Abnormal Skull Base Anatomy

In patients who have had previous transsphenoidal or rhinologic surgery, the transsphenoidal approach to the sella is complicated by previous loss of anatomical landmarks. Since identification of the midline is essential for a safe operation that avoids the risk of carotid injury, the transcranial approach may be preferable in revision surgery if the tumor is mainly suprasellar. In our experience, the use of an interactive image-guidance system has greatly improved the degree of confidence with which repeat transsphenoidal surgery may be attempted, thus reducing the number of patients requiring a transcranial operation for this indication.

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