Expanded Endoscopic Endonasal Transtuberculum / Transplanum Approach to the Suprasellar Area: A Stepwise Approach

Cavalcante, Rodrigo; Marques, Rômulo Alberto Silva; Santos, Vinícius Gonçalves dos; Nunes, Renato Mariano; Scopel, Tiago Fernando; Zaccariotti, Vladimir Arruda; Arruda, João; Fernandes, Yvens Barbosa

doi:10.1055/s-0036-1579755

Cited by 1 publication

(1 citation statement)

References 20 publications

(16 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…41 43 If lesions have a marked suprasellar spread – including large pituitary macroadenomas, craniopharyngiomas, and tuberculum-planum meningiomas (Cases 3, 4) – extension through the prechiasmatic sulcus is paramount, with consideration of a transplanum adjunct. 44 A key aspect in affording adequate visualization of neurovascular structures in any of the aforementioned suprasellar extensions is the removal of prechiasmatic sulcus, whose description has been often neglected in the anatomical description of approaches, and often included in the description of transtuberculum or transplanum approaches. The prechiasmatic sulcus exposure constitutes the main window to the suprasellar extensions.…”

Section: Discussionmentioning

confidence: 99%

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Endoscopic Endonasal Approach to the Sellar and Parasellar Regions

Agosti

Alexander

Leonel

et al. 2022

J Neurol Surg B Skull Base

View full text Add to dashboard Cite

Introduction: Surgery of the sellar and parasellar regions can be challenging due to the complexity of the neurovascular relationships. The main goal of this study is to develop an educational resource to help trainees understand the pertinent anatomy and procedural steps of the endoscopic endonasal approaches (EEAs) to the sellar and parasellar regions. Methods: Ten formalin-fixed latex-injected specimens were dissected. Endoscopic endonasal transsphenoidal transsellar, transtuberculum-transplanum, and transcavernous approaches were performed by a neurosurgery trainee, under supervision from the senior authors and a PhD in anatomy with advanced neuroanatomy experience. Dissections were supplemented with representative case applications. Results: Endoscopic endonasal transsphenoidal approaches afford excellent direct access to sellar and parasellar regions. After a wide sphenoidotomy, a limited sellar osteotomy opens the space to sellar region and medial portion of the cavernous sinus. To reach the suprasellar space (infrachiasmatic and suprachiasmatic corridors), a transplanum-prechiasmatic sulcus- transtuberculum adjunct is needed. The transcavernous approach gains access to the contents of the cavernous sinus and both medial (posterior clinoid and interpeduncular cistern) and lateral structures of the retrosellar region. Conclusion: The anatomical understanding and technical skills required to confidently remove skull base lesions with EEAs are traditionally gained after years of specialized training. We comprehensively describe EEAs to sellar and parasellar regions for trainees to build knowledge and improve familiarity with these approaches and facilitate comprehension and learning in both the surgical anatomy laboratory and the operating room.

show abstract

Section: Discussionmentioning

confidence: 99%