Sellar and parasellar lesions: multidisciplinary management

Area of Science:

• Neurosurgery
• Endoscopic Skull Base Surgery

Background:

• The endoscopic endonasal transsphenoidal approach is increasingly utilized for sellar and parasellar region lesions.
• Endoscopic visualization enhances tumor removal completeness in ventral skull base surgery.
• Detailed anatomical knowledge is essential for this surgical technique.

Purpose of the Study:

• To evaluate the efficacy and outcomes of the endoscopic endonasal approach for sellar and parasellar lesions.
• To analyze surgical complications and endocrinological disturbances associated with the procedure.

Main Methods:

• A retrospective analysis of 153 patients undergoing endoscopic endonasal approach for sellar/parasellar lesions from February 2009 to March 2020.
• Lesions included pituitary adenomas, craniopharyngiomas, Rathke's cysts, meningioma, aneurysm, chordoma, and others.
• Data collected on surgical complications, endocrinological outcomes, and disease recurrence.

Main Results:

• Common complications included cerebrospinal fluid leak (9), bleeding (2), and pituitary abscess (2).
• Endocrinological issues comprised diabetes insipidus (23) and panhypopituitarism (3).
• No visual worsening or operative mortality occurred; 20 cases had persistent disease, and 12 required reoperation for recurrence.

Conclusions:

• Preoperative planning and multidisciplinary specialist collaboration are vital for successful treatment.
• The endoscopic endonasal approach can achieve favorable outcomes for ventral skull base pathologies.
• Minimizing complications requires meticulous surgical technique and comprehensive patient management.