Rerum magistra experientia est: The Evolution of Modern Endoscopic Endonasal Skull Base Surgery and Reconstruction Techniques

Abstract

istorically, surgical management of suprasellar lesions has been done by different transcranial approaches H including the subfrontal, frontolateral, and pterional routes. Nevertheless, in the past decades, the evolution of the transsphenoidal technique and the technological progress has favored the introduction and diffusion of the extended transsphenoidal approaches to the skull base. This was first described by Weiss (19), creating a paradigm in transsphenoidal surgery, with opening a new corridor to the suprasellar space. The transtuberculum-transplanum approach provides a direct route to the sellar suprasellar area, ensuring unrivalled visualization of the undersurface of the optic chiasm, third ventricle, pituitary stalk, and hypothalamus. The close visualization of the infrachiasmatic perforators from the carotid, the basilar, the posterior cerebral, and the posterior communicating arteries ensure a direct bimanual tumor dissection of critical neurovascular structures. Finally, the transtuberculum-transplanum pathway provides a direct midline and minimally invasive approach to the suprasellar region, without any brain retraction.