Extended endoscopic endonasal transtuberculum sellae approach
see also Extended endoscopic endonasal transsphenoidal approach.
The Extended endoscopic endonasal transtuberculum sellae approach represents a versatile route for the treatment of sellar/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 landmarks and strategies of paramount importance for complications 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 1).
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 lesions. 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 craniopharyngiomas: 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 craniopharyngiomas: A series of 103 patients. J Neurosurg. 2014;121:100–13.
Sankhla SK, Jayashankar N, Khan GM. Surgical management of selected pituitary macroadenomas 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.