Transnasal Transsphenoidal Approach to Sellar and Suprasellar Lesions

Indications

• The expanded endonasal transsphenoidal approach is employed for various pathologies involving the sella, suprasellar space, and sphenoid bone, including pituitary adenomas, Rathke pouch cyst, and craniopharyngiomas. Other indications include clival chordomas, meningiomas, metastatic lesions, and medial temporal lobe lesions such as encephaloceles.

• This approach is minimally traumatic to the brain, avoids brain retraction, does not create visible scars, provides excellent visualization of the pituitary, and is thought to cause less surgically related morbidity than transcranial approaches.

• This approach can be augmented with the use of an operative microscope and/or an endoscope. The operative microscope affords magnification, illumination, and three-dimensional viewing, and the endoscope expands the surgeon’s field of view. Both tools can be used simultaneously to complement each other. We typically do these procedures completely endoscopically.