Expanded Endonasal Approach: A Review of the Transsellar Approach to Skull Base Pathology in 306 Patients

Introduction: For the last century, transsphenoidal approaches have been used to access pathology in and around the sella. Using the expanded endonasal approach we have been able to access a variety of lesions not only in the sellar but also the parasellar location.

Methods: We have reviewed the pathology as well as complications associated with the transsellar approach to the skull base.

Results: From 1998 to 2007, over 700 patients have undergone the expanded endonasal approach to skull base pathology. In 306 patients we have utilized the transsellar module for benign (277/90.5%), malignant (9/2.9%), miscellaneous (7/2.3%), trauma (7/2.3%), inflammatory (1%), and infectious (1%) pathology. The most common lesions have been pituitary adenomas (235) and Rathke's cleft cysts (24). We have had a total complication rate of 5.2% with a neurologic-related complication rate of 3.5%. We have had two deaths and two patients with permanent neurologic deficits (both with permanent sixth nerve palsies).

Conclusions: The expanded endonasal approach can be used safely and effectively to access a variety of pathologies in the the sellar. Furthermore, we have been able to safely expand our surgical field into the parasellar region of the skull base.