Endoscopic Neuroanatomy through the Sphenoid Sinus

Abstract

Object: The aim of the study was to perform endoscopic anatomical studies of skull base structures through the sphenoid sinus in order to better understand endoscopic approaches to skull base lesions. Methods: Anatomical studies were performed on six cadavers using sinus endoscopes. The sphenoid sinus was entered via a sublabial nasoseptal approach. Stepwise removal of bone surrounding the sphenoid sinus was done to expose the suprasellar area, the retrosphenoid area and the cavernous sinus. The suprasellar dissection exposed the anterior communicating artery (ACom) complex, optic apparatus, pituitary stalk, lamina terminalis, third ventricle and pituitary gland. The retrosphenoid dissection exposed the mamillary bodies, basilar artery and its branches, the mid-brain, the pons, and the third, fifth, sixth, seventh and eighth cranial nerves. The cavernous sinus dissection exposed the carotid artery, and the third, fourth, fifth and the sixth cranial nerves. Conclusion: Through the sphenoid sinus, most of the structures in the suprasellar area, cavernous sinus and retrosphenoid area can be reached.

Key words

Anterior cranial fossa - brain stem - cavernous sinus - retrosphenoid - suprasellar - transsphenoidal

References

• 1 Hardy J. Transsphenoidal hypophysectomy.  J Neurosurg. 1971;  34 582-594
• 2 Wilson C B. A decade of pituitary microsurgery. The Herbert Olivecrona Lecture.  J Neurosurg. 1984;  61 814-833
• 3 Alifiery A, Jho H D. Endoscopic endonasal approach to the cavernous sinus. An anatomical study.  Neurosurgery. 2001;  48 1-11
• 4 Alfieri A, Jho H D. Endoscopic endonasal approaches to the cavernous sinus: surgical approaches.  Neurosurgery. 2001;  49 354-362
• 5 Divitis E de, Cappabianca P, Cavallo L M. Endoscopic transsphenoidal approach: adaptability of the procedure to different sellar lesions.  Neurosurgery. 2002;  51 699-707
• 6 Jho H D. Endoscopic endonasal approach to the optic nerve: a technical note.  Minim Invas Neurosurg. 2001;  44 190-193
• 7 Jho H D. The expanding role of endoscopy in skull-base surgery.  Clin Neurosurg. 2001;  48 278-305
• 8 Kato T, Sawamura Y, Abe R, Nagashima M. Transsphenoidal-transtuberculum sella approach for supradiaphragmatic tumors. Technical note.  Acta Neurochir (Wien). 1998;  140 715-719
• 9 Kaptain G, Vincent D, Sheehan J, Laws E. Transsphenoidal approaches for extracapsular resection of midline suprasellar and anterior cranial base lesions.  Neurosurgery. 2001;  49 94-101
• 10 Kitano M, Taneda M. Extended transphenoidal approach with submucosal posterior ethmoidectomy for parasellar tumors.  J Neurosurg. 2001;  99 999-1004
• 11 Kouri J, Chen M, Watson J, Oldfield E. Resection of suprasellar tumors by using a modified transsphenoidal approach.  J Neurosurg. 2000;  92 1028-1035
• 12 Lalwani A, Kaplan M, Gutin P. The transsphenoethmoid approach to the sphenoid sinus and clivus.  Neurosurgery. 1992;  31 1008-1014
• 13 Laws E R. Transsphenoidal microsurgery in the management of craniopharyngioma.  J Neurosurg. 1980;  52 661-666
• 14 Parkinson D. Surgical anatomy of the lateral sellar compartment (cavernous sinus).  Clin Neurosurg. 1990;  36 219-239
• 15 Rhoton A. The sellar region.  Neurosurgery. 2002;  51 (suppl 1) 335-374
• 16 Rhoton A. The cavernous sinus, the cavernous venous plexus, and the carotid collar.  Neurosurgery. 2002;  51 (suppl 1) 375-410
• 17 Perneczky A, Tschabitscher M, Resch K. Endoscopic Anatomy for Neurosurgery. Stuttgart, New York: Georg Thieme Verlag 1993
• 18 Spencer W R, Das K, Nwagu C, Wenk E, Schaefer S D, Moscatello A, Couldwell W T. Approaches to the sellar and parasellar region: anatomic comparison of the microscope versus endoscope.  Laryngoscope. 1999;  109 791-794