{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T12:00:09Z","timestamp":1791979209043,"version":"4.4.0"},"reference-count":53,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,3]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>The extended endoscopic endonasal transtuberculum transplanum approach is currently used for the surgical treatment of selected midline anterior skull base lesions. Nevertheless, the possibility of accessing the lateral aspects of the planum sphenoidale could represent a limitation for such an approach. To the authors\u2019 knowledge, a clear definition of the eventual anatomical boundaries has not been delineated. Hence, the present study aimed to detail and quantify the maximum amount of bone removal over the planum sphenoidale required via the endonasal pathway to achieve the most lateral extension of such a corridor and to evaluate the relative surgical freedom.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Six human cadaveric heads were dissected at the Laboratory of Surgical NeuroAnatomy of the University of Barcelona. The laboratory rehearsals were run as follows: 1) preliminary predissection CT scans, 2) the endoscopic endonasal transtuberculum transplanum approach (lateral limit: medial optocarotid recess) followed by postdissection CT scans, 3) maximum lateral extension of the transtuberculum transplanum approach followed by postdissection CT scans, and 4) bone removal and surgical freedom analysis (a nonpaired Student t-test). A conventional subfrontal bilateral approach was used to evaluate, from above, the bone removal from the planum sphenoidale and the lateral limit of the endonasal route.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The endoscopic endonasal transtuberculum transplanum approach was extended at its maximum lateral aspect in the lateral portion of the anterior skull base, removing the bone above the optic prominence, that is, the medial portion of the lesser sphenoid wing, including the anterior clinoid process. As expected, a greater bone removal volume was obtained compared with the approach when bone removal is limited to the medial optocarotid recess (average 533.45 vs 296.07 mm<jats:sup>2<\/jats:sup>; p &lt; 0.01). The anteroposterior diameter was an average of 8.1 vs 15.78 mm, and the laterolateral diameter was an average of 18.77 vs 44.54 mm (p &lt; 0.01). The neurovascular contents of this area were exposed up to the insular segment of the middle cerebral artery. The surgical freedom analysis revealed a possible increased lateral maneuverability of instruments inserted in the contralateral nostril compared with a midline target (average 384.11 vs 235.31 mm<jats:sup>2<\/jats:sup>; p &lt; 0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Bone removal from the medial aspect of the lesser sphenoid wing, including the anterior clinoid process, may increase the exposure and surgical freedom of the extended endoscopic endonasal transtuberculum transplanum approach over the lateral segment of the anterior skull base. Although this study represents a preliminary anatomical investigation, it could be useful to refine the indications and limitations of the endoscopic endonasal corridor for the surgical management of skull base lesions involving the lateral portion of the planum sphenoidale.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2017.9.jns171406","type":"journal-article","created":{"date-parts":[[2018,4,20]],"date-time":"2018-04-20T13:59:58Z","timestamp":1524232798000},"page":"848-860","source":"Crossref","is-referenced-by-count":27,"title":["Defining the lateral limits of the endoscopic endonasal transtuberculum transplanum approach: anatomical study with pertinent quantitative analysis"],"prefix":"10.3171","volume":"130","author":[{"given":"Alberto","family":"Di Somma","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Universita\u0300 degli Studi di Napoli Federico II, Naples, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Torales","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Clinic, Barcelona, Spain; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi Maria","family":"Cavallo","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Universita\u0300 degli Studi di Napoli Federico II, Naples, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Pineda","sequence":"additional","affiliation":[{"name":"Laboratory of Surgical NeuroAnatomy (LSNA), Faculty of Medicine, Universitat de Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Solari","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Universita\u0300 degli Studi di Napoli Federico II, Naples, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa Maria","family":"Gerardi","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Universita\u0300 degli Studi di Napoli Federico II, Naples, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Frio","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Universita\u0300 degli Studi di Napoli Federico II, Naples, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joaquim","family":"Ense\u00f1at","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Clinic, Barcelona, Spain; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Prats-Galino","sequence":"additional","affiliation":[{"name":"Laboratory of Surgical NeuroAnatomy (LSNA), Faculty of Medicine, Universitat de Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Cappabianca","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Universita\u0300 degli Studi di Napoli Federico II, Naples, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"Suppl 3","key":"b1","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1227\/NEU.0000000000000900","article-title":"Endoscopic endonasal approach to the optic canal: anatomic considerations and surgical relevance","volume":"11","author":"Abhinav K","year":"2015","unstructured":"Abhinav K, Acosta Y, Wang WH, Bonilla LR, Koutourousiou M, Wang E, : Endoscopic endonasal approach to the optic canal: anatomic considerations and surgical relevance. 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