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The Role of Endoscopic Transsphenoidal Surgery in the Management of Complex Lesions Involving the Skull Base

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Transsphenoidal Surgery

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Abstract

Since the repopularization of the transsphenoidal approach by Guiot and Hardy, most surgeons have adopted this technique as the primary method for the removal of pituitary adenomas. With the development of modern microinstrumentation, the use of the operating microscope, and advances in endoscopic endonasal instrumentation and navigation, the endonasal transsphenoidal approach has become the preferred method for targeting sellar and parasellar lesions. Exposure beyond the parasellar region in the sagittal and coronal planes can be achieved when the extended transsphenoidal approach is performed using a purely endoscopic endonasal approach (EEA) without a nasal speculum. With the recent advent of extended EEAs, access to a variety of skull base lesions outside of the sella and sphenoid sinus can be accomplished. In the sagittal plane, ventral pathology can be accessed from the frontal sinuses anteriorly to the odontoid process posteroinferiorly. In the coronal plane, lateral access can be achieved to remove lesions occupying the cavernous sinus, infratemporal fossa, middle fossa, and petrous apex. Various endoscopic endonasal corridors have been developed to access a desired target of the ventral skull base. The majority of these EEAs share a common initial transsphenoidal approach to the ventral skull base before branching out into their respective paths along the sagittal or coronal plane. In this chapter, the authors discuss the various endoscopic endonasal corridors that allow access to a wide variety of complex skull base lesions.

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Authors and Affiliations

  1. Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA

    James K. Liu MD, Eleonora F. Spinazzi BA & Jean Anderson Eloy MD

  2. Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ, USA

    James K. Liu MD & Jean Anderson Eloy MD

  3. Department of Otolaryngology-Head & Neck Surgery, Rutgers New Jersey, New Jersey Medical School, Newark, NJ, USA

    James K. Liu MD & Jean Anderson Eloy MD

  4. Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA

    Jean Anderson Eloy MD

  5. Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA

    William T. Couldwell MD, PhD

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  1. James K. Liu MD
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  2. Eleonora F. Spinazzi BA
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  3. Jean Anderson Eloy MD
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  4. William T. Couldwell MD, PhD
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Correspondence to James K. Liu MD .

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Editors and Affiliations

  1. Department of Neurosurgery, Harvard Medical School Brigham and Women’s Hospital, Boston, MA, USA

    Edward R. Laws, Jr

  2. Department of Neurosurgery, Indianapolis Methodist Hospital, Indianapolis, IN, USA

    Aaron A. Cohen-Gadol

  3. Department of Neurosurgery, Weill Cornell Medical College New York Presbyterian Hospital, New York, NY, USA

    Theodore H. Schwartz

  4. Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA

    Jason P. Sheehan

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Liu, J.K., Spinazzi, E.F., Eloy, J.A., Couldwell, W.T. (2017). The Role of Endoscopic Transsphenoidal Surgery in the Management of Complex Lesions Involving the Skull Base. In: Laws, Jr, E.R., Cohen-Gadol, A.A., Schwartz, T.H., Sheehan, J.P. (eds) Transsphenoidal Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-56691-7_17

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  • DOI: https://doi.org/10.1007/978-3-319-56691-7_17

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