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Paolo Cappabianca, Luigi M. Cavallo, Felice Esposito and Enrico De Divitiis

with the report of Gardner et al. They point out the crucial role of the endoscope in the transsphenoidal management of suprasellar skull base lesions in that there are no limitations created by the transsphenoidal speculum. Even more central is the importance they attribute to the perfect knowledge of the once-unfamiliar anatomy of the approach and the relevance of the team strategy to add competences to open and go along well new surgical tasks. Gardner and associates describe 16 adult patients harboring craniopharyngiomas located above the sella, superior and

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Enrico de Divitiis, Felice Esposito, Paolo Cappabianca, Luigi M. Cavallo, Oreste de Divitiis and Isabella Esposito

surgery in which 2 surgeons work through both nostrils, with 2 or 3 instruments plus the endoscope, alternately held by 1 of the surgeons, since it needs to be continuously moved to look around corners during the entire procedure to gain the sense of depth. Kassam and his team from Pittsburgh 27–29 provided the guidelines for performing extended endoscopic endonasal surgery for the management of skull base lesions and systematized such surgical strategies along the coronal and sagittal planes according to strict anatomical principles. Basic Module This first step

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Salvatore Di Maio, Luigi M. Cavallo, Felice Esposito, Vita Stagno, Olga Valeria Corriero and Paolo Cappabianca

of patients either had undergone previous surgery (or radiation) and had significant scar/fibrous tissue formation or had tumors with morphological characteristics (hourglass shape with competent diaphragma sellae, large suprasellar components) that would otherwise render standard transsphenoidal removal difficult. The extended endonasal transsphenoidal approach, with microscopic and/or endoscopic visualization, has become well established in a number of surgical centers, and is used with expanding indications for a variety of midline skull base lesions. 4 , 6