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Extended endoscopic endonasal approach to the suprasellar parachiasmatic cisterns: anatomic study

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Abstract

Objective

The objective of this study is to recognize the available endoscopic routes during approaches to the suprasellar region and the surgical endoscopic anatomy of the related neurovascular structures.

Material and methods

Extended endoscopic endonasal approach to the suprasellar region (EEASR) through the planum sphenoidale was performed in five fresh adult cadavers. The anatomic characteristics of the suprasellar parachiasmatic cisterns were studied and documented following the resection of the planum sphenoidale and opening the dura to expose the anterior incisural space.

Results

Two separate surgical corridors could be used during EEASR: one above and the other below the chiasm. The suprachiasmatic route exposed the gyrus recti, interhemispheric fissure, anterior cerebral artery complex, the lamina terminalis, and through this structure the anterior recess of the third ventricle. The subchiasmatic route exposed the pituitary stalk, superior hypophyseal artery, supraclinoidal internal carotid artery, origin of the ophthalmic artery, anterior choroidal artery, posterior communicating artery, uncus, optic tract, basilar artery and its bifurcation, pons, posterior cerebral artery, superior cerebellar artery, and oculomotor nerve.

Conclusion

The EEASR, a minimally invasive route to suprasellar parachiasmatic area, provided wide exposure of the basal cisterns. The surgical areas that were accessed through the subchiasmatic corridor could be divided into a medial part that included the interpeduncular and prepontine cisterns and a lateral part that contained carotid and sylvian cisterns superiorly and the crural and ambient cisterns inferiorly.

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References

  1. Abuzayed B, Tanriover N, Gazioglu N, Eraslan BS, Akar Z (2009) Endoscopic endonasal approach to the orbital apex and medial orbital wall: anatomic study and clinical applications. J Craniofac Surg 20(5):1594–1600

    Article  PubMed  Google Scholar 

  2. Abuzayed B, Tanriover N, Gazioglu N, Kafadar AM, Akar Z (2010) Endoscopic anatomy of the oculomotor nerve: defining the blind spot during endoscopic skull base surgery. Childs Nerv Syst 26(5):689–696

    Article  PubMed  Google Scholar 

  3. Abuzayed B, Tanriover N, Gazioglu N, Ozlen F, Cetin G, Akar Z (2010) Endoscopic anatomy and approaches of the cavernous sinus: cadaver study. Surg Radiol Anat 32:499–508. doi:10.1007/s00276-010-0651-3

    Article  PubMed  Google Scholar 

  4. Abuzayed B, Tanriover N, Gazioglu N, Sanus GZ, Ozlen F, Biceroglu H, Kafadar AM, Eraslan BS, Akar Z (2010) Endoscopic endonasal anatomy and approaches to the anterior skull base: a neurosurgeon's viewpoint. J Craniofac Surg 21(2):529–537

    Article  PubMed  Google Scholar 

  5. Abuzayed B, Tanriöver N, Ozlen F, Gazioğlu N, Ulu MO, Kafadar AM, Eraslan B, Akar Z (2009) Endoscopic endonasal transsphenoidal approach to the sellar region: results of endoscopic dissection on 30 cadavers. Turk Neurosurg 19(3):237–244

    PubMed  Google Scholar 

  6. Alfieri A, Jho HD (2001) Endoscopic endonasal approaches to the cavernous sinus: surgical approaches. Neurosurgery 49:354–362

    Article  CAS  PubMed  Google Scholar 

  7. Apuzzo ML, Heifetz MD, Weiss MH, Kurze T (1977) Neurosurgical endoscopy using the side viewing telescope. J Neurosurgery 46:398–400

    Article  CAS  Google Scholar 

  8. Baskin DS, Wilson CB (1986) Surgical management of craniopharyngioma. A review of 74 cases. J Neurosurg 65:22–27

    Article  CAS  PubMed  Google Scholar 

  9. Cappabianca P, Alfieri A, de Divitiis E (1998) Endoscopic endonasal transsphenoidal approach to the sella: towards functional endoscopic pituitary surgery (FEPS). Minim Invasive Neurosurg 41:66–73

    Article  CAS  PubMed  Google Scholar 

  10. Cappabianca P, Cavallo LM, Colao A, Del Basso De Caro M, Esposito F, Cirillo S, Lombardi G, de Divitiis E (2002) Endoscopic endonasal transsphenoidal approach: outcome analysis of 100 consecutive procedures. Minim Invasive Neurosurg 45:1–8

    Article  Google Scholar 

  11. Cappabianca P, Cavallo LM, Mariniello G, de Divitiis O, Romero AD, de Divitiis E (2001) Easy sellar reconstruction in endoscopic endonasal transsphenoidal surgery with polyester-silicone dural substitute and fibrin glue: technical note. Neurosurgery 49:473–475

    Article  CAS  PubMed  Google Scholar 

  12. Cappabianca P, Frank G, Pasquini E, de Divitiis O, Calbucci F (2003) Extended endoscopic endonasal transsphenoidal approaches to the suprasellar region, planum sphenoidale and clivus. In: de Divitiis E, Cappabianca P (eds) Endoscopic endonasal transsphenoidal surgery. Springer, New York, pp 176–187

    Google Scholar 

  13. Carmel P (1993) Craniopharyngioma: transcranial approaches. In: Apuzzo MLJ (ed) Brain surgery: complication avoidance and management, vol 1. Churchill Livingstone, New York, pp 339–356

    Google Scholar 

  14. Carrau RL, Jho HD, Ko Y (1996) Transnasal–transsphenoidal endoscopic surgery of the pituitary gland. Laryngoscope 106:914–918

    Article  CAS  PubMed  Google Scholar 

  15. Catapano D, Sloffer CA, Frank G, Pasquini E, D'Angelo VA, Lanzino G (2006) Comparison between the microscope and endoscope in the direct endonasal extended transsphenoidal approach: anatomical study. J Neurosurg 104:419–425

    Article  PubMed  Google Scholar 

  16. Cavallo LM, Cappabianca P, Galzio R, Iaconetta G, de Divitiis E, Tschabitscher M (2005) Endoscopic transnasal approach to the cavernous sinus versus transcranial route: anatomical study. Neurosurgery 56(Suppl 2):379–389

    Article  PubMed  Google Scholar 

  17. Cavallo LM, de Divitiis E, Aydin S, Messina A, Esposito F, Laconetta G, Talat K, Cappabianca P, Tschabitscher M (2007) Extended endoscopic endonasal transsphenoidal approach to the suprasellar area: anatomic considerations—part 1. Neurosurgery 61:24–34

    Article  PubMed  Google Scholar 

  18. Cavallo LM, Messina A, Cappabianca P, Esposito F, de Divitiis E, Gardner P, Tschabitscher M (2005) Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations. Neurosurg Focus 19(1):E2

    PubMed  Google Scholar 

  19. Chakrabarti I, Amar AP, Couldwell W, Weiss MH (2005) Long-term neurological, visual, and endocrine outcomes following transnasal resection of craniopharyngioma. J Neurosurg 102:650–657

    Article  PubMed  Google Scholar 

  20. Couldwell WT, Weiss MH, Rabb C, Liu JK, Apfelbaum RI, Fukushima T (2004) 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 55:539–550

    Article  PubMed  Google Scholar 

  21. de Divitiis E, Cappabianca P (2002) Endoscopic endonasal transsphenoidal surgery. In: Pickard JD (ed) Advances and technical standards in neurosurgery, vol 27. Springer, New York, pp 137–177

    Google Scholar 

  22. de Divitiis E, Cappabianca P, Cavallo LM (2002) Endoscopic transsphenoidal approach: adaptability of the procedure to different sellar lesions. Neurosurgery 51:699–707

    Article  PubMed  Google Scholar 

  23. de Divitiis E, Cappabianca P, Cavallo LM, Esposito F, de Divitiis O, Messina A (2007) Extended endoscopic transsphenoidal approach for extrasellar craniopharyngiomas. Neurosurgery 61(5 Suppl 2):219–227

    Article  PubMed  Google Scholar 

  24. de Divitiis E, Cavallo LM, Cappabianca P, Esposito F (2007) Extended endoscopic endonasal transsphenoidal approach for the removal of suprasellar tumors: part 2. Neurosurgery 60:46–59

    PubMed  Google Scholar 

  25. Doglietto F, Prevedello DM, Jane JA Jr, Han J, Laws ER Jr (2005) Brief history of endoscopic transsphenoidal surgery—from Philipp Bozzini to the First World Congress of Endoscopic Skull Base Surgery. Neurosurg Focus 19:E3

    Article  PubMed  Google Scholar 

  26. Dusick JR, Esposito F, Kelly DF, Cohan P, DeSalles A, Becker DP (2005) The extended direct endonasal transsphenoidal approach for nonadenomatous suprasellar tumors. J Neurosurg 102:832–841

    Article  PubMed  Google Scholar 

  27. Fahlbusch R, Honegger J, Paulus W, Huk W, Buchfelder M (1999) Surgical treatment of craniopharyngiomas: experience with 168 patients. J Neurosurg 90:237–250

    Article  CAS  PubMed  Google Scholar 

  28. Figueiredo EG, Zabramski JM, Deshmukh P, Crawford NR, Preul MC, Spetzler RF (2006) Anatomical and quantitative description of the transcavernous approach to interpeduncular and prepontine cisterns. Technical note. J Neurosurg 104(6):957–964

    Article  PubMed  Google Scholar 

  29. Frazier JL, Chaichana K, Jallo GI, Quiñones-Hinojosa A (2008) Combined endoscopic and microscopic management of pediatric pituitary region tumors through one nostril: technical note with case illustrations. Childs Nerv Syst 24(12):1469–1478

    Article  PubMed  Google Scholar 

  30. Froelich SC, Abdel Aziz KM, Cohen PD, van Loveren HR, Keller JT (2008) Microsurgical and endoscopic anatomy of Liliequist's membrane: a complex and variable structure of the basal cisterns. Neurosurgery 63(ONS suppl 1):1–9

    Google Scholar 

  31. Fujii K, Chambers SM, Rhoton AL Jr (1979) Neurovascular relationships of the sphenoid sinus. A microsurgical study. J Neurosurg 50:31–39

    Article  CAS  PubMed  Google Scholar 

  32. Goel A, Muzumdar D, Desai KI (2002) Tuberculum sellae meningioma: a report on management on the basis of a surgical experience with 70 patients. Neurosurgery 51:1358–1564

    Article  PubMed  Google Scholar 

  33. Guiot G, Rougerie J, Fourestier M, Fournier A, Comoy C, Vulmiere J, Groux R (1963) Explorations endoscopiques intracrannienes. Press Med 71:1225–1228

    CAS  PubMed  Google Scholar 

  34. Honegger J, Buchfelder M, Fahlbusch R, Daubler B, Dorr HG (1992) Transsphenoidal microsurgery for craniopharyngioma. Surg Neurol 37:189–196

    Article  CAS  PubMed  Google Scholar 

  35. Jallo GI, Benjamin V (2002) Tuberculum sellae meningiomas: microsurgical anatomy and surgical technique. Neurosurgery 51:1432–1440

    Article  PubMed  Google Scholar 

  36. Jankowski R, Auque J, Simon C, Marchal JC, Hepner H, Wayoff M (1992) Endoscopic pituitary tumor surgery. Laryngoscope 102:198–202

    Article  CAS  PubMed  Google Scholar 

  37. Jho HD (2001) Endoscopic endonasal approach to the optic nerve: a technical note. Minim Invasive Neurosurg 44:190–193

    Article  CAS  PubMed  Google Scholar 

  38. Jho HD, Ha HG (2004) Endoscopic endonasal skull base surgery. Part 1: the midline anterior fossa skull base. Minim Invasive Neurosurg 47:1–8

    Article  PubMed  Google Scholar 

  39. Kaptain GJ, Vincent DA, Sheehan JP, Laws ER Jr (2001) Transsphenoidal approaches for the extracapsular resection of midline suprasellar and anterior cranial base lesions. Neurosurgery 49:94–101

    Article  CAS  PubMed  Google Scholar 

  40. Kassam AB, Gardner PA, Snyderman CH, Carrau RL, Mintz AH, Prevedello DM (2008) Expanded endonasal approach, a fully endoscopic transnasal approach for the resection of midline suprasellar craniopharyngiomas: a new classification based on the infundibulum. J Neurosurg 108(4):715–728

    Article  PubMed  Google Scholar 

  41. Kassam AB, Prevedello DM, Thomas A, Gardner P, Mintz A, Snyderman C, Carrau R (2008) Endoscopic endonasal pituitary transposition for a transdorsum sellae approach to the interpeduncular cistern. Neurosurgery 62(3 Suppl 1):57–72

    Article  PubMed  Google Scholar 

  42. Kassam AB, Snyderman CH, Mintz A, Gardner P, Carrau R (2005) Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurg Focus 19(1):E3

    PubMed  Google Scholar 

  43. Kato T, Sawamura Y, Abe H, Nagashima M (1998) Transsphenoidal–transtuberculum sellae approach for supradiaphragmatic tumours: technical note. Acta Neurochir (Wien) 140:715–719

    Article  CAS  Google Scholar 

  44. Kim J, Choe I, Bak K, Kim C, Kim N, Jang Y (2000) Transsphenoidal supradiaphragmatic intradural approach: technical note. Minim Invasive Neurosurg 43:33–37

    Article  CAS  PubMed  Google Scholar 

  45. Kitano M, Taneda M (2001) Extended transsphenoidal approach with submucosal posterior ethmoidectomy for parasellar tumors. Technical note. J Neurosurg 94:999–1004

    Article  CAS  PubMed  Google Scholar 

  46. Kitano M, Taneda M (2004) Subdural patch graft technique for watertight closure of large dural defects in extended transsphenoidal surgery. Neurosurgery 54:653–660

    Article  PubMed  Google Scholar 

  47. Kouri JG, Chen MY, Watson JC, Oldfield EH (2000) Resection of suprasellar tumors by using a modified transsphenoidal approach. Report of four cases. J Neurosurg 92:1028–1035

    Article  CAS  PubMed  Google Scholar 

  48. Laws ER Jr (1980) Transsphenoidal microsurgery in the management of craniopharyngioma. J Neurosurg 52:661–666

    Article  PubMed  Google Scholar 

  49. Laws ER Jr, Kanter AS, Jane JA Jr, Dumont AS (2005) Extended transsphenoidal approach. J Neurosurg 102:825–828

    Article  PubMed  Google Scholar 

  50. Lu XJ, Chen KL, Wang Q, Ji WY, Li B, Sun JY, Li JA (2009) Endoscopic expand transnasal approach to the suprasellar region: anatomical study and clinical considerations. Chin Med J (Engl) 122(20):2444–2448

    Google Scholar 

  51. Maira G, Anile C, Albanese A, Cabezas D, Pardi F, Vignati A (2004) The role of transsphenoidal surgery in the treatment of craniopharyngiomas. J Neurosurg 100:445–451

    Article  PubMed  Google Scholar 

  52. Mason RB, Nieman LK, Doppman JL, Oldfield EH (1997) Selective excision of adenomas originating in or extending into the pituitary stalk with preservation of pituitary function. J Neurosurg 87:343–351

    Article  CAS  PubMed  Google Scholar 

  53. Pirris SM, Pollack IF, Snyderman CH, Carrau RL, Spiro RM, Tyler-Kabara E, Kassam AB (2007) Corridor surgery: the current paradigm for skull base surgery. Childs Nerv Syst 23(4):377–384

    Article  PubMed  Google Scholar 

  54. Prevedello DM, Thomas A, Gardner P, Snyderman CH, Carrau RL, Kassam AB (2007) Endoscopic endonasal resection of a synchronous pituitary adenoma and a tuberculum sellae meningioma: technical case report. Neurosurgery 60(4 Suppl 2):E401

    Article  PubMed  Google Scholar 

  55. Renn WH, Rhoton AL Jr (1975) Microsurgical anatomy of the sellar region. J Neurosurg 43:288–298

    Article  CAS  PubMed  Google Scholar 

  56. Snyderman CH, Kassam AB (2006) Endoscopic techniques for pathology of the anterior cranial fossa and ventral skull base. J Am Coll Surg 202:563

    Article  PubMed  Google Scholar 

  57. Tanriover N, Rhoton AL Jr, Kawashima M, Ulm AJ, Yasuda A (2004) Microsurgical anatomy of the insula and the sylvian fissure. J Neurosurg 100(5):891–922

    Article  PubMed  Google Scholar 

  58. Teo C (2005) Application of endoscopy to the surgical management of craniopharyngiomas. Childs Nerv Syst 21(8–9):696–700

    Article  PubMed  Google Scholar 

  59. Tschabitscher M, Galzio R (2003) Endoscopic anatomy along the transnasal approach to the pituitary gland and the surrounding structures. In: Cappabianca P, de Divitiis E (eds) Endoscopic endonasal transsphenoidal surgery. Springer, Wien, pp 21–39

    Google Scholar 

  60. Ulm AJ, Tanriover N, Kawashima M, Campero A, Bova FJ, Rhoton A Jr (2004) Microsurgical approaches to the perimesencephalic cisterns and related segments of the posterior cerebral artery: comparison using a novel application of image guidance. Neurosurgery 54(6):1313–1327

    Article  PubMed  Google Scholar 

  61. Weiss MH (1987) The transnasal transsphenoidal approach. In: Apuzzo MLJ (ed) Surgery of the third ventricle. Williams & Wilkins, Baltimore, pp 476–494

    Google Scholar 

  62. Zhou D, Patil AA, Rodriguez-Sierra J (2005) Endoscopic neuroanatomy through the sphenoid sinus. Minim Invasive Neurosurg 48:19–24

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey

    Bashar Abuzayed, Necmettin Tanriover, Ziya Akar & Nurperi Gazioglu

  2. Morgue Specialization Department, Forensic Medicine Institute, Ministry of Justice, Istanbul, Turkey

    Berna Senel Eraslan

  3. Department of Neurosurgery, Cerrahpasa St. Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey, 34123

    Bashar Abuzayed

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  1. Bashar Abuzayed
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  2. Necmettin Tanriover
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  3. Ziya Akar
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  4. Berna Senel Eraslan
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  5. Nurperi Gazioglu
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Correspondence to Bashar Abuzayed.

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Abuzayed, B., Tanriover, N., Akar, Z. et al. Extended endoscopic endonasal approach to the suprasellar parachiasmatic cisterns: anatomic study. Childs Nerv Syst 26, 1161–1170 (2010). https://doi.org/10.1007/s00381-010-1204-0

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  • DOI: https://doi.org/10.1007/s00381-010-1204-0

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