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

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.

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Surgical nuances for the endoscopic endonasal transpterygoid approach to lateral sphenoid sinus encephaloceles

Neurosurgical FOCUS ◽

10.3171/2012.3.focus1267 ◽

2012 ◽

Vol 32 (6) ◽

pp. E5 ◽

Cited By ~ 30

Author(s):

Richard F. Schmidt ◽

Osamah J. Choudhry ◽

Joseph Raviv ◽

Soly Baredes ◽

Roy R. Casiano ◽

...

Keyword(s):

Skull Base ◽

Sphenoid Sinus ◽

Skull Base Surgery ◽

Surgical Anatomy ◽

Endoscopic Endonasal ◽

Csf Rhinorrhea ◽

Lateral Recess ◽

Sternberg Canal ◽

Deep Location ◽

Repair Techniques

Lateral sphenoid encephaloceles of the Sternberg canal are rare entities and usually present with spontaneous CSF rhinorrhea. Traditionally, these were treated via transcranial approaches, which can be challenging given the deep location of these lesions. However, with advancements in endoscopic skull base surgery, including improved surgical exposures, angled endoscopes and instruments, and novel repair techniques, these encephaloceles can be resected and successfully repaired with purely endoscopic endonasal approaches. In this report, the authors review the endoscopic endonasal transpterygoid approach to the lateral recess of the sphenoid sinus for repair of temporal lobe encephaloceles, including an overview of the surgical anatomy from an endoscopic perspective, and describe the technical operative nuances and surgical pearls for these cases. The authors also present 4 new cases of lateral sphenoid recess encephaloceles that were successfully treated using this approach.

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Bone Removal With a New Ultrasonic Bone Curette During Endoscopic Endonasal Approach to the Sellar-Suprasellar Area: Technical Note

Operative Neurosurgery ◽

10.1227/01.neu.0000365929.26699.02 ◽

2010 ◽

Vol 66 (suppl_1) ◽

pp. ons-E118-ons-E118 ◽

Cited By ~ 7

Author(s):

Paolo Cappabianca ◽

Luigi M. Cavallo ◽

Isabella Esposito ◽

Mohamed Barakat ◽

Felice Esposito

Keyword(s):

Skull Base ◽

Skull Base Surgery ◽

Technical Note ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Bone Removal ◽

Hand Piece ◽

Skull Base Lesions ◽

Neurovascular Structures

Abstract Background: Accessing intradural lesions via an extended endoscopic endonasal approach requires a relatively large bony removal over the skull base. Objective: We describe the Sonopet ultrasonic bone curette with a new dedicated endonasal hand-piece. Materials and Methods: We used this ancillary device in 27 nonconsecutive endonasal procedures for different skull base lesions (18 standard pituitary operations and 9 extended approaches for either meningiomas or craniopharyngiomas). Results: The ultrasonic bone curette with endonasal hand-piece was easy to use and effective during the removal of the bone covering or when close to the carotid and optic prominences, as well as in preserving the integrity of the superior intercavernous sinus. In only 1 case was small tearing of the dura mater observed during the bony removal. No cases of injury to the major neurovascular structures occurred. Conclusion: The Sonopet ultrasonic bone curette is a useful tool during endoscopic endonasal skull base surgery.

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