- •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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Operative Techniques in Otolaryngology-Head and Neck Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Endoscopic transphenoidal approach for fibrous dysplasia of clivus, tuberculum sellae and sphenoid sinus; report of three cases.Turk Neurosurg. 2012; 22: 662-666
- Endoscopic approach to cavernous sinus aneurysm.Turk Neurosurg. 2013; 23: 404-406
- Extended endoscopic transphenoidal approach for tuberculum sellae meningiomas.Acta Neurochir (Wien). 2011; 153: 1-9
- Quality of life in extended endonasal approaches for skull base tumors.Rhinology. 2012; 50: 255-261
- From above or from below? That is the question. Comparison of the supraorbital approach with the endonasal approach. A cadaveric study.Br J Neurosurg. 2018; 32: 548-552
- Endoscopic Endonasal Approach for Adrenocorticotropic Hormone-Secreting Pituitary Adenomas: Outcomes and Analysis of Remission Rates and Tumor Biochemical Activity with Respect to Tumor Invasiveness.World Neurosurg. 2017; 102: 651-658.e1
- Anatomical considerations for endoscopic endonasal skull base surgery in pediatric patients.Laryngoscope. 2010; 120: 1730-1737
Published online: December 02, 2021
Publication stageIn Press Journal Pre-Proof
© 2021 Elsevier Inc. All rights reserved.