The Endoscopic Anatomical Study And Clinical Application Via Transsphenoidal Approach To The Sellar And Clivus

PartⅠAnatomical Study of Endoscopic Operation via the Transsphenoid Sinus ApproachObjective The endoscopic surgical study of the sphenoid sinus and sellar area via transsphenoidal approach was studied to establish an anatomic basis for surgical treatment . Methods 40 dry adult skulls were used to observe and measure , simulated surgical was performed on 10 adult cadaver head and some anatomic details were observed by endoscopy . Results Average distance between the anterior nasal spina to ostia of sphenoidal sinus was 55.00±4.50mm, The distance from central line to ostia of sphenoidal sinus was 3.00±2.20mm, the angle between sphenoid ostia and nasal base was 31.80±5.20o . The distances from sphenoid ostia to the anterior wall of sella was 16.00±3.50 mm, to optic strut was 11.00±2.30mm, to internal carotid eminence was 13.50±2.00 mm. 30% of optical nerve canal and 70% of internal carotid bugle on the area of lateral sphenoid sinus . The distances from midline of cellar floor to optic strut was 5.67±1.53mm, to internal carotid eminence was 5.39±1.38mm,to diaphragm was 9.97±1.42mm, to optic chiasm was 14.96±1.91mm, to internal carotid artery was 11.05±1.99mm, to oculomotor nerve was 13.81±1.82mm, to trochlear nerve was 15.15±1.53mm and to abducens nerve was 12.70±1.63mm respectively. By transsphenoidal approach ostia of sphenoidal sinus was exposed cleanly. In sphenoidal sinus optical nerve and internal carotid eminence bony of sellar floor were exposed. After removal of bony of sellar floor such anatomic structures such as dura of cellar floor, dura of clivus and medial wall of cavernous sinus were exposed. after removal of dura of sellar floor and sellar diaphragm, optic nerve,chiasm,pituilary bland, and hypothalamus were exposed. Conclusion: The anatomic structures of ostia of sphenoidal, sinus sellar and parasellar regions can be clearly through the transnaso-sphenoidal approach which is available to surgery for lesions located in parasellar and supersellar regions.PartⅡThe Endoscopic Anatomic Study via the Transsphenoidal Approach to the ClivusObjective The endoscopic surgical study of the clivus via the transsphenoidal approach was studied to establish an anatomic basis for surgical treatment . Methods 40 dry adult skulls were used to observe and measure , simulated surgical was performed on 10 adult cadaver head and some anatomic details were observed by endoscopy . Results Average distance between the anterior nasal spina to ostia of sphenoidal sinus , tuberculum sellae , root of sellar area , dorsum sellae , cranial entrance of internal carotid artery and optic canal , anterior part of great occipital foramen were 55.62±4.23mm, 71.50±6.21, 79.02±4.97 mm, 81.04±8.02 mm, 68.39±6.42 mm, 67.96±6.45 mm, 91.08±5.20mm respectively . The angle between root of nasal cavity and those structures were 32.09±3.90 o, 31.34±6.02o , 35.02±4.03o , 34.65±3.23o , 32.01±3.02o, 36.55±5.20o, 39.04±8.02 o respectively. The distance from central line to inner border of oval foramen, to lacerated foramen , to outer entrance of carotid canal and to inner border of outer entrance of hypoglossal canal were 23.30±1.97 mm ,10.56±2.39 mm , 25.07±2.77 mm , 16.98±1.99 mm respectively. The length and height of clivus were 32.43±5.46 mm ,35.01±4.12 mm. and the thickness of upper , middle and lower part were 17.23±3.12 mm,9.96±3.10mm,6.35±2.95mm respectively . the thickness of anterior part of great occipital foramen(3. 8±0. 4)mm. extradural structures such as root of sellar area , clivus , great occipital foramen ; Intradural structures such as basal artery bifurcation ,posterior cerebral artery ,oculomotor nerve ,can also be exposted under transsphenoidal approach by endoscopy to clivus. Conclusions Endoscopic transsphenoidal approach can well expose easily reach the area of central skull base . This finding provide a rational surgical approach for operation from transsphenoidal to clivus by endoscopicy. PartⅢClinical Study on Endoscopic Endonasal Transsphenoidal Surgery for Diseases of the Sellar and ClivusObjective To evaluate the possibility and gain surgical experiences on endoscopic endonasal transsphenoidal surgery for diseases of the sellar and the clivus. Methods Sixteen cases of pituitary adenomas were proformed transsphenoidal microsurgery under the assistance of nasal endoscope, 35 cases of pituitary adenomas , 2 cases cerebrospinal rhinorrhea, 2 cases chordoma invading the sphenoid bone and clivus were treated by neuroendoscopic techniques . Results The structures of the sphenoid sinus and sellar regions can be exposed clearly by this approach . The blind area of microscope may be showed through endoscope .of 16 patients underwent the assistance of nasal endoscope ,Tumor was totally removed in 13 cases ,subtotally removed in 3 cases. Of 35 patients underwent endoscopic endonasal transsphenoidal surgery with pituitary adenomas, 30 underwent total resection of the tumor and 5 subtotal resection, 2 cases cerebrospinal rhinorrhea were cured . Of 2 cases chordoma invading the sphenoid bone and clivus ,1 underwent total resection of the tumor and 1 subtotal resection, The complication included transient diabetes insipidus in 17 patients, transient cerebrospinal rhinorrhea in 5 patients,and transient visual deterioration in 3 patients ,There was no severe complication and no operative death .Conclusions The clinical study showed that endoscopic endonasal transsphenoidal surgery is a safe and effective method of treatment of the patients with diseases of the sellar and the clivus. That microsurgical technique combined with nasal endoscope had dual advantages and gained minimally invasive effects in the operation of endonasal transsphenoidal surger. endoscope-assisted microneurosurgery can improve the quality of neurosurgery.