent tumors in patients with previous craniotomies, in whom it is a virgin route, providing the possibility of bypassing adherences and avoiding further brain manipulation ( Fig. 1 ). F ig . 1. Schematic drawing of the suprasellar area as observed from a transcranial pterional approach. The tuberculum sellae and the

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Amin B. Kassam, Daniel M. Prevedello, Ricardo L. Carrau, Carl H. Snyderman, Ajith Thomas, Paul Gardner, Adam Zanation, Bulent Duz, S. Tonya Stefko, Karin Byers and Michael B. Horowitz

Table 3 ). TABLE 2: Median sagittal plane EEAs * Module Corridor Anatomical Boundary Cistern Neurovascular Structures Key Anatomical Landmark Common Pathology transsellar sphenoid & pst ethmoid SIS to IIS, cavernous to cavernous subdiaphragmatic & suprasellar carotid siphon; medial cavernous sinus; CNs III, IV, & VI; optic chiasm tuberculum sellae, sellar floor, “4 blues” SIS to IIS & cavernous sinuses RCC, pituitary adenoma transplanum sphenoid & pst ethmoid pst ethmoidal artery, sella pst, optic

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Ricardo L. L. Dolci, Leo F. S. Ditzel Filho, Carlos R. Goulart, Smita Upadhyay, Lamia Buohliqah, Paulo R. Lazarini, Daniel M. Prevedello and Ricardo L. Carrau

area around the QS in more detail; the sympathetic nerve fibers running with the paraclival segment of the ICA are visible, leaving it to join to the abducens nerve. CNII = optic nerve; iMS = impression of maxillary strut; iQSS = impression of QS strut; LOCR = lateral opticocarotid recess; LRSS = lateral recess of sphenoid sinus; QSS = QS strut; SF = sympathetic fibers; SS = sphenoid sinus; TS = tuberculum sellae; VC = vidian canal. Our study used the ICA angle classification scheme proposed by Cebula et al., 6 which categorizes the angle between the parasellar and

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André Beer-Furlan, Ali O. Jamshidi, Ricardo L. Carrau and Daniel M. Prevedello

craniopharyngiomas Types I and II. The approach consists in a focused bone removal of the tuberculum sellae and only the posterior part of the planum sphenoidale. There is no need to extend the planum sphenoidale bone opening anteriorly because the surgical corridor used is below the optic chiasm and above the pituitary gland. Bone drilling and removal of the medial opticocarotid recess is performed in all cases to maximize latero-lateral exposure and to facilitate maneuverability of surgical instruments and microsurgical dissection. Likewise, the rostrum and floor of the sella

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Andrew Conger, Fan Zhao, Xiaowen Wang, Amalia Eisenberg, Chester Griffiths, Felice Esposito, Ricardo L. Carrau, Garni Barkhoudarian and Daniel F. Kelly

craniopharyngiomas ( Figs. 2 and 5 ) or tuberculum sellae meningiomas, the fat is placed directly in the sellar and/or supraglandular space with care taken not to injure the superior hypophyseal arteries or infundibulum, which are frequently in the surgical field. In patients undergoing resection of clival chordomas or other clival lesions with intradural extension, fat is gently placed against the brainstem. Fat placement should fill the dead space but not create undue mass effect upon the optic apparatus or brainstem. Next, collagen sponge is placed over the dural defect

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Ali O. Jamshidi, André Beer-Furlan, Daniel M. Prevedello, Ronald Sahyouni, Mohamed A. Elzoghby, Mina G. Safain, Ricardo L. Carrau, John A. Jane Jr. and Edward R. Laws

“retrochiasmatic.” 8 Prechiasmatic tumors can displace the optic chiasm and the anterior cerebral artery complex superiorly and posteriorly. Retrochiasmatic masses grow toward the third ventricle and displace the chiasm anteriorly against the tuberculum sellae. Other than describing their location, these classifications imply corresponding surgical approaches. For example, prechiasmatic tumors are traditionally removed via a pterional approach or a variation of the frontotemporal orbital craniotomy. For craniopharyngiomas that expand the sella and are primarily located in the