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Neurosurgery
Expanded Endonasal Approach to the Sella and Anterior Skul
Built from Feldman — Neurosurgical Operative Atlas: Neuro-Oncology
What’s inside
9 sections · 49 slides
The Big Idea
Why operate on the skull base through the nose
- What this approach actually is
- The core concept: modular, air-space corridors
- Three ideas that make the approach work
Choosing the Patient
Which tumors suit the nasal route — and which do not
- What can be treated this way
- When the nose is the wrong door
- The deciding question: what lies in the way
- Anatomic barriers to complete removal of clival lesions
Before the First Cut
Imaging, position and the two-surgeon team
- Mapping the road with imaging
- Positioning the patient
- Operating room set-up for endonasal skull base surgery
- Two surgeons, four hands
Building the Corridor
The exposure and dissection every module shares
- General exposure: opening the sphenoid
- Intradural dissection: how tumor is taken out
- Hemostasis: stopping bleeding without harm
- Why is crushed muscle — not packing gauze — used for an internal carotid artery injury?
The Sellar Approach
The foundation operation: reaching the pituitary
- Finding the landmarks
- Removing the tumor inside the sella
- Sellar bone removal and step-by-step tumor resection
- Confirming a complete removal
- When tumor invades the cavernous sinus
- Rebuilding the floor (sellar reconstruction)
Sealing the Skull Base
Vascularized flaps for the larger openings
- Why extended approaches need a living flap
- Harvesting and protecting the flap
Going Forward and Up
The transtuberculum / transplanum module
- Opening the exposure forward
- Cutting off the blood supply early
- Transtuberculum dissection around the optic apparatus
- Opening the dura and freeing the tumor
- Protecting the hidden vessels
Reaching the Very Front
The transcribriform module to the crista galli
- Extending all the way forward
- Endoscopic transcribriform exposure
- Handling benign vs malignant tumors
- Dissecting through the falx
After Surgery and the Long View
Reconstruction, recovery, and mastering the approach
- Reconstruction for anterior cranial base modules
- Postoperative management
- The learning curve is real and staged
- Key takeaways
- The bottom line
- Image Source Citations
- Neurosurgical Operative Atlas: Neuro-Oncology