Endoscopic endonasal transsphenoidal approach to the sellar region: results of endoscopic dissection on 30 cadavers.
OBJECTIVE
To recognize the endoscopic anatomy of the surgical corridor along the nasal cavity, sphenoidal sinus and the sellar area to delineate the pure endoscopic endonasal transsphenoidal approach (EETSA) to the region of the pituitary gland.


METHODS
The endoscopic anatomy of the nasal cavity, sphenoid sinus and the sellar region was studied in 30 fresh cadavers (mean age 42.1 / range 18-66) and dissections were performed in a stepwise manner to simulate EETSA to the sellar region.


RESULTS
The sphenoid ostium, located 14.9 mm superior to the choana, was identified at the midpoint between the nasal septum and the superior turbinate in 23 specimens. The shape of the sphenoid ostium was linear (35%), fusiform (30%), oval(22%) or circular (13%). The mean width of the pituitary gland was 14.3 mm and the average minimum distance between the internal carotid arteries on both sides ranged between 13 to 22 mm. Following total hypophysectomy in 12 specimens, the width and length of diaphragma sellae was measured 10.83 and 5.83 mms respectively.


CONCLUSIONS
This study documents that variations are common in nasal, sphenoidal and sellar phases of the trans-sphenoidal approach. Detailed knowledge of the basic anatomical relationships through the view of the endoscope and performing endoscopic dissections in large number of specimens will facilitate the endoscopic surgical procedures and decrease the rate of surgical complications.
Abuzayed
Bashar
B
Istanbul University Cerrahpasa Medical Faculty, Department of Neurosurgery, Istanbul, Turkey.
Tanriöver
Necmettin
N
Ozlen
Fatma
F
Gazioğlu
Nurperi
N
Ulu
Mustafa Onur
MO
Kafadar
Ali Metin
AM
Eraslan
Berna
B
Akar
Ziya
Z
D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D004210:Dissection; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D009296:Nasal Cavity / Q000033:anatomy & histology / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods*; D012658:Sella Turcica / Q000033:anatomy & histology* / Q000601:surgery*; D019291:Skull Base / Q000033:anatomy & histology / Q000601:surgery; D013100:Sphenoid Bone / Q000033:anatomy & histology* / Q000601:surgery*; D055815:Young Adult