Surgical anatomy and nuances of the expanded endonasal transdorsum sellae and posterior clinoidectomy approach to the interpeduncular and prepontine cisterns: a stepwise cadaveric dissection of various pituitary gland transpositions.

Abstract

Excelsior knowledge of endoscopic anatomy and techniques to remove the natural barriers preventing full endonasal access to the interpeduncular and prepontine cisterns determines the ease of transposing the pituitary gland (hypophysiopexy) preserving the glandular function without manipulating the optic apparatus and the oculomotor nerves. Throughout stepwise cadaveric dissections, we describe the expanded endonasal approach (EEA) to the interpeduncular and prepontine cisterns with special references to the intricate anatomy of the region and techniques for hypophysiopexy and posterior clinoidectomies. This article illustrates sellar-diaphragmatic dural incisions and various "pituitary gland transpositions" techniques performed via extradural (lifting the gland still covered by both dural layers), interdural (transcavernous), and intradural (between the medial wall of the cavernous sinus and the pituitary tunica) to access the prepontine and interpeduncular cisterns.