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Evolution of Minimally Invasive Approaches to the Sella and Parasellar Region
Introduction Given advancements in endoscopic image quality, instrumentation, surgical navigation, skull base closure techniques, and anatomical understanding, the endonasal endoscopic approach has rapidly evolved into a widely utilized technique for removal of sellar and parasellar tumors. Although...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Thieme Publicações Ltda
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4399582/ https://www.ncbi.nlm.nih.gov/pubmed/25992138 http://dx.doi.org/10.1055/s-0034-1395265 |
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author | Louis, Robert G. Eisenberg, Amy Barkhoudarian, Garni Griffiths, Chester Kelly, Daniel F. |
author_facet | Louis, Robert G. Eisenberg, Amy Barkhoudarian, Garni Griffiths, Chester Kelly, Daniel F. |
author_sort | Louis, Robert G. |
collection | PubMed |
description | Introduction Given advancements in endoscopic image quality, instrumentation, surgical navigation, skull base closure techniques, and anatomical understanding, the endonasal endoscopic approach has rapidly evolved into a widely utilized technique for removal of sellar and parasellar tumors. Although pituitary adenomas and Rathke cleft cysts constitute the majority of lesions removed via this route, craniopharyngiomas, clival chordomas, parasellar meningiomas, and other lesions are increasingly removed using this approach. Paralleling the evolution of the endonasal route to the parasellar region, the supraorbital eyebrow craniotomy has also been increasingly used as an alternative minimally invasive approach to reach this skull base region. Similar to the endonasal route, the supraorbital route has been greatly facilitated by advances in endoscopy, along with development of more refined, low-profile instrumentation and surgical navigation technology. Objectives This review, encompassing both transcranial and transsphenoidal routes, will recount the high points and advances that have made minimally invasive approaches to the sellar region possible, the evolution of these approaches, and their relative indications and technical nuances. Data Synthesis The literature is reviewed regarding the evolution of surgical approaches to the sellar region beginning with the earliest attempts and emphasizing technological advances, which have allowed the evolution of the modern technique. The surgical techniques for both endoscopic transsphenoidal and supraorbital approaches are described in detail. The relative indications for each approach are highlighted using case illustrations. Conclusions Although tremendous advances have been made in transitioning toward minimally invasive transcranial and transsphenoidal approaches to the sella, further work remains to be done. Together, the endonasal endoscopic and the supraorbital endoscope-assisted approaches are complementary minimally invasive routes to the parasellar region. |
format | Online Article Text |
id | pubmed-4399582 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Thieme Publicações Ltda |
record_format | MEDLINE/PubMed |
spelling | pubmed-43995822015-05-19 Evolution of Minimally Invasive Approaches to the Sella and Parasellar Region Louis, Robert G. Eisenberg, Amy Barkhoudarian, Garni Griffiths, Chester Kelly, Daniel F. Int Arch Otorhinolaryngol Article Introduction Given advancements in endoscopic image quality, instrumentation, surgical navigation, skull base closure techniques, and anatomical understanding, the endonasal endoscopic approach has rapidly evolved into a widely utilized technique for removal of sellar and parasellar tumors. Although pituitary adenomas and Rathke cleft cysts constitute the majority of lesions removed via this route, craniopharyngiomas, clival chordomas, parasellar meningiomas, and other lesions are increasingly removed using this approach. Paralleling the evolution of the endonasal route to the parasellar region, the supraorbital eyebrow craniotomy has also been increasingly used as an alternative minimally invasive approach to reach this skull base region. Similar to the endonasal route, the supraorbital route has been greatly facilitated by advances in endoscopy, along with development of more refined, low-profile instrumentation and surgical navigation technology. Objectives This review, encompassing both transcranial and transsphenoidal routes, will recount the high points and advances that have made minimally invasive approaches to the sellar region possible, the evolution of these approaches, and their relative indications and technical nuances. Data Synthesis The literature is reviewed regarding the evolution of surgical approaches to the sellar region beginning with the earliest attempts and emphasizing technological advances, which have allowed the evolution of the modern technique. The surgical techniques for both endoscopic transsphenoidal and supraorbital approaches are described in detail. The relative indications for each approach are highlighted using case illustrations. Conclusions Although tremendous advances have been made in transitioning toward minimally invasive transcranial and transsphenoidal approaches to the sella, further work remains to be done. Together, the endonasal endoscopic and the supraorbital endoscope-assisted approaches are complementary minimally invasive routes to the parasellar region. Thieme Publicações Ltda 2014-10 /pmc/articles/PMC4399582/ /pubmed/25992138 http://dx.doi.org/10.1055/s-0034-1395265 Text en © Thieme Medical Publishers |
spellingShingle | Article Louis, Robert G. Eisenberg, Amy Barkhoudarian, Garni Griffiths, Chester Kelly, Daniel F. Evolution of Minimally Invasive Approaches to the Sella and Parasellar Region |
title | Evolution of Minimally Invasive Approaches to the Sella and Parasellar Region |
title_full | Evolution of Minimally Invasive Approaches to the Sella and Parasellar Region |
title_fullStr | Evolution of Minimally Invasive Approaches to the Sella and Parasellar Region |
title_full_unstemmed | Evolution of Minimally Invasive Approaches to the Sella and Parasellar Region |
title_short | Evolution of Minimally Invasive Approaches to the Sella and Parasellar Region |
title_sort | evolution of minimally invasive approaches to the sella and parasellar region |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4399582/ https://www.ncbi.nlm.nih.gov/pubmed/25992138 http://dx.doi.org/10.1055/s-0034-1395265 |
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