Expanded endoscopic endonasal approach for extending suprasellar and third ventricular lesions. 2020

Giuliano Silveira-Bertazzo, and Sunil Manjila, and Ricardo L Carrau, and Daniel M Prevedello
Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, OH, USA.

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. 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. 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.

UI MeSH Term Description Entries
D009296 Nasal Cavity The proximal portion of the respiratory passages on either side of the NASAL SEPTUM. Nasal cavities, extending from the nares to the NASOPHARYNX, are lined with ciliated NASAL MUCOSA. Nasal Cavities,Cavities, Nasal,Cavity, Nasal
D004724 Endoscopy Procedures of applying ENDOSCOPES for disease diagnosis and treatment. Endoscopy involves passing an optical instrument through a small incision in the skin i.e., percutaneous; or through a natural orifice and along natural body pathways such as the digestive tract; and/or through an incision in the wall of a tubular structure or organ, i.e. transluminal, to examine or perform surgery on the interior parts of the body. Endoscopic Surgical Procedures,Surgical Procedures, Endoscopic,Endoscopic Surgical Procedure,Endoscopy, Surgical,Surgical Endoscopy,Surgical Procedure, Endoscopic,Procedure, Endoscopic Surgical,Procedures, Endoscopic Surgical
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012658 Sella Turcica A bony prominence situated on the upper surface of the body of the sphenoid bone. It houses the PITUITARY GLAND. Sella Turcicas,Turcica, Sella,Turcicas, Sella
D044583 Neuroendoscopy PROCEDURES that use NEUROENDOSCOPES for disease diagnosis and treatment. Neuroendoscopy, generally an integration of the neuroendoscope with a computer-assisted NEURONAVIGATION system, provides guidance in NEUROSURGICAL PROCEDURES. Neuroendoscopies
D019291 Skull Base The inferior region of the skull consisting of an internal (cerebral), and an external (basilar) surface. Basicranium,Cranial Base,Base of Skull,Basis cranii,Base, Cranial,Base, Skull
D019635 Neurosurgical Procedures Surgery performed on the nervous system or its parts. Procedures, Neurosurgical,Surgical Procedures, Neurologic,Neurologic Surgical Procedure,Neurologic Surgical Procedures,Neurosurgical Procedure,Procedure, Neurologic Surgical,Procedure, Neurosurgical,Procedures, Neurologic Surgical,Surgical Procedure, Neurologic
D020542 Third Ventricle A narrow cleft inferior to the CORPUS CALLOSUM, within the DIENCEPHALON, between the paired thalami. Its floor is formed by the HYPOTHALAMUS, its anterior wall by the lamina terminalis, and its roof by EPENDYMA. It communicates with the FOURTH VENTRICLE by the CEREBRAL AQUEDUCT, and with the LATERAL VENTRICLES by the interventricular foramina. 3rd Ventricle,3rd Ventricles,Third Ventricles,Ventricle, 3rd,Ventricle, Third,Ventricles, 3rd,Ventricles, Third

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