title: Transsphenoidal Approach in Endoscopic Endonasal Surgery for Skull Base Lesions: What Radiologists and Surgeons Need to Know.
abstract: In the last 2 decades, endoscopic endonasal transsphenoidal surgery has become the most popular choice of neurosurgeons and otolaryngologists to treat lesions of the skull base, with minimal invasiveness, lower incidence of complications, and lower morbidity and mortality rates compared with traditional approaches. The transsphenoidal route is the surgical approach of choice for most sellar tumors because of the relationship of the sphenoid bone to the nasal cavity below and the pituitary gland above. More recently, extended approaches have expanded the indications for transsphenoidal surgery by using different corridors leading to specific target areas, from the crista galli to the spinomedullary junction. Computer-assisted surgery is an evolving technology that allows real-time anatomic navigation during endoscopic surgery by linking preoperative triplanar radiologic images and intraoperative endoscopic views, thus helping the surgeon avoid damage to vital structures. Preoperative computed tomography is the preferred modality to show bone landmarks and vascular structures. Radiologists play an important role in surgical planning by reporting extension of sphenoid pneumatization, recesses and septations of the sinus, and other relevant anatomic variants. Radiologists should understand the relationships of the sphenoid bone and skull base structures, anatomic variants, and image-guided neuronavigation techniques to prevent surgical complications and allow effective treatment of skull base lesions with the endoscopic endonasal transsphenoidal approach.
authors.affiliation: From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.).
authors.forename: Elena
authors.initials: E
authors.lastname: García-Garrigós
authors.affiliation: From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.).
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Arenas-Jiménez
authors.affiliation: From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.).
authors.forename: Irene
authors.initials: I
authors.lastname: Monjas-Cánovas
authors.affiliation: From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.).
authors.forename: Javier
authors.initials: J
authors.lastname: Abarca-Olivas
authors.affiliation: From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.).
authors.forename: Jesús Julián
authors.initials: JJ
authors.lastname: Cortés-Vela
authors.affiliation: From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.).
authors.forename: Javier
authors.initials: J
authors.lastname: De La Hoz-Rosa
authors.affiliation: From the Departments of Radiology (E.G.G., J.J.A.J., J.D.L.H.R., M.D.G.R.), Otolaryngology (I.M.C.), and Neurosurgery (J.A.O.), Hospital General Universitario de Alicante, Avenida Pintor Baeza 12, 03010 Alicante, Spain; and Department of Radiology, Complejo Hospitalario la Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain (J.J.C.V.).
authors.forename: Maria Dolores
authors.initials: MD
authors.lastname: Guirau-Rubio
mesh_terms: D006801:Humans; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D019292:Skull Base Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D013101:Sphenoid Sinus / Q000000981:diagnostic imaging; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*