Surgical Experience of Transsphenoidal Supradiaphragmatic Intradural Approach to Presellar and Suprasellar Lesions.

Park, Min Woo; Kim, Jae Min; Kim, Jae Hoon; Bak, Koang Hum; Kim, Choong Hyun; Jeong, Jin Hyeok

Original Article

Journal of Korean Neurosurgical Society 2006;39(5): 329-334.

Min Woo Park, Jae Min Kim, Jae Hoon Kim, Koang Hum Bak, Choong Hyun Kim, Jin Hyeok Jeong

¹Department of Neurosurgery, Hanyang University Guri Hospital, College of Medicine, Guri, Korea. kjm2323@hanyang.ac.kr
²Department of Otolaryngology, Hanyang University Guri Hospital, College of Medicine, Guri, Korea.

ABSTRACT

OBJECTIVE
In selected cases, the transsphenoidal approach(TSA) can be extended anteriorly to the tuberculum sellae, chiasmatic sulcus, and planum sphenoidale to obtain direct exposure of the suprasellar cisterns and its contents. We applied this modification of the TSA to various lesions of the presellar and suprasellar areas. We evaluate our clinical experience of this technique and review the related literature.
METHODS
From 1999 to 2004, we used the transsphenoidal supradiaphragmatic intradural approachs(TSIAs) in 9 patients who had various lesions at the pre- and suprasellar regions. Concomitant presellar extension of the bone window was performed with the sublabial or transnasal transseptal transphenoidal techniques. After removal of the lesions, sellar or anterior cranial floor was repaired with silicone plate substitute.
RESULTS
The TSIAs have been applied in the following cases: four tuberculum sellae meningiomas, two craniopharyngiomas, two Rathke's cleft cysts, and one non-functioning macroadenoma. The complications were one case of visual acuity decrease and one cerebrospinal fluid rhinorrhea.
CONCLUSION
The TSIA is easily applicable through a minor modification of the standard TSA. It is suitable for removing lesions located in the presellar and suprasellar area adjacent to the pituitary stalk with minimal brain manipulation and decreased morbidity.

Key Words: Transsphenoidal supradiaphragmatic intradural approach; Presellar region; Suprasellar region; Craniopharyngioma; Tuberculum sellae meningioma