Extended Endoscopic Endonasal Surgery

Abstract

  Tumors originating in the suprasellar region have previously been considered a contraindication for transsphenoidal surgery (TSS). However, in the late 1980s, the transsphenoidal removal of suprasellar tumors became possible with the adoption of extended TSS, which allows excellent midline access and visibility to the suprasellar region without brain retraction and with minimal neurovascular manipulation. Recently, the endoscopic endonasal approach has become a valid alternative to transcranial approaches for the surgical treatment of craniopharyngiomas in many cases. For a safe and effective surgery, a wide surgical corridor, fine microsurgical procedures, and a secure repair of cerebrospinal fluid leakage are essential. A direct and wide exposure of the craniopharyngioma and the surrounding vital structures can be obtained following an accurate and careful approach. There are some pitfalls involved in this approach ; therefore, thorough understanding of the procedure in each anatomical step (nasal sinus, skull base, and suprasellar cistern) is required to achieve successful outcomes. In addition to tumor extensions and characteristics (such as size, configuration, and calcification), anatomical conditions that can most affect the approach are positions of the chiasm and stalk.