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J Neurol Surg A Cent Eur Neurosurg 2024; 85(01): 007-013
DOI: 10.1055/s-0042-1759828
Original Article

Comparison of the Endoscopic Endonasal Approach with the Endoscopic Supraorbital Keyhole Approach to the Tuberculum Sellae Region: A Quantitatively Cadaveric Study

Junhao Zhu   *
1   Department of Neurosurgery, Medical School of Nanjing University, Affiliated Jinling Hospital, Nanjing, Jiangsu Province, China
,
Zixiang Cong   *
1   Department of Neurosurgery, Medical School of Nanjing University, Affiliated Jinling Hospital, Nanjing, Jiangsu Province, China
,
Jin Yang
1   Department of Neurosurgery, Medical School of Nanjing University, Affiliated Jinling Hospital, Nanjing, Jiangsu Province, China
,
Feng Yuan
1   Department of Neurosurgery, Medical School of Nanjing University, Affiliated Jinling Hospital, Nanjing, Jiangsu Province, China
,
Xiangming Cai
2   Medical School of Southeast University, Nanjing, Jiangsu Province, China
,
Chao Tang
1   Department of Neurosurgery, Medical School of Nanjing University, Affiliated Jinling Hospital, Nanjing, Jiangsu Province, China
,
Chaonan Du
1   Department of Neurosurgery, Medical School of Nanjing University, Affiliated Jinling Hospital, Nanjing, Jiangsu Province, China
,
Dongxia Feng
3   Department of Neurosurgery, Baylor Scott and White Medical Center, Temple, Texas, United States
,
Chiyuan Ma
1   Department of Neurosurgery, Medical School of Nanjing University, Affiliated Jinling Hospital, Nanjing, Jiangsu Province, China
2   Medical School of Southeast University, Nanjing, Jiangsu Province, China
4   Medical School of Southern Medical University, Guangzhou, Guangdong Province, China
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Abstract

Background The endoscopic endonasal approach (EEA) and the endoscopic supraorbital keyhole approach (eSKA) provide minimally invasive access to tuberculum sellae (TS) tumors. Evaluation of the operating maneuverability is helpful for approach selection. Herein, we compared the two approaches and aimed to provide quantitative anatomic data for surgical decision-making in the management of TS lesions.

Methods Fifteen dissections were performed on five silicone-injected cadaveric heads. The EEA and eSKA (both right and left) were performed on each head. Surgical freedom and working angles in the axial and sagittal planes were calculated using the stereotactic navigation system in the selected six targets: the midpoint of the leading edge of the sphenoid sinus (leSS), the midpoint of the edge of the dorsum sellae (eDS), the ipsilateral medial opticocarotid recess (imOCR), the contralateral medial opticocarotid recess (cmOCR), the ipsilateral lateral opticocarotid recess (ilOCR), and the contralateral lateral opticocarotid recess (clOCR).

Results The surgical freedom at the ilOCR and the axial working angles at the leSS, ilOCR, and imOCR (imOCR with excessive manipulation of the optic apparatus) were greater in the eSKA. The EEA provided greater surgical freedom and/or working angles at most targets than eSKA (the surgical freedom at the imOCR, cmOCR, clOCR, and eDS; the axial working angles at the cmOCR and clOCR; and the sagittal working angles at the leSS, imOCR, cmOCR, clOCR, and eDS).

Conclusion The EEA provides greater surgical freedom and working angles for paramedian lesions, whereas the eSKA provides better surgical maneuverability for lesions with lateral extension.

Keywords

endoscopic endonasal approach - supraorbital keyhole approach - tuberculum sellae region

Authors' Contributions

C.M. and D.F. designed the study. J.Z., Z.C., and J.Y. performed the anatomical study. J.Z. and Z.C. analyzed the data and wrote the manuscript. C.T., F.Y., C.D., and X.C. revised the final manuscript.


All the authors read and approved the final version of the manuscript.


* Junhao Zhu and Zixiang Cong contributed equally to this work.




Publication History

Received: 05 December 2021

Accepted: 01 September 2022

Article published online:
23 May 2023

© 2023. Thieme. All rights reserved.

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