The Endoscopic Endonasal Approach to Lesions of the Planum and Tuberculum: Anatomic Considerations and Clinical Correlations

Introduction: Over the past 10 years, we have performed more than 1000 endoscopic endonasal approaches to the skull base. Lesions of the tuberculum and planum have been amenable to this approach as the optic nerves, chiasm, and carotid arteries often lie on the perimeter of these lesions.

Methods: We will review the clinical and anatomic considerations associated with endoscopic endonasal approaches to the tuberculum and planum. Using examples from our cadaveric dissections as well as clinical cases, we will discuss the approaches, control, access, and decompression of the critical neurovascular structures with an emphasis on optic nerve decompression.

Results: Over the past 10 years, we have been able to access the planum and tuberculum through completely endoscopic endonasal techniques. The most common lesions have been benign, most commonly meningiomas. Using this technique, we have been able to adequately visualize and control the critical neurovascular structures in this region while obtaining adequate tumor removal. We have been able to adequately decompress the involved optic nerves and chiasm, and, using the nasoseptal flap, we have been able to repair associated skull base defects. This approach has been associated with a low rate of morbidity.

Conclusions: The endoscopic endonasal approach to the planum and tuberculum allows access to skull base lesions without transgression or manipulation of the associated critical neurovascular structures. It also provides adequate access, control, and decompression of these structures and is associated with a low rate of morbidity.