Rarely Used Endoscopic Transnasal Transdiaphragmatic Technique in Patients with Suprasellar Extension: A Tertiary Center's Experience with Eleven Patient Cases

Abstract

OBJECTIVEIn our age,as surgical techniques are advancing towards being less invasive,the use of endoscopy in brain surgery supports this trend.There are numerous endoscopic surgical approaches defined,especially for skull base pathologies.The current study summarizes our experience of using the rarely reported endoscopic transnasal transdiaphragmatic approach through the existing hole in the diaphragma sella to access lesions extending into the suprasellar region. METHODSOur surgical team performed 4876 endoscopic endonasal surgeries between August 1997 and December 2022 at the Department of Neurosurgery, Pituitary Research Center, Faculty of Medicine, Kocaeli University. The current study retrospectively analyzed data from 11 patients who underwent endoscopic transnasal transdiaphragmatic surgery since January 2020. Pre- and postoperative magnetic resonance imaging, pituitary function examination, and clinical observation was carried out. RESULTSThe mean age of the patients was 31.1±10.7 years and the female: male ratio was 6:5. Pathological subtypes observed included breast cancer metastasis(n=1), ACTH-secreting adenoma(n=4), GH-secreting adenoma(n=3), craniopharyngioma(n=2), and Rathke’s cleft cyst(n=1).The mean postoperative hospital stay was 4.7±1.1 days and none of the patients exhibited cerebrospinal fluid leakage during this period. CONCLUSIONSThe endoscopic transnasal transdiaphragmatic approach may be considered as an alternative for the conventional extended endoscopic transnasal approach in patients with lesions extending into the suprasellar region. The main strength of this method is that it facilitates suprasellar region access through a small dural incision and bone defect in the base of the skull. As a result, it also reduces the risk of postoperative cerebrospinal fluid leakage and associated complications.