Abstract
A.B. Kassam; C.H. Snyderman; A. Mintz; P. Gardner*; R.L. Carrau
Objective
Transsphenoidal
approaches have been used for a century for the resection of pituitary and
other sellar tumors. More recently, the standard endonasal approach has been
expanded to provide access to other, parasellar lesions. With the addition of
the endoscope, this expansion carries significant potential for the resection
of skull base lesions.
Methods
The anatomical
landmarks and surgical techniques used in expanded (extended) endoscopic approaches
to the rostral, anterior skull base are reviewed and presented, accompanied by
case illustrations of each segment (or module) of approach. The rostral half of
the anterior skull base is divided into modules of approach: sellar/parasellar,
transplanum/transtuberculum, and transcribriform. Case illustrations of
successful resections of lesions with each module are presented and discussed.
Conclusions
Endoscopic, expanded
endonasal approaches to rostral anterior skull base lesions are feasible and
hold great potential for decreased morbidity. The effectiveness and appropriate
use of these techniques must be evaluated by close examination of outcomes as
case series expand.