Evolution of Minimally Invasive Approaches to the Sella and Parasellar Region

Introduction: Given advancements in endoscopic image quality, instrumentation, surgical navigation, skull base closure techniques, and anatomical understanding, the endonasal endoscopic approach has rapidly evolved into a widely utilized technique for removal of sellar and parasellar tumors. Although pituitary adenomas and Rathke cleft cysts constitute the majority of lesions removed via this route, craniopharyngiomas, clival chordomas, parasellar meningiomas, and other lesions are increasingly removed using this approach. Paralleling the evolution of the endonasal route to the parasellar region, the supraorbital eyebrow craniotomy has also been increasingly used as an alternative minimally invasive approach to reach this skull base region. Similar to the endonasal route, the supraorbital route has been greatly facilitated by advances in endoscopy, along with development of more refined, low-profile instrumentation and surgical navigation technology. Objectives: This review, encompassing both transcranial and transsphenoidal routes, will recount the high points and advances that have made minimally invasive approaches to the sellar region possible, the evolution of these approaches, and their relative indications and technical nuances. Data Synthesis: The literature is reviewed regarding the evolution of surgical approaches to the sellar region beginning with the earliest attempts and emphasizing technological advances, which have allowed the evolution of the modern technique. The surgical techniques for both endoscopic transsphenoidal and supraorbital approaches are described in detail. The relative indications for each approach are highlighted using case illustrations. Conclusions: Although tremendous advances have been made in transitioning toward minimally invasive transcranial and transsphenoidal approaches to the sella, furtherwork remains to be done. Together, the endonasal endoscopic and the supraorbital endoscope-assisted approaches are...

As variações na anatomia do seio esfenoidal e assoalho selar para realização de endoscopia transesfenoidal em adultos: revisão de literatura / The variations in anatomy of the sphenoid sinus and sellar floor to perform transsphenoidal endoscopy in adult age: a literature review

A cirurgia transesfenoidal depende da habilidade de visualizar e identificar referências anatômicas chaves durante cada fase da operação. Um grau notável de variação anatômica existe no seio esfenoidal, sela túrcica e estruturas ao redor da base do crânio. Nosso objetivo é revisar as variações anatômicas no seio esfenoidal e assoalho selar que são importantes para realizar uma cirurgia endoscópica transesfenoidal de modo efetivo e seguro em pacientes adultos. Uma detalhada informação em relação a anatomia é o meio mais confiável e efetivo de evitar complicações de todos os tipos na cirurgia transesfenoidal.