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Endoscopic Endonasal Transsphenoidal Approach

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Midline Skull Base Surgery

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Abstract

Sellar arachnoid cysts (SACs) are a rare occurrence and, when symptomatic, they cause symptoms and signs related with the mass effect they may produce over the surrounding neurovascular structures.When needed, the surgical treatment of SACs mainly involves the marsupialization of the cyst’s wall via a transsphenoidal route or, less frequently,through a craniotomy. In such settings and in most cases, an endoscopic endonasal transsphenoidal approach represents the optimal surgical strategy for the marsupialization of SACs. Someone advocates a simple drainage of the cystic content through a limited opening of the sellar dura and the subsequent closure of the sural defect, while others favour the excision of the cyst’s membranes either partially or entirely and/or to enlarge the communication between the cyst cavity and the suprasellar subarachnoid space. Anyway, a key step of the endoscopic endonasal transsphenoidal treatment of sellar or sellar/suprasellar arachnoid cysts is the avoidance of their recurrence and, in case of communicating cysts, the prevention of the postoperative CSF leak.It should be remembered that although the transsphenoidal treatment of SACs can improve the preoperative symptoms in a relatively high percentage of patients, such treatment has been associated with the occurrence of serious complications including visual loss, postoperative CSF leak, and meningitis.

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Authors and Affiliations

  1. Division of Neurosurgery, Department of Biomedical Sciences, Dentistry, and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, Messina, 98125, Italy

    Felice Esposito MD, PhD

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  1. Felice Esposito MD, PhD
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Correspondence to Felice Esposito MD, PhD .

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Editors and Affiliations

  1. Div. of Neurosurgery Dept. of Neuroscien, University of Naples “Federico II” , Naples, Italy

    Paolo Cappabianca

  2. Div. of Neurosurgery Dept. of Neuroscien, University of Naples “Federico II” , Naples, Italy

    Luigi Maria Cavallo

  3. Div. of Neurosurgery Dept. of Neuroscien, University of Naples “Federico II” , Naples, Italy

    Oreste de Divitiis

  4. Div. of Neurosurgery Dept. of Neuroscien, University of Messina , Messina, Messina, Italy

    Felice Esposito

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Esposito, F. (2016). Endoscopic Endonasal Transsphenoidal Approach. In: Cappabianca, P., Cavallo, L., de Divitiis, O., Esposito, F. (eds) Midline Skull Base Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-21533-4_15

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  • DOI: https://doi.org/10.1007/978-3-319-21533-4_15

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-21532-7

  • Online ISBN: 978-3-319-21533-4

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