For the Dr. Fernando MuñozDr. Gras and Dr. Casasayas
Endoscopic endonasal skull base surgery continues to solidify its position as the preferred approach for the resection of complex sellar and suprasellar lesions. In this case, the neurosurgeon Dr. Fernando Muñoz, in collaboration with otolaryngologists Dr. Gras y Dr. Casasayas, present in the online surgery app SurgSchool the complete resection of a pituitary macroadenoma with marked suprasellar extensionascending beyond the level of the anterior cerebral arteries and producing severe distortion of the optic chiasm.
Transplanum endoscopic approach
The magnitude of the suprasellar extension necessitated a endoscopic approach expanded to the sphenoidal planumproviding direct control of the suprasellar region and allowing safe dissection of critical neurovascular structures. After opening the bone and dura, the sellar component was initially approached, emptying the adenoma from the sella turcica and subsequently widening the diaphragmatic opening to access the tumor dome.
Through meticulous arachnoid dissectionBy preserving the natural planes, the suprasellar component was progressively lowered without the need for a second approach. The resection strategy from inside the dome allowed preserve the normal pituitary gland adhered peripherally, reducing the risk of postoperative endocrine deficiencies.
Critical anatomy and suprasellar control
The final exposure clearly showed the suprasellar region, including the severely distorted optic chiasm, the surrounding neurovascular structures, and the intact pituitary stalk. The absence of tumor remnants was confirmed, achieving a complete resection.
Multi-layer reconstruction
The reconstruction was performed using a classic technique of multi-layer closure:
- Autologous fat as an adaptable filler for the defect.
- Fascia lata as reinforcement.
- Pedicled nasoseptal flap for the final coverage.
This closure provided an effective barrier, preventing CSF fistula.
Clinical evolution
The patient's condition improved excellently:
- Without cerebrospinal fluid fistula.
- Partial visual recovery, after chiasmatic decompression.
- Without new hormonal deficiencies, maintaining only the previous treatment for hypothyroidism.
Advanced surgical training in SurgSchool
This case exemplifies the complexity and precision of endoscopic skull base surgery. SurgSchool, the number 1 app for surgical learning, You will be able to access the full video narrated by the surgical team and more than 400 expert surgeries in neurosurgery, otolaryngology and skull base subspecialties.
