Abstract
Background: Extending the transsphenoidal approach has allowed its increasing use for suprasellar pathologies. The addition of the endoscope has further advanced this approach. Methods: To describe the endoscopic transsphenoidal approach to the sella and suprasellar regions from nasal phase to reconstruction. Results: The endoscopic endonasal transsphenoidal transtuberculumtransplanum approach to the suprasellar area provides direct access for large or fibrotic pituitary adenomas, suprasellar Rathke’s cleft cysts and meningiomas and craniopharyngiomas. The use of two surgeons allows for bimanual dissection and thereby maintains the advantages of a craniotomy while employing a less invasive approach to this region. This and other techniques for safely performing this approach are presented and reviewed. Conclusions: The endoscopic endonasal transsphenoidal approach to the suprasellar region provides direct access for many tumor types. Bleeding and reconstruction concerns can be overcome by an experienced team.