BrainCare

step 1

Sphenoid Rostrum and the anterior wall of the Sphenoid Sinus

step 2

Cochal Sphenoid

step 3

Wide Sphenoidotomy Sphenoid Sinus and diaphragm

step 4

Sella Turcica

step 5

Dura Matter and Adenomas

step 6

Sella Turcica

In case of conchal sphenoid sinus we can use the high speed drill to approach the sella turcica using the endoscope.

At this point a nasal speculum is placed with a self-retaining speculum which is opened only enough to allow placement of the endoscope. The sphenoid sinus is opened. Kerisson rongeurs are also used to enlarge the opening. It is imperative to perform a wide sphenoidotomy to allow manipulation of the neurosurgical instruments with the endoscope in place. The sphenoid sinus mucosa is gently dissected ant totally removed with traction.

This approach provides excellent access to the sphenoid and the sella turcica. A rigid endoscope 0 degree –30 degree are used to begin the surgery and give a panoramic view of the planum sphenoidale, the anterior wall of the sella, the clival indentation, the optic and the carotid protuberances. Then the floor of the sella turcica is removed and the dura matter is opened. Evacuation of tumor is accomplished with a curette and the endoscope can be placed directly into the sella for views laterally and superiorly. After tumor debulking the tumor’s capsule is removed carefully using microdisectors and small curettes. Finally, the sella is packed with fat, muscle and fascia.

Endoscope with 70 degree viewing angle are useful for work inside the sella. You can also see at the postopoperative MRI sagittal image the complete removal of the lesion.

step 7

Sella Turcica