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

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 appliedthis modification of the TSA to various lesions of the presellar and suprasellar areas. We evaluate our clinical experience ofthis technique and review the related literature. Methods : From 1999 to 2004, we used the transsphenoidal supradiaphragmatic intradural approachs(TSIAs) in 9 patientswho had various lesions at the pre- and suprasellar regions. Concomitant presellar extension of the bone window was performedwith the sublabial or transnasal transseptal transphenoidal techniques. After removal of the lesions, sellar or anteriorcranial 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 decreaseand one cerebrospinal fluid rhinorrhea. Conclusion : The TSIA is easily applicable through a minor modification of the standard TSA. It is suitable for removinglesions located in the presellar and suprasellar area adjacent to the pituitary stalk with minimal brain manipulation and decreased morbidity.