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Neurosurgery

Transsphenoidal Approaches to the Sella and Suprasellar Re

Built from Feldman — Neurosurgical Operative Atlas: Neuro-Oncology

What’s inside

11 sections · 51 slides

  1. 01

    Overview

    • What this chapter teaches

    1 slide

  2. 02

    The problem and the anatomy

    Why go through the nose at all

    • The target: sella and suprasellar region
    • The transsphenoidal idea in one line
    • What these approaches are used to treat

    3 slides

  3. 03

    A century of evolution

    From Schloffer and Cushing to the endoscope

    • How the approach evolved
    • Why the early approaches added a septal dissection
    • The learning curve in numbers

    3 slides

  4. 04

    The three approaches

    Direct endonasal, sublabial, and transseptal

    • Three corridors to the same target
    • How the surgeon chooses
    • Transseptal approach to the sphenoid rostrum

    3 slides

  5. 05

    Before the operation

    Hormones, vision, and the MRI

    • Endocrine and neuro-ophthalmology work-up
    • Reading the preoperative MRI
    • When should you NOT do a transsphenoidal approach?
    • Macroadenoma with suprasellar extension on MRI

    4 slides

  6. 06

    The direct endonasal approach

    Positioning, instruments, and technique

    • Patient positioning
    • Skin prep and packing
    • Instruments for the endonasal route
    • Endonasal pituitary surgery instruments
    • Operating room and patient positioning
    • Navigating the nose to the sphenoid
    • Opening the sphenoid and the sella
    • Opening the dura safely

    8 slides

  7. 07

    Removing the tumor

    Order, landmarks, and pitfalls

    • Recognising and removing a macroadenoma
    • The two big pitfalls
    • Finishing the resection

    3 slides

  8. 08

    Closing up

    Sealing the sella and preventing CSF leak

    • Reconstructing the sella
    • When leaks are big — and final steps
    • The authors' endonasal experience

    3 slides

  9. 09

    Sublabial and transseptal routes

    Wider corridors for larger tumors

    • The sublabial approach step by step
    • Sublabial exposure and a key safety warning
    • The transseptal approach
    • Postoperative nasal packing by approach

    4 slides

  10. 10

    After surgery

    Fluids, sodium, hormones, and vision

    • Watching fluid balance and diabetes insipidus
    • Managing sodium and hormones
    • Hormones, vision, and antibiotics

    3 slides

  11. 11

    Takeaways

    The essence of the transsphenoidal approach

    • Key points to remember
    • What three principles define a successful transsphenoidal operation?
    • References (1/2)
    • References (2/2)
    • Neurosurgical Operative Atlas: Neuro-Oncology

    5 slides