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Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases.
Neurosurgery. 2004 Sep; 55(3):539-47; discussion 547-50.N

Abstract

OBJECTIVE

The traditional boundaries of the transsphenoidal approach may be expanded to include the region from the cribriform plate of the anterior cranial base to the inferior clivus in the anteroposterior plane, and laterally to expose the cavernous cranial nerves and the optic canal. We review our combined experience with these variations on the transsphenoidal approach to various lesions of the sellar and parasellar region.

METHODS

From 1982 to 2003, we used the extended and parasellar transsphenoidal approaches in 105 patients presenting with a variety of lesions of the parasellar region. This study specifically reviews the breadth of pathological lesions operated and the complications associated with the approaches.

RESULTS

Variations of the standard transsphenoidal approach have been used in the following series: 30 cases of pituitary adenomas extending laterally to involve the cavernous sinus, 27 craniopharyngiomas, 11 tuberculum/diaphragma sellae meningiomas, 10 sphenoid sinus mucoceles, 18 clivus chordomas, 4 cases of carcinoma of the sphenoid sinus, 2 cases of breast carcinoma metastatic to the sella, and 3 cases of monostotic fibrous dysplasia involving the clivus. There was no mortality in the series. Permanent neurological complications included one case of monocular blindness, one case of permanent diabetes insipidus, and two permanent cavernous cranial neuropathies. There were four cases of internal carotid artery hemorrhage, one of which required ligation of the cervical internal carotid artery and resulted in hemiparesis. The incidence of postoperative cerebrospinal fluid fistulae was 6% (6 of 105 cases).

CONCLUSION

These modifications of the standard transsphenoidal approach are useful for lesions within the boundaries noted above, they offer excellent alternatives to transcranial approaches for these lesions, and they avoid prolonged exposure time and brain retraction. Technical details are discussed and illustrative cases presented.

Authors+Show Affiliations

Couldwell WT
Department of Neurological Surgery, University of Utah, Salt Lake City, Utah, USA. william.couldwell@hsc.utah.edu
Weiss MH
No affiliation info available
Rabb C
No affiliation info available
Liu JK
No affiliation info available
Apfelbaum RI
No affiliation info available
Fukushima T
No affiliation info available

MeSH

AdenocarcinomaAdenomaAdolescentAdultAgedBreast NeoplasmsChordomaCranial Fossa, PosteriorCranial NervesCraniopharyngiomaDisability EvaluationEthmoid BoneFemaleFibrous Dysplasia, MonostoticHumansMaleMeningeal NeoplasmsMeningiomaMiddle AgedMucoceleNeurologic ExaminationParanasal Sinus NeoplasmsPituitary NeoplasmsPostoperative ComplicationsRetrospective StudiesSella TurcicaSkull BaseSkull Base NeoplasmsSphenoid Sinus

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

15335421

Citation

Couldwell, William T., et al. "Variations On the Standard Transsphenoidal Approach to the Sellar Region, With Emphasis On the Extended Approaches and Parasellar Approaches: Surgical Experience in 105 Cases." Neurosurgery, vol. 55, no. 3, 2004, pp. 539-47; discussion 547-50.
Couldwell WT, Weiss MH, Rabb C, et al. Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases. Neurosurgery. 2004;55(3):539-47; discussion 547-50.
Couldwell, W. T., Weiss, M. H., Rabb, C., Liu, J. K., Apfelbaum, R. I., & Fukushima, T. (2004). Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases. Neurosurgery, 55(3), 539-47; discussion 547-50.
Couldwell WT, et al. Variations On the Standard Transsphenoidal Approach to the Sellar Region, With Emphasis On the Extended Approaches and Parasellar Approaches: Surgical Experience in 105 Cases. Neurosurgery. 2004;55(3):539-47; discussion 547-50. PubMed PMID: 15335421.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases. AU - Couldwell,William T, AU - Weiss,Martin H, AU - Rabb,Craig, AU - Liu,James K, AU - Apfelbaum,Ronald I, AU - Fukushima,Takanori, PY - 2003/10/16/received PY - 2004/02/24/accepted PY - 2004/9/1/pubmed PY - 2004/11/13/medline PY - 2004/9/1/entrez SP - 539-47; discussion 547-50 JF - Neurosurgery JO - Neurosurgery VL - 55 IS - 3 N2 - OBJECTIVE: The traditional boundaries of the transsphenoidal approach may be expanded to include the region from the cribriform plate of the anterior cranial base to the inferior clivus in the anteroposterior plane, and laterally to expose the cavernous cranial nerves and the optic canal. We review our combined experience with these variations on the transsphenoidal approach to various lesions of the sellar and parasellar region. METHODS: From 1982 to 2003, we used the extended and parasellar transsphenoidal approaches in 105 patients presenting with a variety of lesions of the parasellar region. This study specifically reviews the breadth of pathological lesions operated and the complications associated with the approaches. RESULTS: Variations of the standard transsphenoidal approach have been used in the following series: 30 cases of pituitary adenomas extending laterally to involve the cavernous sinus, 27 craniopharyngiomas, 11 tuberculum/diaphragma sellae meningiomas, 10 sphenoid sinus mucoceles, 18 clivus chordomas, 4 cases of carcinoma of the sphenoid sinus, 2 cases of breast carcinoma metastatic to the sella, and 3 cases of monostotic fibrous dysplasia involving the clivus. There was no mortality in the series. Permanent neurological complications included one case of monocular blindness, one case of permanent diabetes insipidus, and two permanent cavernous cranial neuropathies. There were four cases of internal carotid artery hemorrhage, one of which required ligation of the cervical internal carotid artery and resulted in hemiparesis. The incidence of postoperative cerebrospinal fluid fistulae was 6% (6 of 105 cases). CONCLUSION: These modifications of the standard transsphenoidal approach are useful for lesions within the boundaries noted above, they offer excellent alternatives to transcranial approaches for these lesions, and they avoid prolonged exposure time and brain retraction. Technical details are discussed and illustrative cases presented. SN - 0148-396X UR - https://www.unboundmedicine.com/medline/citation/15335421/Variations_on_the_standard_transsphenoidal_approach_to_the_sellar_region_with_emphasis_on_the_extended_approaches_and_parasellar_approaches:_surgical_experience_in_105_cases_ DB - PRIME DP - Unbound Medicine ER -