Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Endoscopic Endonasal Approach to the Sellar and Parasellar Regions

Edoardo Agosti; A. Yohan Alexander; Luciano C.P.C. Leonel; Jamie J. Van Gompel; Michael J. Link; Carlos D. Pinheiro-Neto; Maria Peris-Celda

doi:10.1055/a-1869-7532

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2023; 84(04): 361-374
DOI: 10.1055/a-1869-7532

Original Article

Anatomical Step-by-Step Dissection of Complex Skull Base Approaches for Trainees: Surgical Anatomy of the Endoscopic Endonasal Approach to the Sellar and Parasellar Regions

Authors

Edoardo Agosti

¹Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, United States

²Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States

³Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
A. Yohan Alexander

¹Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, United States

²Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
Luciano C.P.C. Leonel

¹Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, United States

²Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
Jamie J. Van Gompel

¹Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, United States

²Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States

⁴Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
Michael J. Link

¹Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, United States

²Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States

⁴Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
Carlos D. Pinheiro-Neto

¹Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, United States

²Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States

⁴Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
Maria Peris-Celda

¹Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, United States

²Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States

⁴Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States

Abstract

Introduction Surgery of the sellar and parasellar regions can be challenging due to the complexity of neurovascular relationships. The main goal of this study is to develop an educational resource to help trainees understand the pertinent anatomy and procedural steps of the endoscopic endonasal approaches (EEAs) to the sellar and parasellar regions.

Methods Ten formalin-fixed latex-injected specimens were dissected. Endoscopic endonasal transsphenoidal transsellar, transtuberculum-transplanum, and transcavernous approaches were performed by a neurosurgery trainee, under supervision from the senior authors and a PhD in anatomy with advanced neuroanatomy experience. Dissections were supplemented with representative case applications.

Results Endoscopic endonasal transsphenoidal approaches afford excellent direct access to sellar and parasellar regions. After a wide sphenoidotomy, a limited sellar osteotomy opens the space to sellar region and medial portion of the cavernous sinus. To reach the suprasellar space (infrachiasmatic and suprachiasmatic corridors), a transplanum-prechiasmatic sulcus-transtuberculum adjunct is needed. The transcavernous approach gains access to the contents of the cavernous sinus and both medial (posterior clinoid and interpeduncular cistern) and lateral structures of the retrosellar region.

Conclusion The anatomical understanding and technical skills required to confidently remove skull base lesions with EEAs are traditionally gained after years of specialized training. We comprehensively describe EEAs to sellar and parasellar regions for trainees to build knowledge and improve familiarity with these approaches and facilitate comprehension and learning in both the surgical anatomy laboratory and the operating room.

Keywords

step-by-step description - anatomical understanding - skull base surgery - endoscopic endonasal approaches - transsellar approach - transcavernous approach - transplanum approach

Full Text

References

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