The endoscope, particularly in a well-pneumatized sphenoid sinus, allows the surgeon to see an astonishing amount of anatomic detail, such as the planum sphenoidale, the clivus, the carotid, and optic bony protuberances. Pathologies arising or extending in these regions are obvious candidates for endoscopic surgical removal. These include suprasellar craniopharyngiomas, tuberculum sellae meningiomata, macroadenomas involving the cavernous sinus, and upper clival chordomas (18).
To be effective and safe, these procedures need:
• Adequate endoscopic skill;
• A detailed knowledge of the anatomy of different pathologies of these regions to avoid major injuries;
• Dedicated instruments to perform the operation under the best conditions with both the 0° or angled endoscopes;
• Adequate materials and techniques of reconstruction for the planum sphenoidale and the clivus, to prevent CSF leaks.
Knowledge of anatomy, the improvement of surgical equipment, and the development of intraoperative ultrasonography and intraoperative magnetic resonance imaging could extend what is possible in the sella to these parasellar pathologies.
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