Skip to main content
SpringerLink
Log in

5 Suprasellar Pathology

  • Chapter
  • First Online:
Endoscopic and Keyhole Cranial Base Surgery

  • 729 Accesses

Abstract

Suprasellar lesions are varied in pathology, but are challenging due to the proximity to the optic apparatus, pituitary gland, infundibulum, hypothalamus, and third ventricle. Surgical interventions to remove these lesions may result in visual field loss, endocrine dysfunction, and hydrocephalus. The endoscopic endonasal transplanum and transtuberculum approach is the defining endonasal endoscopic approach to the suprasellar lesions and is the most direct route to the region that avoids manipulation of the optic nerves and carotid artery that obviates the need for brain retraction. Meningiomas, craniopharyngiomas, and pituitary adenomas are common examples of lesions that can be resected using these approaches. These approaches differ from traditional microneurosurgical approaches with the instruments and endoscopic techniques that are utilized. Safety and success of these procedures require careful patient selection and expertise in the endonasal endoscopic method.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Patel CR, Fernandez-Miranda JC, Wang WH, Wang EW. Skull Base Anatomy. Otolaryngol Clin N Am. 2016;49(1):9–20.

    Article  Google Scholar 

  2. McCrea HJ, George E, Settler A, Schwartz TH, Greenfield JP. Pediatric Suprasellar tumors. J Child Neurol. 2016 Oct;31(12):1367–76.

    Article  PubMed  Google Scholar 

  3. Patel SG, Singh B, Polluri A, Bridger PG, Cantu G, Cheesman AD, et al. Craniofacial surgery for malignant skull base tumors: report of an international collaborative study. Cancer. 2003;98(6):1179–87.

    Article  PubMed  Google Scholar 

  4. Origitano TC, Petruzzelli GJ, Leonetti JP, Vandevender D. Combined anterior and anterolateral approaches to the cranial base: complication analysis, avoidance, and management. Neurosurgery. 2006;58(4 Suppl 2):ONS-327–36; discussion ONS-36-7.

    Google Scholar 

  5. Schwartz TH, Fraser JF, Brown S, Tabaee A, Kacker A, Anand VK. Endoscopic cranial base surgery: classification of operative approaches. Neurosurgery. 2008;62(5):991–1002; discussion −5.

    Google Scholar 

  6. Silva D, Attia M, Kandasamy J, Alimi M, Anand VK, Schwartz TH. Endoscopic endonasal transsphenoidal “above and below” approach to the retroinfundibular area and interpeduncular cistern – cadaveric study and case illustrations. World Neurosurg. 2014;81(2):374–84.

    Article  PubMed  Google Scholar 

  7. Khan OH, Raithatha R, Anand VK, Schwartz TH. Endoscopic surgery of the Sella and Suprasellar region. In: Sataloff RT, editor. Sataloff’s comprehensive textbook of otolaryngology: head and neck surgery, vol. 2. New Delhi: Jaypee Brothers Medical Publishers; 2015. p. 805–21.

    Google Scholar 

  8. McCrea HJ, Yang T, Schwartz TH. Controversies: endoscopic resection. In: Evans JJ, Kenning TJ, editors. Craniopharyngiomas. Cambridge, MA: Academic Press; 2015.

    Google Scholar 

  9. Schwartz TH, Anand VK. The endoscopic endonasal transsphenoidal approach to the suprasellar cistern. Clin Neurosurg. 2007;54:226–35.

    PubMed  Google Scholar 

  10. Harris AE, Lee JY, Omalu B, Flickinger JC, Kondziolka D, Lunsford LD. The effect of radiosurgery during management of aggressive meningiomas. Surg Neurol. 2003;60(4):298–305; discussion.

    Google Scholar 

  11. Kreil W, Luggin J, Fuchs I, Weigl V, Eustacchio S, Papaefthymiou G. Long term experience of gamma knife radiosurgery for benign skull base meningiomas. J Neurol Neurosurg Psychiatry. 2005;76(10):1425–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Paravati AJ, Heron DE, Gardner PA, Snyderman C, Ozhasoglu C, Quinn A, et al. Combined endoscopic endonasal surgery and fractionated stereotactic radiosurgery (fSRS) for complex cranial base tumors-early clinical outcomes. Technol Cancer Res Treat. 2010;9(5):489–98.

    Article  PubMed  Google Scholar 

  13. Pollock BE, Stafford SL, Utter A, Giannini C, Schreiner SA. Stereotactic radiosurgery provides equivalent tumor control to Simpson grade 1 resection for patients with small- to medium-size meningiomas. Int J Radiat Oncol Biol Phys. 2003;55(4):1000–5.

    Article  PubMed  Google Scholar 

  14. Milker-Zabel S, Zabel-du Bois A, Huber P, Schlegel W, Debus J. Fractionated stereotactic radiation therapy in the management of benign cavernous sinus meningiomas: long-term experience and review of the literature. Strahlenther Onkol. 2006;182(11):635–40.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  16. Schwartz TH, Anand VJ. Endonasal transplanum approach to the anterior cranial fossa. In: Snyderman C, Gardner P, editors. Master techniques in otolaryngology-head and neck surgery. Philadelphia: Lippincott Williams & Wilkins; 2014.

    Google Scholar 

  17. Placantonakis DG, Tabaee A, Anand VK, Hiltzik D, Schwartz TH. Safety of low-dose intrathecal fluorescein in endoscopic cranial base surgery. Neurosurgery 2007;61(3 Suppl):161–5; discussion 5–6.

    Google Scholar 

  18. Banu MA, Kim JH, Shin BJ, Woodworth GF, Anand VK, Schwartz TH. Low-dose intrathecal fluorescein and etiology-based graft choice in endoscopic endonasal closure of CSF leaks. Clin Neurol Neurosurg. 2014;116:28–34.

    Article  PubMed  Google Scholar 

  19. Woodworth G, McCoul E, Anand V, Greenfiled J, Schwartz T. Endoscopic management of anterior cranial fossa meningiomas. Oper Tech Otolaryngol Head Neck Surg. 2011;22(4):Issue 4.

    Google Scholar 

  20. Laufer I, Anand VK, Schwartz TH. Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions. J Neurosurg. 2007;106(3):400–6.

    Article  PubMed  Google Scholar 

  21. Leng LZ, Brown S, Anand VK, Schwartz TH. “Gasket-seal” watertight closure in minimal-access endoscopic cranial base surgery. Neurosurgery. 2008;62(5 Suppl 2):ONSE342–3; discussion ONSE3.

    Google Scholar 

  22. Patel KS, Komotar RJ, Szentirmai O, Moussazadeh N, Raper DM, Starke RM, et al. Case-specific protocol to reduce cerebrospinal fluid leakage after endonasal endoscopic surgery. J Neurosurg. 2013;119(3):661–8.

    Article  PubMed  Google Scholar 

  23. Kovacs K, Horvath E. Pathology of pituitary tumors. Endocrinol Metab Clin N Am. 1987;16(3):529–51.

    Article  CAS  Google Scholar 

  24. Hofstetter CP, Mannaa RH, Mubita L, Anand VK, Kennedy JW, Dehdashti AR, et al. Endoscopic endonasal transsphenoidal surgery for growth hormone-secreting pituitary adenomas. Neurosurg Focus. 2010;29(4):E6.

    Article  PubMed  Google Scholar 

  25. Messerer M, De Battista JC, Raverot G, Kassis S, Dubourg J, Lapras V, et al. Evidence of improved surgical outcome following endoscopy for nonfunctioning pituitary adenoma removal. Neurosurg Focus. 2011;30(4):E11.

    Article  PubMed  Google Scholar 

  26. Farrell CJ, Nyquist GG, Farag AA, Rosen MR, Evans JJ. Principles of pituitary surgery. Otolaryngol Clin N Am. 2016;49(1):95–106.

    Article  Google Scholar 

  27. Kouri JG, Chen MY, Watson JC, Oldfield EH. Resection of suprasellar tumors by using a modified transsphenoidal approach. Report of four cases. J Neurosurg. 2000;92(6):1028–35.

    Article  CAS  PubMed  Google Scholar 

  28. Komotar RJ, Starke RM, Raper DM, Anand VK, Schwartz TH. Endoscopic endonasal compared with microscopic transsphenoidal and open transcranial resection of giant pituitary adenomas. Pituitary. 2012;15(2):150–9.

    Article  PubMed  Google Scholar 

  29. Hofstetter CP, Shin BJ, Mubita L, Huang C, Anand VK, Boockvar JA, et al. Endoscopic endonasal transsphenoidal surgery for functional pituitary adenomas. Neurosurg Focus. 2011;30(4):E10.

    Article  PubMed  Google Scholar 

  30. Fahlbusch R, Honegger J, Paulus W, Huk W, Buchfelder M. Surgical treatment of craniopharyngiomas: experience with 168 patients. J Neurosurg. 1999;90(2):237–50.

    Article  CAS  PubMed  Google Scholar 

  31. Yaşargil MG, Curcic M, Kis M, Siegenthaler G, Teddy PJ, Roth P. Total removal of craniopharyngiomas. Approaches and long-term results in 144 patients. J Neurosurg. 1990;73(1):3–11.

    Article  PubMed  Google Scholar 

  32. Honegger J, Buchfelder M, Fahlbusch R. Surgical treatment of craniopharyngiomas: endocrinological results. J Neurosurg. 1999;90(2):251–7.

    Article  CAS  PubMed  Google Scholar 

  33. Chakrabarti I, Amar AP, Couldwell W, Weiss MH. Long-term neurological, visual, and endocrine outcomes following transnasal resection of craniopharyngioma. J Neurosurg. 2005;102(4):650–7.

    Article  PubMed  Google Scholar 

  34. Benjamin V, Russell SM. The microsurgical nuances of resecting tuberculum sellae meningiomas. Neurosurgery. 2005;56(2 Suppl):411–7; discussion −7.

    Google Scholar 

  35. Buslei R, Nolde M, Hofmann B, Meissner S, Eyupoglu IY, Siebzehnrubl F, et al. Common mutations of beta-catenin in adamantinomatous craniopharyngiomas but not in other tumours originating from the sellar region. Acta Neuropathol. 2005;109(6):589–97.

    Article  CAS  PubMed  Google Scholar 

  36. Schaberg MR, Anand VK, Schwartz TH, Cobb W. Microscopic versus endoscopic transnasal pituitary surgery. Curr Opin Otolaryngol Head Neck Surg. 2010;18(1):8–14.

    Article  PubMed  Google Scholar 

  37. Bresson D, Herman P, Polivka M, Froelich S. Sellar lesions/pathology. Otolaryngol Clin N Am. 2016;49(1):63–93.

    Article  Google Scholar 

  38. Frank G, Sciarretta V, Mazzatenta D, Farneti G, Modugno GC, Pasquini E. Transsphenoidal endoscopic approach in the treatment of Rathke’s cleft cyst. Neurosurgery. 2005;56(1):124–8; discussion 9.

    Google Scholar 

  39. Zada G, Lin N, Ojerholm E, Ramkissoon S, Laws ER. Craniopharyngioma and other cystic epithelial lesions of the sellar region: a review of clinical, imaging, and histopathological relationships. Neurosurg Focus. 2010;28(4):E4.

    Article  PubMed  Google Scholar 

  40. Aho CJ, Liu C, Zelman V, Couldwell WT, Weiss MH. Surgical outcomes in 118 patients with Rathke cleft cysts. J Neurosurg. 2005;102(2):189–93.

    Article  PubMed  Google Scholar 

  41. Tzortzidis F, Elahi F, Wright D, Natarajan SK, Sekhar LN. Patient outcome at long-term follow-up after aggressive microsurgical resection of cranial base chordomas. Neurosurgery. 2006;59(2):230–7; discussion −7.

    Google Scholar 

  42. Chibbaro S, Cornelius JF, Froelich S, Tigan L, Kehrli P, Debry C, et al. Endoscopic endonasal approach in the management of skull base chordomas – clinical experience on a large series, technique, outcome, and pitfalls. Neurosurg Rev. 2014;37(2):217–24; discussion 24–5.

    Google Scholar 

  43. Koutourousiou M, Gardner PA, Tormenti MJ, Henry SL, Stefko ST, Kassam AB, et al. Endoscopic endonasal approach for resection of cranial base chordomas: outcomes and learning curve. Neurosurgery. 2012;71(3):614–24; discussion 24–5.

    Google Scholar 

  44. DMS R, Komotar RJ, Starke RM, Anand VK, Schwartz TH. Endoscopic versus open approaches to the skull base: a comprehensive literature review. Oper Tech Otolaryngol Head Neck Surg. 2011;22(4):302–7.

    Article  Google Scholar 

  45. Komotar RJ, Starke RM, Raper DM, Anand VK, Schwartz TH. The endoscope-assisted ventral approach compared with open microscope-assisted surgery for clival chordomas. World Neurosurg. 2011;76(3–4):318–27; discussion 259–62.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY, USA

    Sacit Bulent Omay

  2. Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA

    Sacit Bulent Omay

  3. Department of Otolaryngology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY, USA

    Vijay K. Anand

  4. Departments of Neurosurgery, Otolaryngology, and Neuroscience, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY, USA

    Theodore H. Schwartz

Authors
  1. Sacit Bulent Omay
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vijay K. Anand
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Theodore H. Schwartz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Theodore H. Schwartz .

Editor information

Editors and Affiliations

  1. Cranial Base and Pituitary Surgery Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA

    James J. Evans

  2. Pituitary and Cranial Base Surgery, Department of Neurosurgery, Albany Medical Center, Albany, NY, USA

    Tyler J. Kenning

  3. Cranial Base and Pituitary Surgery Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA

    Christopher Farrell

  4. Skull Base, Pituitary and Cerebrovascular Surgery Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA

    Varun R. Kshettry

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Omay, S.B., Anand, V.K., Schwartz, T.H. (2019). 5 Suprasellar Pathology. In: Evans, J., Kenning, T., Farrell, C., Kshettry, V. (eds) Endoscopic and Keyhole Cranial Base Surgery . Springer, Cham. https://doi.org/10.1007/978-3-319-64379-3_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-64379-3_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-64378-6

  • Online ISBN: 978-3-319-64379-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation