{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T19:44:03Z","timestamp":1775850243987,"version":"3.50.1"},"reference-count":65,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2011,2]]},"abstract":"\nObject<\/jats:title>\nEndonasal approaches have become the gold standard intervention for many anterior and middle skull base tumors. The authors aimed to define some of the existing limitations of these approaches by reviewing their experience with complex sellar region tumors that were initially considered for both transsphenoidal and open skull base approaches and were thus deemed tumors at \u201cthe edge of the envelope.\u201d<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nBetween April 2008 and April 2010, 250 transsphenoidal operations were performed at Brigham and Women's Hospital. All cases were retrospectively reviewed to identify patients with complex sellar region tumors that were initially considered for, or soon thereafter required, an open craniotomy as the definitive treatment. The anatomical tumor characteristics that posed limitations to performing safe and effective endonasal skull base operations were reviewed.<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nThirteen cases exemplifying some of the existing limitations to achieving optimal surgical outcomes via transsphenoidal-based approaches are presented. The following 8 factors are separately discussed that repeatedly limited the extent of resection, increased the risk of the operation, and contributed to perioperative complications: significant suprasellar extension, lateral extension, retrosellar extension, brain invasion with edema, firm tumor consistency, involvement or vasospasm of the arteries of the circle of Willis, and encasement of the optic apparatus or invasion of the optic foramina.<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nAlthough the ability to approach and resect complex tumors using endonasal skull base techniques has evolved dramatically in recent years, several inherent tumor characteristics mandate extensive preoperative consideration. In selected cases these characteristics may lend support to selecting an open craniotomy as the initial operation.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2010.8.jns10520","type":"journal-article","created":{"date-parts":[[2010,9,3]],"date-time":"2010-09-03T14:18:40Z","timestamp":1283523520000},"page":"286-300","source":"Crossref","is-referenced-by-count":106,"title":["Defining the \u201cedge of the envelope\u201d: patient selection in treating complex sellar-based neoplasms via transsphenoidal versus open craniotomy"],"prefix":"10.3171","volume":"114","author":[{"given":"Gabriel","family":"Zada","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rose","family":"Du","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edward R.","family":"Laws","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-jns10520","series-title":"Surg Neurol","first-page":"380","article-title":"Combined transsphenoidal and pterional craniotomy approach to giant pituitary tumors","volume":"57","author":"Alleyne","year":"2002"},{"key":"b2-jns10520","series-title":"Cancer","first-page":"2457","article-title":"Chordoma and chondrosarcoma: similar, but quite different, skull base tumors","volume":"110","author":"Almefty","year":"2007"},{"key":"b3-jns10520","series-title":"J Neurosurg","first-page":"182","article-title":"Skull base chordomas: a management challenge","volume":"86","author":"al-Mefty","year":"1997"},{"key":"b4-jns10520","series-title":"Br J Neurosurg","first-page":"324","article-title":"To assess the ability of MRI to predict consistency of pituitary macroadenomas","volume":"20","author":"Bahuleyan","year":"2006"},{"key":"b5-jns10520","series-title":"Neurosurgery","first-page":"60","article-title":"Loss of vision after transsphenoidal surgery","volume":"27","author":"Barrow","year":"1990"},{"key":"b6-jns10520","series-title":"Surg Neurol","first-page":"443","article-title":"Management of large pituitary adenomas by transsphenoidal surgery","volume":"29","author":"Black","year":"1988"},{"key":"b7-jns10520","series-title":"Neurosurgery","first-page":"382","article-title":"Vasospasm after trans-sphenoidal hypophysectomy","volume":"7","author":"Camp","year":"1980"},{"key":"b8-jns10520","series-title":"Minim Invasive Neurosurg","first-page":"66","article-title":"Endoscopic endonasal transsphenoidal approach to the sella: towards functional endoscopic pituitary surgery (FEPS)","volume":"41","author":"Cappabianca","year":"1998"},{"key":"b9-jns10520","series-title":"Pituitary","first-page":"385","article-title":"Endoscopic pituitary surgery","volume":"11","author":"Cappabianca","year":"2008"},{"issue":"Suppl 2","key":"b10-jns10520","series-title":"Neurosurgery","first-page":"240","article-title":"Endoscopic transnasal versus open transcranial cranial base surgery: the need for a serene assessment","volume":"63","author":"Cappabianca","year":"2008"},{"key":"b11-jns10520","series-title":"Neuroradiology","first-page":"532","article-title":"MRI of intracranial meningiomas: correlations with histology and physical consistency","volume":"35","author":"Carpeggiani","year":"1993"},{"issue":"6","key":"b12-jns10520","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Surgery for clival lesions: open resection versus the expanded endoscopic endonasal approach","volume":"25","author":"Carrabba","year":"2008"},{"key":"b13-jns10520","series-title":"J Neurosurg","first-page":"578","article-title":"Extended endoscopic endonasal transsphenoidal approach for residual or recurrent craniopharyngiomas. 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histological factors affecting the degree of resection","volume":"87","author":"Sen","year":"1997"},{"issue":"5 Suppl","key":"b56-jns10520","series-title":"J Neurosurg","first-page":"408","article-title":"Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma","volume":"97","author":"Sheehan","year":"2002"},{"key":"b57-jns10520","series-title":"J Neurosurg","first-page":"937","article-title":"Long-term follow-up of meningiomas of the cavernous sinus after surgical treatment alone","volume":"107","author":"Sindou","year":"2007"},{"key":"b58-jns10520","series-title":"Neurosurgery","first-page":"268","article-title":"Endoscopic endonasal approach for clival chordomas","volume":"64","author":"Stippler","year":"2009"},{"key":"b59-jns10520","series-title":"Acta Neurochir (Wien)","first-page":"39","article-title":"Meningiomas: correlation between MRI characteristics and operative findings including consistency","volume":"129","author":"Suzuki","year":"1994"},{"key":"b60-jns10520","series-title":"Acta Radiol","first-page":"249","article-title":"Magnetic resonance elastography of brain tumors","volume":"48","author":"Tikkakoski","year":"2007"},{"key":"b61-jns10520","series-title":"Acta Radiol","first-page":"327","article-title":"Magnetic resonance elastography of brain tumors: preliminary results","volume":"48","author":"Xu","year":"2007"},{"key":"b62-jns10520","series-title":"Surg Neurol","first-page":"579","article-title":"Prediction of consistency of meningiomas with preoperative magnetic resonance imaging","volume":"48","author":"Yamaguchi","year":"1997"},{"issue":"1 Suppl","key":"b63-jns10520","series-title":"Neurosurgery","first-page":"168","article-title":"Transcranial surgery for pituitary adenomas","volume":"57","author":"Youssef","year":"2005"},{"issue":"6","key":"b64-jns10520","series-title":"Neurosurg Focus","first-page":"E3","article-title":"The extradural temporopolar 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article"],"short-title":[],"issued":{"date-parts":[[2011,2]]},"references-count":65,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2010.8.jns10520","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,2]]}}}