Endoscopic Surgery of Sellar and Suprasellar Tumors

Objective: Transnasal endoscopic surgery of the sella and suprasellar region has been increasingly utilized by skull base surgeons. A dual surgeon approach, with an otolaryngologist and neurosurgeon operating together, provides excellent visualization and operative maneuverability. We describe our experience with this method, including operative techniques, complications, and sinonasal sequelae. Study Design: Retrospective case review Methods: Medical records for patients who underwent transnasal endoscopic surgery for sellar and suprasellar lesions were examined. Preand post-operative imaging, videographic records, and pathology were reviewed. Results: Tumor pathology in patients who underwent transnasal endoscopic surgery for sellar and suprasellar lesions included pituitary and hypothalamic lesions, esthesioneuroblastomas, and meningiomas. Complete tumor removal was achieved in nearly all patients. The incidence of diabetes insipidus post-operatively was rare. The incidence of post-operative CSF leak was 6%. Most patients were discharged from the hospital in 3-4 days. Sinonasal complaints were frequent in the first few months, but gradually diminished over time. Conclusions: Transnasal endoscopic surgery of the sella and suprasellar region of the anterior skull base provides superior visualization and exposure, allowing complete extirpation of tumor. A dual surgeon technique allows maximal maneuverability of instruments within the operative field. A multilayered repair of the sellar defect decreases the risk of CSF leak. Post-operative care of the sinonasal cavity is a critical part of a patient’s successful recovery.