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Acta Neurochirurgica

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01-06-2021 | Pituitary Adenoma | How I Do it - Pituitaries

Techniques and challenges of the expanded endoscopic endonasal sellar and parasellar approaches to invasive pituitary tumors

Authors: Thaïs Cristina Rejane-Heim, Giuliano Silveira-Bertazzo, Ricardo L. Carrau, Daniel M. Prevedello

Published in: Acta Neurochirurgica | Issue 6/2021

Abstract

Background

Superb knowledge of surgical anatomy and nuances to remove the natural barriers preventing full access to the paramedian skull base determines the ease of using the expanded sellar/parasellar approaches as the main gateway for all the parasagittal modules during endoscopic endonasal access (EEA) to pituitary tumors with cavernous sinus (CS) invasion.

Methods

Throughout stepwise-cadaveric dissections and pertinent intraoperative analysis, we describe surgical pearls and pitfalls of the parasellar-EEA with special references to the utility of various lines/classifications on neuroimaging correlated with strategies to enhance surgical safety and tumor resection.

Conclusion

EEA to invasive parasellar pathologies needs to address strict bleeding control and displacement of neurovascular structures inside the CS, posing a chance for neurologic morbidities/ICA injury. Meticulous utilization of operative landmarks and strategies can help avoid and mitigate surgical complications.

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Almeida JP, Ruiz-Treviño AS, Liang B, Omay SB, Shetty SR, Chen Y-N, Anand VK, Grover K, Christos P, Schwartz TH (2018) Reoperation for growth hormone-secreting pituitary adenomas: report on an endonasal endoscopic series with a systematic review and meta-analysis of the literature. J Neurosurg 129(2):404–416CrossRef

Dhandapani S, Singh H, Negm HM, Cohen S, Anand VK, Schwartz TH (2016) Cavernous sinus invasion in pituitary adenomas: systematic review and pooled data meta-analysis of radiologic criteria and comparison of endoscopic and microscopic surgery. World Neurosurg 96:36–46CrossRef

Harris FS, Rhoton AL (1976) Anatomy of the cavernous sinus: a microsurgical study. J Neurosurg 45(2):169–180CrossRef

Hofstetter CP, Shin BJ, Mubita L, Huang C, Anand VK, Boockvar JA, Schwartz TH (2011) Endoscopic endonasal transsphenoidal surgery for functional pituitary adenomas. Neurosurg Focus 30(4):E10CrossRef

Kassam AB, Prevedello DM, Thomas A, Gardner P, Mintz A, Snyderman C, Carrau R (2008) Endoscopic endonasal pituitary transposition for a transdorsum sellae approach to the interpeduncular cistern. Neurosurgery 62(3 Suppl 1):54–57

Micko ASG, Wöhrer A, Wolfsberger S, Knosp E (2015) Invasion of the cavernous sinus space in pituitary adenomas: endoscopic verification and its correlation with an MRI-based classification. J Neurosurg 122(4):803–811CrossRef

Nishioka H, Fukuhara N, Horiguchi K, Yamada S (2014) Aggressive transsphenoidal resection of tumors invading the cavernous sinus in patients with acromegaly: predictive factors, strategies, and outcomes. J Neurosurg 121(3):505–510CrossRef

Rejane-Heim TC, Silveira-Bertazzo G, Carrau RL, Prevedello DM (2021) Surgical anatomy and nuances of the expanded endonasal transdorsum sellae and posterior clinoidectomy approach to the interpeduncular and prepontine cisterns: a stepwise cadaveric dissection of various pituitary gland transpositions. Acta Neurochir 163(2):407–413CrossRef

Silveira-Bertazzo G, Martinez-Perez R, Carrau RL, Prevedello DM (2021) Surgical anatomy and nuances of the expanded transpterygoid approach to the pterygopalatine fossa and upper parapharyngeal space: a stepwise cadaveric dissection. Acta Neurochir 163(2):415–421CrossRef

10.

Truong HQ, Lieber S, Najera E, Alves-Belo JT, Gardner PA, Fernandez-Miranda JC (2018) The medial wall of the cavernous sinus. Part 1: surgical anatomy, ligaments, and surgical technique for its mobilization and/or resection. J Neurosurg 131(1):122–130CrossRef

Title: Techniques and challenges of the expanded endoscopic endonasal sellar and parasellar approaches to invasive pituitary tumors
Authors: Thaïs Cristina Rejane-Heim
Giuliano Silveira-Bertazzo
Ricardo L. Carrau
Daniel M. Prevedello
Publication date: 01-06-2021
Publisher: Springer Vienna
Keyword: Pituitary Adenoma
Published in: Acta Neurochirurgica / Issue 6/2021
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-021-04805-3

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Techniques and challenges of the expanded endoscopic endonasal sellar and parasellar approaches to invasive pituitary tumors

Abstract

Background

Methods

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Conclusion

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