• Enrico de Divitiis, Paolo Cappabianca, and Luigi Maria Cavallo.
• Division of Neurosurgery, Department of Neurological Sciences, Federico II University of Naples, Naples, Italy.
• Neurosurgery. 2002 Sep 1; 51 (3): 699-705; discussion 705-7.

ObjectiveTo demonstrate the flexibility of the endoscopic transsphenoidal approach, with respect to nasal and paranasal anatomic features and the extension of different sellar lesions, for customization of the procedure for specific conditions.MethodsIn 16 of 170 consecutive endoscopic transsphenoidal operations, some modifications of the standard approach were adopted to optimize surgical removal of different lesions. These modifications consisted of a hemisphenoidotomy, a partial ethmoidectomy, extended sellar floor opening toward the planum sphenoidale or the clivus, enlarged opening of the sphenoid ostium area with ipsilateral removal of the superior turbinate, and a bilateral approach.ResultsThe endoscopic endonasal procedure is easily adaptable to different specific conditions, with slight changes in the standard approach (more or less invasive). Therefore, this surgical procedure is satisfactory for different lesion locations and for the nasal and paranasal sinus anatomic features of individual patients.ConclusionThe endoscopic surgical route should be tailored to different sellar lesions, and some modifications of the procedure are recommended in selected cases.

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