Endoscopic transsphenoidal approach: adaptability of the procedure to different sellar lesions.
OBJECTIVE
To demonstrate the flexibility of the endoscopic transsphenoidal approach, with respect to nasal and paranasal anatomic features and the extension of different sellar lesions, for customization of the procedure for specific conditions.


METHODS
In 16 of 170 consecutive endoscopic transsphenoidal operations, some modifications of the standard approach were adopted to optimize surgical removal of different lesions. These modifications consisted of a hemisphenoidotomy, a partial ethmoidectomy, extended sellar floor opening toward the planum sphenoidale or the clivus, enlarged opening of the sphenoid ostium area with ipsilateral removal of the superior turbinate, and a bilateral approach.


RESULTS
The endoscopic endonasal procedure is easily adaptable to different specific conditions, with slight changes in the standard approach (more or less invasive). Therefore, this surgical procedure is satisfactory for different lesion locations and for the nasal and paranasal sinus anatomic features of individual patients.


CONCLUSIONS
The endoscopic surgical route should be tailored to different sellar lesions, and some modifications of the procedure are recommended in selected cases.
Division of Neurosurgery, Department of Neurological Sciences, Federico II University of Naples, Naples, Italy.
Enrico
E
de Divitiis
Paolo
P
Cappabianca
Luigi Maria
LM
Cavallo
D000236:Adenoma / Q000601:surgery; D002426:Cavernous Sinus / Q000473:pathology; D020863:Central Nervous System Cysts / Q000601:surgery; D002817:Chordoma / Q000601:surgery; D003388:Cranial Fossa, Posterior; D004724:Endoscopy; D006801:Humans; D009361:Neoplasm Invasiveness; D019635:Neurosurgical Procedures; D010911:Pituitary Neoplasms / Q000601:surgery; D012189:Retrospective Studies; D012658:Sella Turcica / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000601:surgery; D013101:Sphenoid Sinus / Q000601:surgery