Endoscopic endonasal approach for a XXXX .

@entity1 @entity227 @entity41 @entity5 @entity3538 @entity3459 @entity1653 @entity10
The authors present the technical and anatomical nuances needed to perform an endoscopic endonasal removal of a @entity1653 . The @entity1 is a 47-year-old female with @entity10 and an incidental finding of a small @entity1653 with no vascular encasement, no optic canal invasion, but mild inferior to superior compression of the cisternal segment of the left optic nerve. Neuroophthalmology assessment revealed no @entity227 . Treatment options included clinical observation with imaging follow-up studies, radiosurgery, and resection. The @entity1 elected to undergo surgical removal and an endonasal endoscopic approach was the preferred surgical option. Preoperative radiological studies showed the presence of an osseous ring between the left middle and anterior clinoids, the so-called carotico-clinoidal ring. The surgical implications of this finding and its management are illustrated. The surgical anatomy of the suprasellar region is reviewed, including concepts such as the chiasmatic sulcus and limbus sphenoidale, medial and lateral optico-carotid recesses, and the paraclinoidal and @entity3538 . Emphasis is made in the importance of exposing the distal dural ring of the internal carotid artery and the precanalicular segment of the optic nerve for adequate intradural dissection. The endonasal route allows for @entity3459 of the @entity5 meningeal supply and extensive resection of dural attachments, and importantly, provides an inferior to superior access to the infrachiasmatic region that facilitates complete @entity5 removal without any manipulation of the optic nerve. The lateral limit of dural removal is formed by the distal dural ring, which is gently coagulated after the @entity5 is resected. A 45   scope is used to inspect for any @entity41 , in particular at the entrance of the optic nerve into the optic canal and at the most anterior margin of the exposure (limbus sphenoidale). The steps for reconstruction are detailed and include intradural placement of dural substitute and extradural placement of the nasoseptal flap. The nuances for proper harvesting, positioning, and reinforcement of the flap are described. No lumbar drain was used. The @entity1 had an uneventful recovery with no CSF leak or any other complications. Imaging follow-up at 6 months showed complete @entity5 . The @entity1 had no sinonasal or neurological symptoms, and olfaction was fully preserved. The video can be found here: http://youtu.be/kkuV-yyEHMg .
