Endoscopic anatomy of the approaches to the sellar area and planum sphenoidale

Abstract

The productive work between otolaryngologists and neurosurgeons has resulted in the emergence of endoscopic endonasal skull base surgery. The goal of the present study is to describe the endoscopic anatomy of the endonasal approach to the sellar region and planum sphenoidale, highlighting the key points of the surgical approach and the neurovascular landmarks. Method: Descriptive study of the endoscopic endonasal dissection of 9 fresh cadavers with exposure of the anatomic structures. Results: The endoscopic endonasal ethmoidectomy and sphenoidotomy allows an expanded access to the sellar area and planum sphenoidale. The surface anatomy of the sphenoid sinus is easily identifiable and provides safe landmarks, guiding the intracranial dissection. Conclusion: The endoscopic endonasal approach to the skull base by the ENT and neurosurgeon is feasible, but it requires adequate anatomical knowledge and endoscopic skills for its realization, which can be obtained by practicing in cadavers. Key words: anatomy, skull base, endoscopic surgery, sphenoid sinus.Anatomia endoscópica do acesso à região selar e plano esfenoidal RESUMO O trabalho cooperativo entre otorrinolaringologistas e neurocirurgiões resultou no aprimo ramento das técnicas cirúrgicas e no surgimento da cirurgia endoscópica endonasal da base do crânio. O estudo tem como objetivo descrever a anatomia endoscópica do acesso endonasal da região selar e plano esfenoidal, destacando os pontos fundamentais do acesso cirúrgico e referências neurovasculares. Método: Estudo descritivo da dissecção endoscópica endonasal de 9 cadáveres frescos com exposição das estruturas anatômicas. Resultados: A etmoidectomia e esfenoidotomia endonasal endoscópica permite um acesso estendido à região selar e plano esfenoidal. A anatomia de superfície do seio esfenoidal é facilmente identificada e fornece pontos de referência seguros, guiando a dissecção intracraniana. Conclusão: O acesso endoscópico endonasal para a base do crânio pelo otorrinolaringologista e neurocirurgião é perfeitamente viável, mas para isso o conhecimento anatômico da região e de seus pontos de referência é essencial, o que pode ser obtido pelo treinamento em cadáveres. Palavras-chave: anatomia, base do crânio, procedimentos cirúrgicos endoscópicos, seio esfenoidal. CorrespondenceHenrique Faria Ramos Rua Capote Valente 188 / ap 91 05409-000 São Paulo SP -Brasil

Study of the relationship between sphenoid sinus volume and protrusions in the sphenoid sinus

“…Anatomical and radiological studies dealt with the sphenoid sinus and its surrounding structures based on cadavers or CT studies in these years. Several literatures have documented the dimensions, septation, pattern of SS pneumatization, SS surrounding structures [3][4][5], prevalence of protrusions [6] and the relation between pneumatization and protrusions [7]. These studies provided important information for surgeries in this area and promoted advancement of the surgery as well.…”

Endoscopic sphenoid sinus anatomy in View of Transsphenoidal Surgery: Standardized Way-point Cadaver Dissection

“…Sphenoid sinus is extremely variable in size and degree of pneumatization, for this the bony landmarks of the sphenoid sinus may be prominent, inappreciable or absent [45] . It is easier to identify the bony protuberances and depressions inside the well-peumatized sinuses [41], [46] .…”

Rhino-Neurochirurgie

“…Im Anschluss kann die Hypophyse zeitweise nach suprasellär in die prächiasmatische Zisterne geschoben werden. Nach Entfernen der Sella-Rückwand und der Processus clinoidei posteriores wird die Fossa interpeduncularis erreicht [228,411]…”

“…u.) ausgeführt -eine vorsorgliche Kauterisation der A. sphenopalatina muss unterbleiben[18,56,60,63,85,89,112,119,120,134,135,137,188,203,307,308,321,331,339,344,349,356,[404][405][406][407][408][409][410][411][412]. Es kann im Einzelfall hilfreich sein, erste Schritte wie z.…”