Giuliano Silveira-Bertazzo1,2, Sunil Manjila3, Ricardo L Carrau1,4, Daniel M Prevedello5,6. 1. Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, OH, USA. 2. Department of Neurological Surgery, University of Joinville Region, and Neurological and Neurosurgical Clinic of Joinville, Joinville, SC, Brazil. 3. Department of Neurological Surgeryand Neck Surgery, McLaren Hospital, Bay Region, Bay City, MI, USA. 4. Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Medical Center, Columbus, OH, USA. 5. Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, OH, USA. dprevedello@gmail.com. 6. Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Medical Center, Columbus, OH, USA. dprevedello@gmail.com.
Abstract
BACKGROUND: Expanded endonasal approaches can provide direct access to the midline skull base from the anterior cranial fossa to the ventral foramen magnum. Surgical strategies of bone drilling, dural opening, and intradural dissection can determine the area of surgical exposure and instrument handling, affecting the safety of devascularizing/debulking suprasellar tumors. METHODS: We describe an expanded endoscopic endonasal approach for suprasellar lesions, with stepwise image-guided dissections highlighting surgical pearls and pitfalls to enhance surgical safety. This article presents transnasal intra-third-ventricular anatomy from trans-tuber cinereum, and trans-lamina terminalis approaches, comparing subchiasmatic and suprachiasmatic trajectories. CONCLUSION: The rostral extension via endoscopic endonasal transsellar-transtubercular-transplanum approaches can provide a safe and feasible route for suprasellar lesions, in subchiasmatic, suprachiasmatic, and intraventricular regions.
BACKGROUND: Expanded endonasal approaches can provide direct access to the midline skull base from the anterior cranial fossa to the ventral foramen magnum. Surgical strategies of bone drilling, dural opening, and intradural dissection can determine the area of surgical exposure and instrument handling, affecting the safety of devascularizing/debulking suprasellar tumors. METHODS: We describe an expanded endoscopic endonasal approach for suprasellar lesions, with stepwise image-guided dissections highlighting surgical pearls and pitfalls to enhance surgical safety. This article presents transnasal intra-third-ventricular anatomy from trans-tuber cinereum, and trans-lamina terminalis approaches, comparing subchiasmatic and suprachiasmatic trajectories. CONCLUSION: The rostral extension via endoscopic endonasal transsellar-transtubercular-transplanum approaches can provide a safe and feasible route for suprasellar lesions, in subchiasmatic, suprachiasmatic, and intraventricular regions.
Entities:
Keywords:
Cranial base; Endonasal; Endoscopic; Suprasellar; Third ventricle; Transplanum; Transtuberculum