Expanded endoscopic endonasal approach for extending suprasellar and third ventricular lesions
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HOW I DO IT - NEUROSURGICAL ANATOMY
Expanded endoscopic endonasal approach for extending suprasellar and third ventricular lesions Giuliano Silveira-Bertazzo 1,2 & Sunil Manjila 3 & Ricardo L. Carrau 1,4 & Daniel M. Prevedello 1,4 Received: 16 December 2019 / Accepted: 21 April 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background Expanded endonasal approaches can provide direct access to the midline skull base from the anterior cranial fossa to the ventral foramen magnum. Surgical strategies of bone drilling, dural opening, and intradural dissection can determine the area of surgical exposure and instrument handling, affecting the safety of devascularizing/debulking suprasellar tumors. Methods We describe an expanded endoscopic endonasal approach for suprasellar lesions, with stepwise image-guided dissections highlighting surgical pearls and pitfalls to enhance surgical safety. This article presents transnasal intra-third-ventricular anatomy from trans-tuber cinereum, and trans-lamina terminalis approaches, comparing subchiasmatic and suprachiasmatic trajectories. Conclusion The rostral extension via endoscopic endonasal transsellar-transtubercular-transplanum approaches can provide a safe and feasible route for suprasellar lesions, in subchiasmatic, suprachiasmatic, and intraventricular regions. Keywords Cranial base . Endonasal . Endoscopic . Suprasellar . Third ventricle . Transtuberculum . Transplanum
Abbreviations EEEa Expanded endoscopic endonasal approaches ICA Internal carotid artery CR Clival recess LOCR Lateral opticocarotid recess MOCR Medial opticocarotid recess MCP Middle clinoid process LTR Lateral tubercular recess This article is part of the Topical Collection on Neurosurgical Anatomy Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00701-020-04368-9) contains supplementary material, which is available to authorized users. * Daniel M. Prevedello [email protected] 1
Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, OH, USA
2
Department of Neurological Surgery, University of Joinville Region, and Neurological and Neurosurgical Clinic of Joinville, Joinville, SC, Brazil
3
Department of Neurological Surgeryand Neck Surgery, McLaren Hospital, Bay Region, Bay City, MI, USA
4
Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Medical Center, Columbus, OH, USA
LTC DOA IGS SSEP SICS
Lateral tubercular crest Distal osseous arch of the carotid sulcus Image guidance system Somato-sensory evoked potential Superior intercavernous sinus
Introduction and relevant surgical anatomy Expanded endoscopic endonasal access (EEA) to suprasellar cistern via transellar-transtuberculum-transplanum approaches has advantages over transcranial surgery obviating cosmetic deformity and brain/chiasmal retraction (Fig. 1) [6]. For rostrally extending suprasellar lesions, the surgical corridor is expanded using bone removal along the tuberculum and planum sphenoidale, followe
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