Preoperative Planning and Use of a Transglabellar Transethmoidal Approach in Removal of Big and Giant Tumors of the Sellar Area

Yu.A. Shulev, D.A. Rzaev, O.R. Akopyan

(Municipal Multi-Field Hospital N 2, Neurosurgical Department N 1, Saint Petersburg)

Introduction. Different transsphenoidal approaches, including endoscopic ones, are used in removal of 90-95% of all sellar tumors. A proposed transglabellar transethmoidal access stands between destructive transbasal and narrow transsphenoidal approaches.

Methods. We use a transglabellar transethmoidal access in removal of big and giant tumors of the sellar region (more than 4 and 5 cm). There are three types of extension of this approach, depending on a character of a growth direction.

There were 35 cases with big and giant sellar tumors, operated in October 2002-May 2005. A direction of the skull base resecton and dura exposure was determined during a preoperative planning.

The first type of extension of the above approach was used in 10 patients with a retrosellar growth of tumors (a clinical picture was characterized by hypertensive hydrocephalus and compression of the brain stem). A surgical target was posterior segments of the third ventricle bottom and the brain stem.

The second type of extension of the tranglabellar transethmoidal approach was applied in 20 cases with a marked suprasellar growth of tumor (a clinical picture was mainly represented by visual disorders). A target of surgical aggression was chiasm decompression.

The rest 5 patients had a parasellar growth of tumor (oculomotor disturbances were dominant). The third type of extension of the approach under discussion was used. Intervention was aimed at maximum decompression of oculomotor nerves in cavernous sinuses.

Results. Tumors were removed with different efficiency. Every patient was subject to hormonal replacement therapy.

Conclusion. The proposed approach is anatomically substantiated and possesses high surgical potentialities in minimum invasiveness.