Extended endoscopic endonasal transsphenoidal approach to the suprasellar region: anatomic study and clinical considerations

The extended endoscopic endonasal approach to the suprasellar region was performed on 10 fresh adult cadavers to describe the anatomic landmarks and key surgical steps for safe performance of the surgical approach. The anatomic features and relationships of the sphenoidal ostia, sphenoidal sinus, and optic-carotid recess are described, as are four intradural suprasellar neurovascular structural areas, including the suprachiasmatic, subchiasmatic, retrosellar and ventricular regions. Various anatomic conditions may influence the use of the extended endoscopic endonasal approach. This approach provides a straight, midline approach to the suprasellar region and offers a multi-angled and close-up view of the relevant neurovascular structures. For clinical use, the most important surgery-related complications concern the management of operative bleeding and the prevention of postoperative cerebrospinal fluid leakage.