[Basic Approach : Transsphenoidal Approach (Nasal and Sphenoid Phase)]

Area of Science:

• Neurosurgery
• Otolaryngology
• Endoscopic Skull Base Surgery

Background:

• Endoscopic endonasal transsphenoidal surgery is a key minimally invasive technique for skull base pathologies, especially pituitary tumors.
• Technological advancements enhance visualization and navigation, enabling direct transnasal access to the skull base.

Purpose of the Study:

• To provide a comprehensive guide to the endoscopic endonasal transsphenoidal approach.
• To detail essential anatomical landmarks and surgical techniques for safe and effective skull base access.

Main Methods:

• Detailed description of nasal cavity expansion, sphenoid sinus access, and sellar floor opening.
• Emphasis on key anatomical landmarks: ethmoid sinus lamellar concept, sphenoid ostium, and carotid artery relationships.
• Guidance on mucosal incision, septal preservation, bone removal, and CSF leak prevention strategies.

Main Results:

• The approach allows safe and effective access to the sella and adjacent skull base structures.
• Enhanced intraoperative orientation and safety are achieved through understanding critical anatomical relationships.
• Standardized techniques facilitate reconstruction and minimize complications like cerebrospinal fluid leakage.

Conclusions:

• This chapter provides a foundational understanding of endoscopic endonasal transsphenoidal surgery.
• Systematic anatomical knowledge and standardized techniques are vital for surgeons transitioning to advanced skull base procedures.