Transsphenoidal transtuberculum sellae approach for suprasellar and midline anterior cranial fossa tumors

Abstract

The transsphenoidal approach has undergone several advancements since its introduction at the beginning of the 20 th century. The operative microscope illuminated and magnified the once dark and narrow corridor and intraoperative videofluoroscopy assured a safe trajectory to the sella. These advances allowed the transsphenoidal approach to become the dominant avenue for sellar lesions. Nevertheless, relative contraindications for the transsphenoidal route have included suprasellar tumors with an unexpanded sella and tumors with significant extension into the anterior cranial fossa. More recently, surgeons have begun to attack parasellar lesions once felt to require craniotomy. Aided by frameless stereotaxy and neuroendoscopy, the transsphenoidal approach has been modified to allow even these lesions to be under its purview. The authors' initial experience with these extended transsphenoidal skull base techniques will be discussed.