TRANSNASAL ENDOSCOPICALL APPROACH TO THE MIDLINE TUMOURS OFF THE SKULL BASE

The evolution of the endoscopic endonasal transsphenoidal technique, which was initially reserved only for sellar lesions through the sphenoid sinus cavity, has lead in the last decades to a progressive possibility to access the sull base from the nose. This route allows midline access and visibility to the suprasellar, retrosellar and parasellar space while obviating brain retraction, and makes possible to treat transsphenoidally a variety of relatively small midline skull base and parasellar lesions traditionally approached transcranially. Between January 2003 and December 2014 we performed 251 endonasal approaches for pituitary lesions and 23 extended endonasal approaches for lesions arising from or involving the sellar region and the surrounding areas. The most representative pathologies of this series were the eleven meningiomas, the four craniopharyngiomas and the two chordomas, we also used this procedure in four cases of Rathke's cleft cysts and two metastasis. Tumor removal, as assessed by post-operative MRI, revealed complete removal of the lesion in 15 cases. Surgical complications have been observed in six patients, mostly a new permanent diabetes insipidus in three cases, in other CSF leak or epistaxis. We registered one surgical mortality.