Surgical Approaches to Sellar Region

Introduction The sellar region is located in the center of the cranial base. A range of mass lesions can occur in and around the sella turcica. These lesions have distinctive features, which require different operative approaches. Over the past years, neurological and ENT surgeons used variety of transcranial, transsphenoidal, or combined approaches with the aid of operative microscope or endoscope.

Aim The purpose of this presentation is to discuss characteristics of patients' treatment with different surgical approaches to sellar region in different conditions in countries of South East Europe.

Material and Methods At the Clinic of Neurosurgery, Clinical Centre of Vojvodina in Novi Sad, we first used the microsurgical endonasal transseptal approach in 1984. In 2010, we performed the first endoscopy-assisted transsphenoidal surgery. After acquiring initial experience, we switched to pure endoscopic transsphenoidal surgery. We performed several operations with the use of endoscope holder before adopting the two nostrils four hands approach that we still use. All surgeries have been performed by a team consisting of a neurosurgeon and an ENT surgeon.

However, we still use transcranial approaches in cases where sellar lesion had a significant supra or parasellar extension. Depending on the location and the type of the lesion, we use three transcranial approaches: subfrontal, pterional, and subtemporal. In the case of one patient with two tumors, we used both approaches: first, the transcranial approach to remove olfactory groove meningioma, followed by the transsphenoidal approach to remove the intrasellar rest of large pituitary adenoma.

Conclusion The transsphenoidal approach (either microscopic or endoscopic) to the sella, which is more direct and less time consuming than a transcranial operation, has become the preferred approach for the resection of most sellar lesions, especially pituitary adenomas. Despite the limitations in accessing the intrasellar component and increased risk of morbidity and mortality, transcranial approaches have retained an important role in the treatment of certain sellar and suprasellar lesions, where they have been shown to offer considerable advantages over transsphenoidal approaches.

Keywords surgical approaches; sellar region