Endoscopic Endonasal Surgery for Nonadenomatous Sellar/Parasellar Lesions

INTRODUCTION: This article demonstrates the experience with endoscopic transphenoidal anterior skull base surgery for lesions other than pituitary adenomas. The spectrum of lesions, results, and complications are presented. PATIENTS AND METHODS: This series includes patients with 102 lesions other than pituitary adenomas operated upon using the endoscopic approach. The results and complications were reviewed retrospectively. RESULTS: The most common lesions treated were Rathke Cleft Cysts (n = 39) and craniopharyngiomas (n = 18) in a total of 82 tumors. There were 8 patients with inflammatory lesions, and the remainder had a variety of unusual pathologies. Complications other than diabetes insipidus (n = 12) were uncommon, with 6 postoperative cerebrospinal fluid leaks. CONCLUSIONS: The endoscopic anterior skull base approach is highly effective in treating a large variety of lesions other than pituitary adenomas. The adoption of the nasoseptal flap for closure has markedly reduced the incidence of spinal fluid leaks, and is used routinely for lesions that violate the intracranial compartment.