title: Endoscopic endonasal transsphenoidal "above and below" approach to the retroinfundibular area and interpeduncular cistern--cadaveric study and case illustrations.
abstract: OBJECTIVE
  To evaluate the feasibility of reaching the interpeduncular cistern (IC) through an endoscopic endonasal approach that leaves the pituitary gland in place.
  
  
  METHODS
  In a series of 10 injected cadaver heads, the transtuberculum ("above") and transclival ("below") approaches were combined, without pituitary transposition. Using 0-degree, 30-degree, and 45-degree endoscopes, the extent of overlap and if a blind spot occurred were determined. Also, the visualization of the IC was compared with the transposition of the pituitary gland approach. Nonparametric statistics were used to evaluate the results. The approach was implemented in 2 patients.
  
  
  RESULTS
  For both the "above" and "below" views, there was a statistically significant increase in field of view when comparing the 0-degree endoscope with either the 30-degree endoscope (P < 0.05) or the 45-degree endoscope (P < 0.05). There was no difference between the 30-degree endoscope and the 45-degree endoscope (P > 0.05) in the "below" approach, but there was a difference (P < 0.05) in the "above" approach. There was no blind spot with any combination of endoscopes. There was no practical statistically significant difference between the transposition approach and the "above and below" approach. The "above and below" approach was used successfully in 2 surgeries.
  
  
  CONCLUSIONS
  It is possible to work both "above" and "below" the pituitary gland to reach the IC through an endoscopic endonasal approach. The advantages are the maintenance of normal pituitary and parasellar anatomy and the minimization of the size of the skull base defect. There is no blind spot using this approach that would be revealed with a pituitary transposition. The feasibility of this approach has been confirmed in 2 patients.
authors.affiliation: Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA.
authors.forename: Danilo
authors.initials: D
authors.lastname: Silva
authors.affiliation: Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA.
authors.forename: Moshe
authors.initials: M
authors.lastname: Attia
authors.affiliation: Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA.
authors.forename: Jothy
authors.initials: J
authors.lastname: Kandasamy
authors.affiliation: Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA.
authors.forename: Marjan
authors.initials: M
authors.lastname: Alimi
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA.
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Anand
authors.affiliation: Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA; Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA; Department of Neurology and Neuroscience, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA. Electronic address: schwarh@med.cornell.edu.
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Schwartz
mesh_terms: D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D002102:Cadaver; D003388:Cranial Fossa, Posterior / Q000033:anatomy & histology / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D009666:Nose; D010902:Pituitary Gland / Q000033:anatomy & histology / Q000601:surgery; D010904:Pituitary Gland, Posterior / Q000033:anatomy & histology / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery*; D012658:Sella Turcica / Q000033:anatomy & histology; D019292:Skull Base Neoplasms / Q000473:pathology / Q000601:surgery*; D013100:Sphenoid Bone / Q000601:surgery*; D020542:Third Ventricle / Q000033:anatomy & histology