Int Arch Otorhinolaryngol 2014; 18(S 02): S136-S148
DOI: 10.1055/s-0034-1395265
Review Article
Thieme Publicações Ltda Rio de Janeiro, Brazil

Evolution of Minimally Invasive Approaches to the Sella and Parasellar Region

Robert G. Louis
1  Brain Tumor Center & Pituitary Disorders Program, John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California, United States
,
Amy Eisenberg
1  Brain Tumor Center & Pituitary Disorders Program, John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California, United States
,
Garni Barkhoudarian
1  Brain Tumor Center & Pituitary Disorders Program, John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California, United States
,
Chester Griffiths
1  Brain Tumor Center & Pituitary Disorders Program, John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California, United States
,
Daniel F. Kelly
1  Brain Tumor Center & Pituitary Disorders Program, John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, California, United States
› Author Affiliations
Further Information

Publication History

17 May 2014

03 July 2014

Publication Date:
10 October 2014 (online)

  

Abstract

Introduction Given advancements in endoscopic image quality, instrumentation, surgical navigation, skull base closure techniques, and anatomical understanding, the endonasal endoscopic approach has rapidly evolved into a widely utilized technique for removal of sellar and parasellar tumors. Although pituitary adenomas and Rathke cleft cysts constitute the majority of lesions removed via this route, craniopharyngiomas, clival chordomas, parasellar meningiomas, and other lesions are increasingly removed using this approach. Paralleling the evolution of the endonasal route to the parasellar region, the supraorbital eyebrow craniotomy has also been increasingly used as an alternative minimally invasive approach to reach this skull base region. Similar to the endonasal route, the supraorbital route has been greatly facilitated by advances in endoscopy, along with development of more refined, low-profile instrumentation and surgical navigation technology.

Objectives This review, encompassing both transcranial and transsphenoidal routes, will recount the high points and advances that have made minimally invasive approaches to the sellar region possible, the evolution of these approaches, and their relative indications and technical nuances.

Data Synthesis The literature is reviewed regarding the evolution of surgical approaches to the sellar region beginning with the earliest attempts and emphasizing technological advances, which have allowed the evolution of the modern technique. The surgical techniques for both endoscopic transsphenoidal and supraorbital approaches are described in detail. The relative indications for each approach are highlighted using case illustrations.

Conclusions Although tremendous advances have been made in transitioning toward minimally invasive transcranial and transsphenoidal approaches to the sella, further work remains to be done. Together, the endonasal endoscopic and the supraorbital endoscope-assisted approaches are complementary minimally invasive routes to the parasellar region.