Parasellar region

The area immediately around the pituitary, the sellar region and parasellar region, is an anatomically complex area that represents a crucial crossroads for important adjacent structures.

The parasellar region is not clearly delineated and includes all the structures that surround the sella turcica.

Vital structures such as the brain parenchyma, meninges, visual pathways and other cranial nerves, major blood vessels, hypothalamopituitary system (HPS) and bony compartments may be involved.

A diversity of clinical symptoms and signs can develop from a number of neoplastic, inflammatory, infectious, developmental and vascular.

pituitary neuroendocrine tumor, pituitary apoplexy, craniopharyngioma, Rathke's cleft cyst, lymphocytic hypophysitis, and other parasellar lesions ¹⁾.

By drilling off the suprameatal tubercle and part of the petrous apex, Meckel's cave may be opened, the trigeminal nerve mobilized, and the tentorium divided. Thus the parasellar region may be exposed and the posterosuperior space of the cavernous sinus approached. Using an endoscope-assisted technique and following cisternal anatomy, the sellar and parasellar region may be explored even if the working space is narrow. The retrosigmoid intradural suprameatal approach provides optimal accessibility to medially located central skull base structures, in particular to the posterior part of the cavernous sinus. Use of the endoscope may remarkably optimize the accessibility ²⁾.