Endonasal Endoscopic Approaches to the Sellar Region and the Anterior Fossa

Endonasal endoscopic approaches have revolutionized surgical access to the sellar region and anterior fossa. These minimally invasive techniques utilize the natural nasal corridors to reach the target area, avoiding the need for external incisions. The endoscope provides excellent visualization and magnification, enabling precise surgical maneuvers. In this chapter, the authors describe the anatomical features for performing endoscopic endonasal approaches to the Sella and the anterior fossa. These approaches include the traditional endoscopic transsphenoidal approach to the Sella and extended endonasal approaches, including trans tuberculum, transplant, and transcribiform approaches. The most remarkable anatomical landmarks and surgical tenets are discussed. The anterior fossa houses critical structures like the anterior cranial base and the olfactory system. These structures can be approached for the resection of tumors, repair of cerebrospinal fluid leaks, and management of traumatic injuries. Endonasal endoscopic approaches offer reduced morbidity, shorter hospital stays, and faster recovery than traditional open approaches. Our clinical series shows that technological advancements and modern endoscopic surgical techniques further enhance the safety and efficacy of conventional transnasal methods, making them indispensable tools in the armamentarium of contemporary skull-base surgeons. 

Keywords: Anterior fossa, Cribriform plate, Endonasal endoscopic, Endoscopic skull base surgery, Planum sphenoidale, Pituitary gland, Sellar region, Transsphenoidal, Tuberculum sellae.