Endoscopic Orientation of the Parasellar Region in Sphenoid Sinus with Ill-Defined Bony Landmarks: An Anatomic Study

✓ A young man with a large sphenoid sinus mucocele developed hypopituitarism, headaches, and visual difficulties. Subsequently the lesion caused complete occlusion of both internal carotid arteries in the parasellar region. The headaches and visual difficulty improved after simple transoral drainage of the cyst.

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Anatomic Study with Computed Tomography of the Lateral Wall of the Sphenoid Sinus of Patients Assisted in Specialized Service of Otorhinolaryngology in Blumenau / SC

International Archives of Otorhinolaryngology ◽

10.1055/s-0034-1388695 ◽

2014 ◽

Vol 18 (S 01) ◽

Author(s):

Jan Socher ◽

João Silva ◽

Luis Ogliari ◽

Marina Schneider ◽

Paloma Lima ◽

...

Keyword(s):

Computed Tomography ◽

Sphenoid Sinus ◽

Lateral Wall ◽

Anatomic Study ◽

Specialized Service

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Variations on the Standard Transsphenoidal Approach to the Sellar Region, with Emphasis on the Extended Approaches and Parasellar Approaches: Surgical Experience in 105 Cases

Neurosurgery ◽

10.1227/01.neu.0000134287.19377.a2 ◽

2004 ◽

Vol 55 (3) ◽

pp. 539-550 ◽

Cited By ~ 329

Author(s):

William T. Couldwell ◽

Martin H. Weiss ◽

Craig Rabb ◽

James K. Liu ◽

Ronald I. Apfelbaum ◽

...

Keyword(s):

Carotid Artery ◽

Internal Carotid Artery ◽

Sphenoid Sinus ◽

Internal Carotid ◽

Prolonged Exposure ◽

Cranial Nerves ◽

Neurological Complications ◽

Transsphenoidal Approach ◽

Anterior Cranial Base ◽

Parasellar Region

Abstract OBJECTIVE: The traditional boundaries of the transsphenoidal approach may be expanded to include the region from the cribriform plate of the anterior cranial base to the inferior clivus in the anteroposterior plane, and laterally to expose the cavernous cranial nerves and the optic canal. We review our combined experience with these variations on the transsphenoidal approach to various lesions of the sellar and parasellar region. METHODS: From 1982 to 2003, we used the extended and parasellar transsphenoidal approaches in 105 patients presenting with a variety of lesions of the parasellar region. This study specifically reviews the breadth of pathological lesions operated and the complications associated with the approaches. RESULTS: Variations of the standard transsphenoidal approach have been used in the following series: 30 cases of pituitary adenomas extending laterally to involve the cavernous sinus, 27 craniopharyngiomas, 11 tuberculum/diaphragma sellae meningiomas, 10 sphenoid sinus mucoceles, 18 clivus chordomas, 4 cases of carcinoma of the sphenoid sinus, 2 cases of breast carcinoma metastatic to the sella, and 3 cases of monostotic fibrous dysplasia involving the clivus. There was no mortality in the series. Permanent neurological complications included one case of monocular blindness, one case of permanent diabetes insipidus, and two permanent cavernous cranial neuropathies. There were four cases of internal carotid artery hemorrhage, one of which required ligation of the cervical internal carotid artery and resulted in hemiparesis. The incidence of postoperative cerebrospinal fluid fistulae was 6% (6 of 105 cases). CONCLUSION: These modifications of the standard transsphenoidal approach are useful for lesions within the boundaries noted above, they offer excellent alternatives to transcranial approaches for these lesions, and they avoid prolonged exposure time and brain retraction. Technical details are discussed and illustrative cases presented.

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Quantitative Analysis of Exposure of Staged Orbitozygomatic and Retrosigmoid Craniotomies for Lesions of the Clivus with Supratentorial Extension

Operative Neurosurgery ◽

10.1227/01.neu.0000326013.99562.eb ◽

2008 ◽

Vol 62 (suppl_5) ◽

pp. ONS318-ONS324 ◽

Cited By ~ 4

Author(s):

Andrew S. Little ◽

Pakrit Jittapiromsak ◽

Neil R. Crawford ◽

Pushpa Deshmukh ◽

Mark C. Preul ◽

...

Keyword(s):

Quantitative Analysis ◽

Cranial Nerves ◽

Three Dimensional ◽

Petrous Bone ◽

Small Region ◽

Bony Landmarks ◽

Parasellar Region ◽

Staged Approach ◽

The Mean ◽

Formalin Fixed

Abstract Objective: A two-stage approach using orbitozygomatic (OZ) and retrosigmoid (RS) craniotomies is one option for the management of petroclival lesions with supratentorial extension. The goal of this study was to investigate the supratentorial and infratentorial exposures of the clivus obtained through this staged approach. Methods: Formalin-fixed, silicon-injected specimens underwent stereotactic imaging. Six paired OZ and RS craniotomies were performed. Neuronavigation was used to determine the areas and limits of exposure and to plot these areas on three-dimensional reconstructions of the skull base. Results: The mean area of exposure of the parasellar region and clivus through the OZ craniotomy was 640 ± 75 mm. Visualization of the parasellar region, cavernous sinus, and upper cranial nerves was achieved. The ventral brainstem corresponding to the cranial quarter of the clivus was visualized. The mean area of exposure of the clivus and petrous bone through the RS was 1930 ± 250 mm. In the cranial quarter of the clivus, there was a small region of overlap in exposure between the two craniotomies. The limits of exposure are described. Conclusion: OZ and RS craniotomies provide complementary exposure with limited redundancy. Significant visualization of the parasellar region, clivus, and surrounding bony landmarks is obtained. The primary limitation is exposure of the contralateral half of Zones II and III of the clivus. This strategy represents a reasonable option for accessing paracentral petroclival lesions with a supratentorial extension.

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NASOPHARYNGEAL ADMANTINOMATOUS CRANIOPHARYNGIOMA IN 14 YEARS OLD BOY- A CASE REPORT STUDY

Era s journal of medical research ◽

10.24041/ejmr2020.43 ◽

2020 ◽

Vol 7 (2) ◽

pp. 251-253

Author(s):

Kshama Tiwari ◽

Parul Gupta ◽

Sumaiya Irfan ◽

Noorin Zaidi ◽

Sharique Ahmad ◽

...

Keyword(s):

Sphenoid Sinus ◽

Cystic Mass ◽

Mass Lesion ◽

Excision Biopsy ◽

Imaging Characteristics ◽

Parasellar Region ◽

Epithelial Tumours ◽

Well Differentiated ◽

Microscopic Findings ◽

Sellar Floor

Craniopharyngiomas are rare benign epithelial tumours arising from the pituitary stalk or gland. The sellar and parasellar region is the most commonly involved sites but at times tumors extend below the sellar floor involving the sphenoid sinus, invade the pharynx and reach upto the nasal cavities. Here is a case of 14 years old boy presenting with nasal cavity mass leading to bilateral obstruction and he was operated to excise the mass lesion. Grossly a grayish white cystic mass lesion was obtained after excision biopsy. On cut section, cyst contained a greyish brown thick liquid like material, with the microscopic findings of densely packed nodules of well differentiated epithelium along with stellate reticulum and wet keratin consistent with the diagnosis of craniopharyngioma. Clinical features along with imaging characteristics (except site of the lesion) and histopathological findings were all consistent with primary admantinomatous craniopharyngioma,

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Supraorbital vs Endo-Orbital Routes to the Lateral Skull Base: A Quantitative and Qualitative Anatomic Study

Operative Neurosurgery ◽

10.1093/ons/opx256 ◽

2018 ◽

Vol 15 (5) ◽

pp. 567-576 ◽

Cited By ~ 1

Author(s):

Alberto Di Somma ◽

Norberto Andaluz ◽

Luigi Maria Cavallo ◽

Jeffrey T Keller ◽

Domenico Solari ◽

...

Keyword(s):

Middle Cranial Fossa ◽

Anatomic Study ◽

Bone Removal ◽

Lateral Skull Base ◽

Supraorbital Approach ◽

Parasellar Region ◽

Surgical Application ◽

Cranial Fossa ◽

Stage 1 ◽

Orbital Rim

Abstract BACKGROUND Various extensions of the supraorbital approach reach the lateral and parasellar middle cranial fossa regions by removing the orbital rim and greater/lesser sphenoid wings. Recent proposals of a purely endoscopic ventral transorbital pathway to these regions heighten the need to compare these surgical windows. OBJECTIVE To detail the lateral and parasellar middle cranial fossa regions and quantify exposures by 2 surgical windows (transcranial and transorbital) through anatomic study. METHODS In 5 cadaveric specimens (10 sides), dissections consisted of 3 stages: stage 1 began with the supraorbital approach via the eyebrow; stage 2, endo-orbital approach via the superior eyelid, continued with removal of lesser and greater sphenoid wings; and stage 3, extended supraorbital, re-evaluated the gains of stage 2 from the perspective of stage 1. Operative working areas were quantified in Sylvian, anterolateral temporal, and parasellar regions; bone removal volumes were measured at each stage (nonpaired Student t-test). RESULTS Visualization into the anterolateral temporal and Sylvian areas, though varied in perspective, were comparable with either eyelid or transcranial routes. Compared with transcranial views through a supraorbital window, the eyelid approach significantly increased exposure in the parasellar region with wider angle of attack (P < .01) and achieved comparable bone removal volumes. CONCLUSION Stage 2’s unique anatomic view of the lateral and parasellar middle cranial fossa regions paves the way for possible surgical application to select pathologies typically treated via transcranial approaches. Disadvantages may be the surgeon's unfamiliarity with the anatomy of this purely endoscopic, ventral route and difficulties of dural and orbital repair.

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