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Endoscopic anatomy of the sellar barrier: From the anatomical model to the operating room
Author(s) -
Villalonga Juan F.,
Fuchssteiner Christoph,
Solari Domenico,
Campero Alvaro,
Cavallo Luigi M.,
Cappabianca Paolo,
Hirtler Lena
Publication year - 2020
Publication title -
clinical anatomy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.667
H-Index - 71
eISSN - 1098-2353
pISSN - 0897-3806
DOI - 10.1002/ca.23566
Subject(s) - medicine , pituitary adenoma , cerebrospinal fluid leak , sella turcica , magnetic resonance imaging , transsphenoidal surgery , pituitary neoplasm , cerebrospinal fluid , radiology , pituitary gland , pathology , adenoma , hormone
Background The sellar barrier concept reflects the association between the components of the roof of the pituitary fossa and the risk of intraoperative cerebrospinal fluid (CSF) leak in the surgery of pituitary adenomas. We based our concept in previous reports on the microsurgical anatomy of the pituitary fossa's superior wall. However, proof of the usefulness of this concept in endoscopic approaches is yet missing. The aim of this study was to describe the endoscopic anatomy of the sellar barrier and its subtypes in a laboratory setting and to provide evidence of its clinical usefulness. Methods We provided anatomical models in six fresh‐frozen head and neck specimens. We performed an endoscopic endonasal approach and recreated a pathological model of each possible subtype of sellar barrier. To demonstrate the usefulness of this model in clinical practice, we conducted a prospective study including all patients with pituitary adenoma operated by an endoscopic approach between June and July 2019. Results We successfully recreated the models for each subtype of sellar barrier. When analyzing the clinical cases, we found that intraoperatively, 73.69% (14) had a strong sellar barrier; 21.05% (4) had mixed sellar barrier, and 5.26% (1) had weak sellar barrier. We recorded one case of intraoperative CSF leak in a patient with a weak sellar barrier by magnetic resonance imaging. Conclusion We described the endoscopic anatomy of the sellar barrier and we recreated the three subtypes in anatomical models. We also identified these subtypes in a series of clinical cases, proving its clinical usefulness.