Endoscopic endonasal approach to sellar-suprasellar lesions

Abstract

The endoscopic endonasal approach through the transphenoidal and transtubercular access provides an excellent and panoramic view of the sellar-suprasellar lesions. The indications include pituitary adenomas, craniopharyngiomas, meningiomas, etc. The surgery is done using a zero-degree endoscope and, if required, angled endoscopes for resecting tumors around the corners. Tumors going lateral to the optic nerves are contraindications. Cerebrospinal fluid leak is a common complication of this skull base approach; however, it has been decreased significantly with the use of the nasoseptal mucosal flap. This educational video article describes a step-by-step approach to a case of pituitary macroadenoma, along with the indications, contraindications, advantages, limitations, complications, and their avoidance of this approach.