title: Extended endoscopic endonasal transsphenoidal approach to the suprasellar area: anatomic considerations--part 1.
abstract: BACKGROUND
  Interest in using the extended endonasal transsphenoidal approach for management of suprasellar lesions, with either a microscopic or endoscopic technique, has increased in recent years. The most relevant benefit is that this median approach permits the exposure and removal of suprasellar lesions without the need for brain retraction.
  
  
  METHODS
  Fifteen human cadaver heads were dissected to evaluate the surgical key steps and the advantages and limitations of the extended endoscopic endonasal transplanum sphenoidale approach. We compared this with the transcranial microsurgical view of the suprasellar area as explored using the bilateral subfrontal microsurgical approach, and with the anatomy of the same region as obtained through the endoscopic endonasal route.
  
  
  RESULTS
  Some anatomic conditions can prevent or hinder use of the extended endonasal approach. These include a low level of sphenoid sinus pneumatization, a small sella size with small distance between the internal carotid arteries, a wide intercavernous sinus, and a thick tuberculum sellae. Compared with the subfrontal transcranial approach, the endoscopic endonasal approach offers advantages to visualizing the subchiasmatic, retrosellar, and third ventricle areas.
  
  
  CONCLUSIONS
  The endoscopic endonasal transplanum sphenoidale technique is a straight, median approach to the midline areas around the sella that provides a multiangled, close-up view of all relevant neurovascular structures. Although a lack of adequate instrumentation makes it impossible to manage all structures that are visible with the endoscope, in selected cases, the extended endoscopic endonasal approach can be considered part of the armamentarium for surgical treatment of the suprasellar area.
authors.affiliation: Department of Neurological Sciences, Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy. lcavallo@unina.it
authors.forename: Luigi M
authors.initials: LM
authors.lastname: Cavallo
authors.forename: Oreste
authors.initials: O
authors.lastname: de Divitiis
authors.forename: Salih
authors.initials: S
authors.lastname: Aydin
authors.forename: Andrea
authors.initials: A
authors.lastname: Messina
authors.forename: Felice
authors.initials: F
authors.lastname: Esposito
authors.forename: Giorgio
authors.initials: G
authors.lastname: Iaconetta
authors.forename: Kiris
authors.initials: K
authors.lastname: Talat
authors.forename: Paolo
authors.initials: P
authors.lastname: Cappabianca
authors.forename: Manfred
authors.initials: M
authors.lastname: Tschabitscher