Surgery of the Sellar Region and Paranasal Sinuses

The sellar region and paranasal sinuses constitute the anatomical sections of the skull base in which pathological entities warrant interdisciplinary management. Processes originating in the paranasal sinuses can reach and involve the skull base in and around the sella, sometimes not respecting the natural dural boundary. On the other hand, lesions involving the sellar block, such as pituitary adenomas and meningiomas, can also extend downwards into the paranasal sinuses. The orbit and cavernous sinus may be subject to involvement and infiltration by both paranasal and sellar pathology. The advancement and new achievements of modern diagnostic procedures, such as high-resolution CT, three-dimensional reconstruc­ tion, MRI, and MRI angiography, as well as the detailed selective angiographic protocols and endovascular techniques, have increased the possibilities for surgical management of this type of pathology with extra- and intracranial involvement. Long-standing and intense inter­ disciplinary work has led to sophisticated operative approaches which for benign tumors allow total excision with preservation of structures and function, and for some malignant lesions permit an en bloc resec­ tion via a combined intracranial-extracranial approach. This volume reflects the work and scientific exchange which took place during the IV International Congress of the Skull Base Study Group, held in Hanover. Leading authorities in the basic sciences including anatomy joined with diagnosticians, clinicians, and surgeons from different fields to evaluate the state of the art of this topic in skull base surgery. Front Matter....Pages I-XXII Front Matter....Pages 1-1 Paranasal Sinuses: Anatomical Considerations....Pages 3-18 The Growth of the Paranasal Sinuses in Craniostenosis....Pages 19-22 Clinical Anatomy of the Sphenoidal Sinus....Pages 23-28 Space-Occupying Processes of Paranasal Sinuses....Pages 29-30 Clinical Manifestation of Sinus Disorders — ENT....Pages 31-32 Ophthalmological Manifestations of Paranasal Sinus Diseases....Pages 33-42 Imaging of the Paranasal Sinuses....Pages 43-50 Influence of Sphenoidal Sinus Size on the Sella Angle in Lateral Cephalograms....Pages 51-54 The Sphenoid Sinus: Typical and Variable Morphologic Pattern Demonstrated by High-Resolution and Multiplanar CT....Pages 55-58 Interventional Angiography....Pages 59-64 Surgical Management of Maxillary Sinus Pathology....Pages 65-70 Neurosurgical/ENT Management of Paranasal Sinus Lesions Extending Through the Skull Base....Pages 71-75 Therapy of Tumors Affecting the Paranasal Sinuses and Sellar Region....Pages 76-80 Microscopic Endonasal Surgery of the Paranasal Sinuses and the Parasellar Region....Pages 81-87 Exeresis and Recontruction Techniques in the Surgical Treatment of Malignant Tumors of the Ethmoid....Pages 88-92 Total Ethmoidectomy for Malignant Tumors of the Anterior Skull Base: 14 Years’ Experience on 62 Cases....Pages 93-97 The Status of the Frontal Sinus After Craniotomy....Pages 98-103 Juvenile Nasopharyngeal Angiofibroma: The Update Concept of Diagnosis and Therapy....Pages 104-108 Computed Tomography-Stereotactic Curie Therapy of Recurrent Nasopharyngeal Carcinoma Invading the Skull Base....Pages 109-113 Isolated Sphenoid Sinus Aspergillosis with Intracranial Extension: Report on Three Cases....Pages 114-119 Front Matter....Pages 1-1 Cranial Complications Following Dental Infection....Pages 120-122 Lesions of the Skull Base and Paranasal Sinuses Presenting with Unilateral Exophthalmos....Pages 123-125 Periorbital Approaches for Resection of Tumors of the Orbita....Pages 126-129 Management of Benign Orbital Tumors Via Medial and Osteoplastic Lateral Orbitotomy....Pages 130-133 Surgical Technique and Results of Orbital Decompression in Graves’ Disease....Pages 134-137 Experiences with an Evacuable Anatomic Maxillary Sinus Implant for the Management of Orbital and Maxillary Injuries....Pages 138-142 Front Matter....Pages 143-143 Clinical Anatomy of the Ophthalmic Artery and Cavernous Sinus....Pages 145-148 Microsurgical Anatomy of the Intracavernous Carotid Artery and Its Branches....Pages 149-153 Microsurgical Anatomy of the Upper Cranial Nerves in the Sellar Region....Pages 154-159 Ophthalmological Symptoms in Tumors of the Sellar Region....Pages 160-165 Anatomy and Imaging of the Normal Sella Turcica and Pituitary Gland....Pages 166-179 New Possibilites for Computed Tomography in the Diagnosis of Pituitary Microadenomas....Pages 180-187 Computed Tomographic Cisternography of the Sellar and Parasellar Region: A Radiological Approach to Cisternal Anatomy....Pages 188-192 Magnetic Resonance Imaging Diagnosis of Microadenoma....Pages 193-198 Magnetic Resonance Imaging of Parasellar Developed Pituitary Adenomas: New Consequences for Pituitary Surgery....Pages 199-204 Magnetic Resonance in Modern Neuroimaging of Skull Base Neoplasms with Particular Reference to the Evaluation of Complications of Medically and Surgically Treated Pituitary Adenomas....Pages 205-210 Diagnostic and Therapeutic Angiography of the Sellar and Parasellar Region....Pages 211-217 Value of Visual Evoked Potentials in Indicating an Operation in Sellar Space-Occupying Processes....Pages 218-220 Preoperative Grading of Visual Function by Pattern Evoked Electroretinogram and Visual Evoked Cortical Potentials in Patients with Sellar and Parasellar Tumors....Pages 221-227 Surgery of Sellar Lesions: Experience from 38 Years....Pages 231-238 Front Matter....Pages 143-143 Pituitary Tumors in the Aged....Pages 239-242 Pituitary Adenomas in Childhood and Adolescence....Pages 243-250 Recurrent Pituitary Adenomas....Pages 251-266 A Clinical, Endocrinological, and Morphological Study of Pituitary Tumor Recurrence....Pages 267-271 The Growth Rate in Pituitary Adenomas: Measurement by Proliferation Marker Ki 67....Pages 272-276 Therapeutic Considerations in Pituitary Tumor Recurrence....Pages 277-281 Aggressive Behavior and Changing Histology in a Pituitary Adenoma....Pages 282-285 Pituitary Adenoma with Cavernous Sinus Involvement....Pages 286-293 Cushing’s Disease....Pages 294-301 Skull Base Involvement in Pituitary Adenomas....Pages 302-308 Sub- and Retrochiasmatic Approach for Microsurgical Removal of Large Suprasellar Tumors....Pages 309-322 The Use of CO 2 Laser in Transsphenoidal Surgery of Sellar Region Tumors....Pages 323-325 Practical Experiences with the Nd-YAG Laser in Pituitary Surgery....Pages 326-330 Pituitary Interstitial Irradiation for Cushing’s Disease and Acromegaly....Pages 331-335 Complications of Transsphenoidal Surgery....Pages 336-340 The Effects of Pituitary Adenoma on the Facial Skeleton in Cases of Acromegaly....Pages 341-345 Some Rare Tumors of the Sella Turcica and Paranasal Sinuses....Pages 346-348 The Empty Sella and the Sellar Arachnoidal Cyst....Pages 349-358 Craniopharyngioma: A Puzzling Neurosurgical Problem....Pages 361-364 The Radical Operation for Removal of Craniopharyngioma....Pages 365-372 Front Matter....Pages 143-143 Experiences with Radical Excision of Craniopharyngioma....Pages 373-380 Some Technical Considerations Regarding Craniopharyngioma Surgery: The Bifrontal Approach....Pages 381-386 Two Rare Craniopharyngiomas....Pages 387-391 Front Matter....Pages 393-393 Thermoregulation in Patients with Skull Base Tumors....Pages 395-406 Operations of Skull Base Processes: Value of Intraoperative Monitoring....Pages 407-413 Surgery of Extracerebral Tumors of the Frontal and Medial Skull Base....Pages 414-419 Craniofacial Resection for Anterior Skull Base Tumors....Pages 420-425 Trigeminal Schwannoma....Pages 426-432 Parasellar Chondrosarcoma: Case Report and Literature Review....Pages 433-438 Cholesterol Granuloma of the Skull Base: A Review....Pages 439-443 The Transpalatal-Transpharyngeal Approach to Chordomas of the Ventral Sphenoclival Regions....Pages 444-448 Transnaso-Sphenoidal Approach to Skull Base Lesions Other than Pituitary Adenomas....Pages 449-452 Transmaxillar-Transnasal Approach: A Microsurgical Anatomical Model....Pages 453-461 Transsylvian Pretemporal Approach to the Infundibular Region....Pages 462-464 Meningioma and Parasellar Pituitary Adenoma Affecting the Cavernous Sinus: Radical Tumor Extirpation?....Pages 465-478 The Microanatomical Basis for Cavernous Sinus Surgery....Pages 479-483 The Cavernous Sinus Syndrome: An Anatomical and Clinical Study....Pages 484-489 Vascular Lesions in the Sellar Region....Pages 490-493 Surgery of Vascular Lesions in the Cavernous Sinus....Pages 494-501 Parasellar Aneurysms: Treatment Options and Results....Pages 502-509 Front Matter....Pages 393-393 Direct Operative Approach and Clipping of Intracavernous Nontraumatic Aneurysms....Pages 510-515 Parasellar Cavernous Angiomas: Report of Two Cases....Pages 516-523 Parasellar Cavernomas Mimicking Meningiomas....Pages 524-528 Ophthalmological Manifestations in Cases of Giant Parasellar Aneurysm....Pages 529-534 Extra-Intracranial Anastomosis with Venous Interpositions in Patients with Giant Aneurysms of the Skull Base....Pages 535-541 Embolization of Four Cases of Carotid-Cavernous Sinus Fistulas by Retrograde Catheterism of the Superior Orbital Vein....Pages 542-550 Back Matter....Pages 551-586 The challenging and interdisciplinary subject of this book, the surgery of the sellar region and paranasal sinuses, is considered and analysed from different viewpoints, bringing together the concept of the pathology, diagnostic procedures and therapeutical modalities of this area of the skull base. Experts from all over the world describe their experiences and give an up-to-date report Considers surgery of the sellar region and paranasal sinuses from different viewpoints, bringing together the concept of pathology, diagnostic procedures and therapeutic techniques of this area of the skull base.