The extended direct endonasal transsphenoidal approach for nonadenomatous suprasellar tumors

• DOI: 10.3171/jns.2005.102.5.0832
• Publication Date: 2009-05-13T18:04:15Z
• Authors: Joshua R. Dusick; Felice Esposito; Daniel F. Kelly; Pejman Cohan; Antonio DeSalles; Donald P. Becker; Neil A. Martin
• Keywords: Tuberculum sellae; Debulking; Craniopharyngioma; Chordoma; Ommaya reservoir; Transsphenoidal surgery

The extended transsphenoidal approach, which requires a bone and dural opening through the tuberculum sellae posterior planum sphenoidale, is increasingly used for treatment of nonadenomatous suprasellar tumors. authors present their experiences in using direct endonasal approach patients with tumors.Surgery was performed aid an operating microscope angled endoscopes were to assess completeness resection. Bone defects repaired abdominal fat, collagen sponge, titanium mesh, and, most cases, lumbar drainage cerebrospinal fluid (CSF). Twenty-six procedures tumor removal 24 (ages 9-79 years), including two repeated operations residual tumor. Gross-total could be accomplished only 46% patients, near-gross-total or better 74% 23 (five eight craniopharyngiomas, six seven meningiomas, five Rathke cleft cysts, one dermoid epidermoid cyst); patient lymphoma underwent biopsy. Of 13 tumor-related visual loss, 85% improved postoperatively. complications that occurred included (21%) postoperative CSF leaks, (4%) bacterial meningitis; new endocrinopathy; (8%) who needed undergo downsize fat grafts. permanent neurological deficit anosmia patient; there no intracranial vascular injuries.The skull-base provides effective minimally invasive means resecting debulking tumors have traditionally been approached sublabial transcranial route. Procedures supraglandular space can effectively excellent visualization optic apparatus while preserving pituitary function cases. major challenge remains developing consistently techniques prevent leaks.