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

Edoardo Agosti
1   Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, United States
2   Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
3   Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
,
A. Yohan Alexander
1   Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, United States
2   Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Luciano C.P.C. Leonel
1   Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, United States
2   Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Jamie J. Van Gompel 
1   Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, United States
2   Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
4   Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Michael J. Link
1   Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, United States
2   Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
4   Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Carlos D. Pinheiro-Neto
1   Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, United States
2   Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
4   Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Maria Peris-Celda
1   Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Rochester, Minnesota, United States
2   Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
4   Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, United States
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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

Ethical Approval

This study was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of the Mayo Clinic approved this study.




Publication History

Received: 13 March 2022

Accepted: 01 June 2022

Accepted Manuscript online:
07 June 2022

Article published online:
25 August 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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