Endocrine Abstracts

The endoscopic endonasal approach, initially reserved only for sellar lesions, is a continuous evolving speciality of modern neurosurgery, which requires precise anatomical knowledge, technical skills and integrated appreciation of the pathology dealt with. Nowadays, it represents a minimally invasive approach to deal with several diseases interesting mostly the entire skull base – namely the suprasellar, retrosellar and parasellar spaces – obviating brain retraction. The endoscopic endonasal approach offers some advantages arising from the use of the endoscope itself: a superior close-up view of the relevant anatomy and an enlarged working angle with an increased panoramic vision inside the surgical area.

Most pituitary adenomas can be managed and removed through a standard transsphenoidal approach either microscopic or endoscopic. Nevertheless, several cases, present some features such as dumbbell shape or para/suprasellar extension and/or fibrous or rubbery consistency – high likely in case of recurrence tumors –, that somehow hinder such route. More recently, the introduction of the endoscope in the extended endoscopic endonasal approach has definitely afforded its widespread so that, nowadays this technique can be considered suitable for removal of lesions extending beyond the sellar area such as parasellar, suprasellar and/or retrosellar spaces.

We have been employing the endoscopic endonasal technique since 1997 on more than 1000 patients aiming to remove first sellar and, recently, skull base lesions applying the so-called extended endonasal approach. Namely, in the management of invasive pituitary adenomas this technique allowed us to use two surgical corridors the conventional endosellar extra-arachnoidal and a suprasellar trans-arachnoidal.

We, though, report our experience throughout a step-by-step depiction of the surgical techniques to access the different compartments, detailing the anatomy as seen from the endonasal perspective, focusing on the ‘dangerous landmarks’, describing possible complications and the techniques to manage this kind of lesions.

Declaration of interest: The author declares that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.