Extended endoscopic endonasal transtuberculum sellae approach [Neurosurgery Wiki]

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====== Extended endoscopic endonasal transtuberculum sellae approach ======

see also [[Extended endoscopic endonasal transsphenoidal approach]].
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The Extended endoscopic endonasal transtuberculum sellae approach represents a versatile route for the treatment of [[sella]]r/[[suprasellar]] pathologies. Although, sizeable extrasellar pituitary tumors still pose a threat due to displacement/encasement of surrounding structures, necessitating accurate knowledge of correlative operative anatomy with traditional landmarks. Complete resection of extrasellar components is essential to avoid postoperative [[apoplexy]].

The nuances of this [[technique]] have rendered a safe, direct, and feasible ventral corridor for the treatment of extending [[suprasellar]] pathologies. A study of Silveira-Bertazzo et al. illustrates surgical [[landmark]]s and strategies of paramount importance for [[complication]]s avoidance, which can be used to remove large pituitary neuroendocrine tumors with suprasellar extension. Special references to cadaveric dissections highlight anatomical landmarks and surgical key points for complications avoidance
((Silveira-Bertazzo G, Albonette-Felicio T, Carrau RL, Prevedello DM. Surgical anatomy and nuances of the extended endoscopic endonasal transtuberculum sellae approach: pearls and pitfalls for complications avoidance. Acta Neurochir (Wien). 2020 Nov 6. doi: 10.1007/s00701-020-04625-x. Epub ahead of print. PMID: 33156946.)).

===== Case reports =====
A 64-year-old woman with progressive bilateral [[vision loss]], including [[visual acuity]] deficits and [[bitemporal hemianopsia]]. MRI revealed a 2-cm [[tuberculum sellae meningioma]] causing optic apparatus compression. An extended endoscopic endonasal transtuberculum approach was utilized for gross-total resection, including microdissection of tumor from the [[optic chiasm]] and [[infundibulum]]. The closure was performed with multilayer tensor [[fascia lata]] autograft and a pedicled nasal-septal flap. The patient's postoperative exam showed visual improvement and normal [[pituitary gland function]] function. The [[video]] can be found in: https://youtu.be/ZfNB_rhlyeI.

===== Literature =====

Laufer I, Anand VK, Schwartz TH. Endoscopic, endonasal extended transsphenoidal, [[transplanum transtuberculum approach]] for resection of [[suprasellar lesion]]s. J Neurosurg. 2007;106:400–6. 

Kassam AB, Gardner PA, Snyderman CH, Carrau RL, Mintz AH, Prevedello DM. Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline [[suprasellar]] [[craniopharyngioma]]s: A new classification based on the infundibulum. J Neurosurg. 2008;108:715–28. 

Cavallo LM, Frank G, Cappabianca P, Solari D, Mazzatenta D, Villa A, et al. The [[endoscopic endonasal approach]] for the management of [[craniopharyngioma]]s: A series of 103 patients. J Neurosurg. 2014;121:100–13. 

Sankhla SK, Jayashankar N, Khan GM. Surgical management of selected [[pituitary macroadenoma]]s using [[extended endoscopic endonasal transsphenoidal approach]]: Early experience. Neurol India. 2013;61:122–30. 

Conger AR, Lucas J, Zada G, Schwartz TH, Cohen-Gadol AA. Endoscopic extended transsphenoidal resection of craniopharyngiomas: Nuances of neurosurgical technique. Neurosurg Focus. 2014;37:E10.