Basal interhemispheric approach for sellar and juxta-sellar lesions

Abstract

Abstract Background Sellar and juxta-sellar lesions represent a surgical challenge due their deep and complex relationships to surrounding important neurovascular structures. The basal interhemispheric (BIH) approach, as a midline approach, has an advantage over the lateral approaches as it allows for the safe removal of these challenging tumors. Aim To describe the technique of BIH approach in a prospective cohort of 17 patients with sellar and juxta-sellar lesions with different pathologies presented to Alexandria Main University and affiliated hospitals. As well as the clinical outcome and complications of this technique, these cases were followed up for a mean period of 20 weeks. Results Gross total resection was achieved in 9 cases (52.9%), subtotal resection was achieved in 5 cases (29.5%), while partial resection was carried out in 3 cases (17.6%). Visual status improved following surgery in 10 patients (58.8%), remained stationary in 5 patients (29.4%) and worsened in 2 cases. Post-operative shunt was needed in three cases, and severe water and electrolyte disturbance was recorded in 3 cases and pan-hypopituitarism in a single case. A single mortality was recorded, but it was due to pulmonary embolism and was not related to the approach. Conclusion BIH could be a panoramic safe approach that allows tumor removal from multiple corridors with identification of the regional anatomy of the tumor thus elaborating the surgical strategy for gross total tumor removal.

Keywords

• Basal interhemispheric approach
• Sellar tumors
• Juxta-sellar tumors
• Craniopharyngiomas