Research Article|Articles in Press

Removal of the Posterior Wall of the Sphenoid Sinus During Trans-sellar Skull Base Surgery: The Meniscus Sign

Published:December 02, 2021DOI:


      • Tumors can distort the appearance of the posterior wall of the sphenoid sinus
      • The trans-sellar approach to the dura occurs in close proximity to the internal carotid artery and cavernous sinus
      • The meninscus sign provides the surgeon useful feedback regarding local anatomy and surrounding vascular structures.
      • Placing pressure with a blunt tipped instrument on the sellar dura results in clearing of blood from the potential space between the posterior sphenoid wall and the sella dura showing the meniscus.
      • Removal of only that bone overlying the clearing of the meniscus will prevent surgeons from entering areas of fixed dural reflections at the cavernous sinus and carotid artery.
      Trans-sellar surgical approaches can be difficult and unpredictable. Tumors can distort the appearance of the posterior wall of the sphenoid sinus and a surgeon's concerns for avoiding the proximal vascular structures of the region may compromise access for the neurosurgical portion of the operation. Bone removal from the sellar dura is sometimes suboptimal. The meniscus sign is a convenient and reliable method for removal of the posterior wall of the sphenoid sinus during trans-sellar skull base surgery. It is a safe technique that maximizes bone removal and surgical access between the cavernous sinuses and internal carotid arteries. The senior author has employed the meniscus sign in trans-sellar surgery for over 15 years, noting that the technique has been free of surgical complications, reproducible amongst trainees, and reliable in safely providing maximum exposure for the intradural portion of the operation.


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