Transsphenoidal-transtuberculum sellae approach for supradiaphragmatic tumours: Technical note

The Classic transsphenoidal approach may not afford sufficient exposure for a supradiaphragmatic tumour adjacent to the pituitary stalk. Various transcranial approaches have been utilized to access such a lesion with adequate results. This report describes a less invasive technique, termed "transsphenoidal-transtuberculum sellae approach". This modified transsphenoidal approach requires a bone ablation of the tuberculum sellae, the limbus sphenoidalis, and a portion of the planum sphenoidale, in addition to an opening of the anterior floor of the sella turcica. The dura mater on the tuberculum sellae and the pituitary fossa is sectioned with a bilateral obliteration of the anterior intercavernous sinus. The anterior pituitary gland is not necessarily resected. The optic chiasm, optic nerves, pituitary stalk, and tuber cinereum can be directly observed, making it possible to safely dissect a lesion from these structures. Utilizing this approach, we have removed 14 supradiaphragmatic tumours without complications and dealt with other lesions such as optic nerve injuries or cerebrospinal fluid rhinorrhea, leaving pituitary function intact. The transsphenoidal-transtuberculum sellae approach for accessing small supradiaphragmatic tumours is a useful procedure requiring only a minor modification of the classic transsphenoidal technique.