Skip to main content
  • History of the Sellar Approach

    Final Number:

    Dr. Felipe Guardini; Dr. Feres Chaddad Neto; Dr. Hugo Leonardo Doria-Netto; Dr. Jose Maria de Campos-Filho; Dr. Ilton Guenhiti Shinzato; Dr. Fernando Kobayashi; Dr. Kleber Soline Monteiro Vargas

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: • We believe that to properly understand the transphenoidal hypophysectomy technique it is important to have a brief and approximate history, based on many publications, of the approaches to the sellar region.

    Methods: • The authors undertook a bibliographic review on many historical publications, educational sites, e.g. pubmed and manuscripts.

    Results: • The current pituitary surgery can be done by the transnasal, transcranial and skull base access, including the craniofacials and transoral.

    Conclusions: • In the transnasal approach there are three transphenoidal accesses: (1) the endonasal submucosal septal lateral of Kocher-Hirsch, (2) the sublabial midline submucosal rhinoseptal with sequential improvements carried out by Halstead-Cushing-Dott-Guiott-Hardy, and (3) the direct extramucosal transnasal with the use of microscope or endoscope. • The transcranial approach is constituted by (1) the subfrontal basal of Krause, or actually, of Krause and Horsley with or without resection of the orbital ridge and (2) the subfrontotemporal, initially accomplished in 1918 by George J. Heuer at Johns Hopkins Hospital, being adopted and modified in 1942 by Walter E. Dandy, extended by Ludwig G. Kempe in 1968 to allow retract more the temporal lobe and refined in 1975 by Yasargil et al with interfascial approach, drilling of the sphenoid ridge and a wider opening of the sylvian fissure; • In the skull base approach, current accesses are (1) the orbitozygomatic infratemporal of Hakuba published in 1986, (2) the supraorbital-pterional of Al-Mefty in 1987 and (3) eventually, the craniofacial derived from the pioneer surgery of Schloffer as the Chiari, Hamburger et al and Macbeth et al. The pioneering works with resection of the orbital ridge belong to McArthur, Frazier and Jane et al. The idea of orbitofrontomalar approach was initiated by Pellerin et al in 1985 and the orbitozygomatic craniotomy was improved by Ikeda et al in 1991 transforming it in an one-piece approach.

    Patient Care: New ideas and new ways to approach the sellar region have to always being improving and consequently adding best care for patients

    Learning Objectives: To review the history and thinking new possibilities for the future selar neurosurgery

    References: 1. Al-Mefty O. Supraorbital-pterional approach to skull base lesions. Neurosurgery. 1987; 21:474-477. 2. Al-Mefty O. Petrosal approach for petroclival meningiomas. Neurosurgery. 1988; 22:510-517. 3. Al-Mefty O, Borba LAB. Skull base highways: surgical approaches to lesions of the cranial base. J.Bras.Neuroc. 1996; 7(3):5-16. 4. Anson JA, Segal MN, Baldwin NG et al. Resection of giant invasive pituitari tumors through a transfacial approach. Technical case report. Neurosurgery. 1995; 37(3):541-6. 5. Arita N, Mori S, Sano M, et al. Surgical treatment of tumours in the anterior skull base using the transbasal approach. Neurosurgery. 1989; 24:379-384. 6. Arlant PA. Microcirurgia da hipófise. In: Stamm AC, editor. Microcirurgia Naso-Sinusal. Rio de Janeiro: Revinter Ltda; 1995.p.313-320. 7. Artico M, Pastore FS, Fraioli B, Giuffrè R. The Contribution of Davide Giordano (1864-1954) to Pituitary Surgery: The Transglabellar-Nasal Approach. Neurosurgery. 1998; 42(4):909-911. 8. Ballenger, JJ. Diseases of the Nose, Throat and Ear. The Clinical Anatomy and Physiology of the Nose and Accessory Sinuses, Lea & Febiger; 1977. p.2-12. 9. Berwig LC, Silva AMT, Corrêa ECR, Moraes AB, Montenegro MM, Ritzel RA. Hard palate dimensions in nasal and mouth breathers from different etiologies. J. Soc. Bras. Fonoaudiol. 2011; 23(4):308-314. 10. Borba LAB, Al-Mefty O. Surgical removal of benign tumors in the cavernous sinus. Contemporary Neurs. 1996; 18(14). 11. Borden WB, Tamargo RJ. George J. Heurer: forgotten pioneer neurosurgeon at the Johns Hopkins Hospital. J Neurosug. 2002; 96(6):1139-1146. 12. Broeckaert J. A contribution to the surgery of the hypophysis. J Laringol. 1913; 28:340-352. 13. Carrau RL, Jho HD, Ko Y. Transnasal-transphenoidal endoscopic surgery of the pituitary gland. Laringoscope. 1996;106:914-918. 14. Caton R, Paul FT. Notes of a case of acromegaly treated by operation. BMJ. 1893; 2:1421. 15. Chiari O. Zur Kasusistik der Erkrankungen der Unterkieferspeicheldruse. Wien Klin. Wschr. 1912; 25:1562-1567. 16. Chiari O. Über eine Modification der Schlofferschen Operation von Tumoren der Hypophyse. Klin Wschr Wien. 1912; 25:5-6. 17. Crockard A. Transoral Approach to Intra/Extradural Tumors. In: Laligam N Sekhar and Ivo P Janecka editors. Surgery of Cranial Base Tumors. NY: Raven Press: 1993. p.225-234. 18. Crockard A. The Transmaxillary Approach to the Clivus. In: Laligam N Sekhar and Ivo P Janecka editors. Surgery of Cranial Base Tumors. NY: Raven Press: 1993. p.235-244. 19. Cushing H. The Pituitary Body and Its Disorders. Philadelphia, J.B. Lippincott Co.,1912. 20. Dandy WE. A new hypophysis operation. Maryland: Bulletin of the Johns Hopkins Hospital. 1918; 29:154. 21. Dandy WE. Aneurysms of the anterior cerebral artery. JAMA. 1942; 119:1253-1254. 22. Dandy WE. Intracranial Arterial Aneurysms. New York, Hafner. 1944, reprinted 1969. 23. de Martel T. Un point de technique opératoire dans la craniotomie. Presse Med. 1908 ;16 ;641-643. 24. Derome PJ. The transbasal approach to tumors invading the base of the skull. In: Schimidek HH and Sweet WH, editor. Operative Neurosurgical Techniques, vol 1. Florida: Grune & Stratton; 1988. p.619-633. 25. Dolenc VV. Extradural approach to intravernous ICA aneurysm. Acta Neurochir (Wien). 1999;72(suppl);99-106. 26. Dott NM, Bailey P. A consideration of the hypophyseal adenomata. Br.J.Surg. 1925; 13:314-366. 27. Eiselsberg A. Operations upon the hypophysis. Annals or Surgery. 1910; 52:1. 28. Fahlbusch R, Buchfelder M. The Transsphenoidal Approach to Invasive Sellar and Clival Lesions. In: Sekhar LN and Janecka IP editor. Surgery of Cranial Base Tumors. New York: Raven Press; 1993. p.337-349. 29. Frazier CH. An approach to the hypophysis through the anterior cranial fossa. Ann Surg. 1913; 57:145-150. 30. Fein J. Zur Operation der Hypophyse. Wien Klin Wschr. 1910; 23:1035. 31. Galdino, AC; Klescoscki Junior, J; Landeiro, JA. História da cirurgia da hipófise. Arquivo Brasileiro de Neurocirurgia. 2005; 24(3):112-118. 32. Gardner E, Gray D, O’Rahilly R. Anatomia: Estudo Regional do Corpo Humano. 4ª ed. Rio de Janeiro: Guanabara Koogan; 1978. 33. Gigli L. Über ein neues Instrument zum Durchtrennen der Knochen, die Drahtsäge. Centralbl Chir. 1894;21:409-411. 34. Goodrich J. A millennium review of skull base surgery. Childs Nerv Sys. 2000;16:669-685. 35. Gray H. Anatomia. 29ed. Rio de Janeiro; Guanabara Koogan SA, 1988. 36. Griffith HB, Veerapen R. A direct transnasal approach to the sphenoid sinus. Technical note. J Neurosurg. 1987; 66:140-142. 37. Guiot G, Rougerie J, Brion S, et al. L’utilisation des amplificateurs de brilliance en neuro-radiologie e dans la chirugie stéréotaxique. Ann Chir. 1958;12:689. 38. Guiot G. Adenom hypophysaires. Masson, Paris, 1958. 39. Guiot G, Derome P. Surgical problems of pituitary adenomas. In: Krayenbuhl H et al. eds. Advances and technical standards in neurosurgery, vol 3. New York; Springer-Verlag, 1976, 7-33. 40. Guleke N. Die Eingriffe am Gehirnschädel. Gehirn, an der Wirbelsäule und am Rückenmark. Berlin Göttingen Heidelberg: Aufl Springer; 1950. p.335. 41. Hakuba, A. Transoral approach for atlantoaxial dislocation. Neurosurgeons (proceeding of the 4th annual meeting of the Japan congress of neurological surgery); 1985, 4:231-2367. 42. Hakuba A, Liu S, Nishimura S. The orbitozigomatic infratemporal approach: a new surgical technique. Surg Neurol. 1986; 26:271-276. 43. Hakuba A, Nishimura S, Jang BJ. A combined retroauricular and preauricular transpetrosal-transtentorial approach to clivus meningiomas. Surg Neurolol. 1988;30:108-116. 44. Halstead AE. Remarks on the operative treatment of tumors of the hypophysis, with the report of two cases operated on by an oronasal method. Surg. Gynecol.Obstet. 1919; 10:494-502. 45. Hamburger CA, Hammer G, Norlen G, Sjogren B. Transantrosphenoidal Hypophysectomy. Arch. Otolaryng. 1961; 74:2-8. 46. Hardy J. Transsphenoidal surgery of pituitary fossa tumors with televised radiofluoroscopic control. J Neurosurg. 1965; 23:612-19. 47. Hardy J. Transsphenoidal microsurgery of the normal and pathological pituitary. Clin Neurosurg. 1969; 16:185-216. 48. Hardy J. Transsphenoidal hypophysectomy. In: Youmans JR, editor. Neurological Surgery. Philadelphia: W.B.Saunders Company; 1982.p.3959-3972. 49. Hardy J. Historique de la chirurgie hypophysaire. Neurochirugie. 2010; 56:358-362. 50. Heermann J. História e Perspectivas da Microcirurgia Intranasal. In: Stamm AC, editor. Microcirurgia Naso-Sinusal. Rio de Janeiro: Revinter Ltda; 1995.p.1-14. 51. Heuer GJ. Surgical experience with an intracranial approach to chiasmal lesions. Arch Surg. 1920; 1:368-381 52. Hirsch O. Eine neue methode der endonasalen operation von hypophysentumoren. Wie med Wschr 636, 1909. 53. Hirsch O. Ueber Methoden der operativen Behandlung von Hypophysistumoren auf endonasalen Wege. Arch. f. Laring. u. Rhinol, 1910, 24:129-177. 54. Hirsch O. Endonasal method of removal of hypophyseal tumors: With report of two successful cases. Jour AMA 55:772-774, 1910. 55. Honeybul S, Neil-Dwyer, G, Lang A, Evans BT, Weller RO, Gill J. The extended transbasal approach: A quantitative anatomical and histological study. Acta Neurochir (Wien). 1999; 141:251-289. 56. Horsley V. On the technique of operations on the central nervous system. Br Med J. 1906;2:411-423. 57. Ikeda K, Yamashita J, Hashimoto M, Futami K. Orbitozygomatic temporopolar approach for a high basilar tip aneurism associated with a short intracranial internal carotid artery: a new surgical approach. Neurosurgery 1991; 28:105-110. 58. Janecka IP, Sen C, Sekhar LN and Nuss, DW. Facial Translocation Approach to Nasopharynx, Clivus and Intratemporal Fossa in Surgery of Cranial Base Tumors. Laligam N. Sekhar and Ivo P. Janecka editors. Raven Press, NY, 1993; p.245-259. 59. Jane JA, Park TS, Pobereskin LH, Winn HR, Butler AB. The supraorbital approach. Technical note. Neurosurgery. 1982; 11:537-542. 60. Jane Jr JA, Thapar K, Laws Jr ER. A history of pituitary surgery. Oper Tech Neurosurg. 2002; p.5(4):200-209. 61. Jane Jr JA, Thapar K, Laws Jr ER. Pituitary Tumors: Functioning and Nonfunctioning. In: Youmans JR, editor. Neurological Surgery. Philadelphia: W.B.Saunders Company; 2011.p.1476-1510. 62. Jankowski R, Auque J, Simon C, et al. Endoscopic pituitary tumor surgery. Laryngoscope. 1992;102:198-202. 63. Jho HD, Carrau RL. Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg 1997;87:44-51. 64. Junqueira LC, Carneiro J. Histologia Básica. Editora Guanabara Koogan. 9a edição. 1999. 65. Kanavel AV. The removal of tumor of the pituitary body by an infranasal route. A proposed operation with a description of the technic. Jama 53:1704-1707, 1909. 66. Kawase T, Shiobara R, Toya S. Anterior transpetrosal-transtentorial approach for sphenopetroclival meningioma: surgical method an results in 10 patients. Neurosurgery. 1991; 28:869-876. 67. Kempe LG. Operative neurosurgery. Springer Verlag, New York. 1970. 68. Kempe LG. Operative Neurosurgery, vol1, Cranial, Cerebral and Intracranial Vascular Disease. Berlin, Springer-Verlag. 1968. 69. Kitano M, Taneda M. Extended transsphenoidal approach with submucosal posterior ethmoidectomy for parasellar tumors. Technical note. J Neurosurg 2001; 94(6):999-1004. 70. Kobayashi S and Sakai K, editor. Neurosurgery of Complex Vascular Lesions and Tumors. New York - Stuttgart: Thieme Med Pub Inc; 2005. p.135-292. 71. Kocher, AB. Ein Fall von Hypophysis tumor mit operativer Heilung. Deutsch. Z. Chir. 1909; 100:13-37. 72. Koenig (König) F. Zur totalestirpation der hypophysis cerebri. Berl Klin Wochenschr, 1909, 37: 1040. 73. Kopp P. Theodor Kocher (1841-1917) Nobel Prize Centenary 2009. Arq Bras Endocrinol Metab. 2009; 53/9:1176-1180. 74. Krause F, Hirnchirurgie. Deutsch.Klib. 1905; 8:953-1024. 75. Krayenbühl HA, Yasargil MG. Cerebral Angiography. London Butterworths, 1968, p129-133. 76. Krmpotic-Nemanic J, Draft W, Helms, J. Chirurgische Anatomie des Kopft-Halls-Bereiches. Berlin, Heidelberg, New York, Tokyo: Springer; 1985. 77. Landeiro JA, Flores MS, Ribeiro CH, Braga FM. Complicações rinológicas da hipofisectomia transesfenoidal. Arq Bras Neurocirurg. 1994;13:159-162. 78. Landeiro JA, Teixeira LB, Marins Filho J, Silva LCH. Esfenoidotomia anterior para acesso aos tumors selares. Arq.Neuro-Psiquiatr. 2001;59(3):286-288. 79. Landolt AM. History of Pituitary Surgery from the technical aspect. Nerosurgery Clinics of North America. 2001; 12/1:37-44. 80. Lang J. Anatomy of the Sellar Region. In: Samii M, Draft W, editor. Surgery of the Skull Base. An Interdisciplinary Approach. Berlin. Springer-Verlag; 1989. p.27-35. 81. Lang J. Anatomy of the Clivus. In: Samii M, Draft W, editor. Surgery of the Skull Base. An Interdisciplinary Approach. Berlin: Springer-Verlag; 1989.p.90-95. 82. Lang J. Anatomy of the Paranasal Sinus. In: Laligam N. Sekhar & Ivo P. Janecka editors. Surgery of Cranial Base Tumors. New York: Raven Press; 1993.p.123-130. 83. Lanzino G, Laws Jr ER, Feiz-Erfan I, White WL. Tanssphenoidal approach to Lesions of the sella turcica: historical overview. Barrow Quarterly. 2002;18(3). 84. Laws Jr ER. Transsphenoidal Approach to Lesions In and About the Sella Turcica. In: Schimidek HH and Sweet WH, editor. Operative Neurosurgical Techniques, vol 1. Florida: Grune & Stratton; 1988.p.309-319. 85. Liu JK, Das K, Weiss MH et al. The history end evolution of transsphenoidal surgery. J Neurosurg 2001; 95:1083-96. 86. Ljunggren B, Fox JL. History of the Pterional Approach. Atlas of Neurosurgical Anatomy. New York: Springer; 1989.p.1-9. 87. Logan BM, Reynolds PA, Hutchings RT. McMinn’s Color Atlas of Head and Neck Anatomy. Philadelphia: Elsevier Limited; 2004. 88. Löwe L. Die Eingriffe am Gehirnschädel, Gehirn, an der Wirbelsäule und am Rückenmark. In Guleke N, Zenker R (Hrsg) Allgemeine und spezielle chirurgiesche Operations-lehre 2nd Ed. Vol2. Berlin Göttingrn Heidelberg. Springer; 1905.p.335. 89. McArthur LL. An aseptic surgical access to the pituitary body and its neighborhood. JAMA. 1912; 58:2009-2011. 90. Macbeth R and Hall M. Hypophysectomy as a Rhinological Procedure. Arch. Otolaryng 1962; 75:440-450. 91. Maroon JC. Skull Base Surgery: Past, Present, and Future Trends. Neurosurg Focus. 2005; 19(1-6). 92. Mattox DE, Carson BS. Transpalatal Transsphenoidal Approach to the Sella in Children. In: Skull Base Surgery, Vol 1, Nº 3, Departments of Otolaryngology-Head and Neck Surgery and Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland: Thieme Medical Publishers, Inc.; 1991.p.177-182. 93. Monnier DS. Séquelles endonasales après hypophysectomie. Ann Otolaryngol Chir Cervicofac. 1998;115;49-53. 94. Montgomery WW. Hypophysectomy. In: Surgery of the Upper Respiratory System. Volume One. Philadelphia: Lea & Febiger; 1979.p.79-115. 95. Murta AA, Carneiro CG, Felippu A. Anatomia endoscópica do seio esfenoidal. Rev. Bras. Otorrinolaringol. 2002;68(4):522-5. 96. Myoken Y, Sugata T, Kiriyama T et al. Transoral approach for large pituitary adenoma using Le Fort 1 osteotomy with mandibulectomy. A case report. Int J Oral Maxillofac Surg. 2000; 29(2):128-130. 97. Nabe-Nielsen J. Nasal complication after transsphenoidal surgery for pituitary pathologies. Acta Neurochirurgica, 1989, Volume: 96, Issue 3-4, 122-125. 98. Nakane T. Transsphenoidal approach to pituitary adenomas with supraselar extention. Surg Neurol 1981, 16(3):225-229. 99. Navarro JAC. Anatomia do Nariz, Seios Paranasais e Estruturas Correlatas. In: Stamm AC, editor. Microcirurgia Naso-Sinusal. Rio de Janeiro: Revinter Ltda; 1995.p.15-36. 100. Oliveira E. The pretemporal approach to the interpeduncular and petroclival regions. Wien. Acta Neurochir. 1995; 136:204-211. 101. Pellerin P, Lesoin F, Dhelemmes P, et al. Usefulness of the orbitofrontomalar approach associated with bone reconstruction for frontotemporosphenoid meningiomas. Neurosurgery. 1984; 15:715-718. 102. Petry C, Leães CGS, Pereira-Lima JFS, Gerhardt KD, Sant GD, Oliveira MC. Complicações oronasais em pacientes pós-abordagem hipofisária via transesfenoidal. Braz. J. Otorhinolaryng. 2009;75(3):345-349. 103. Preysing H. Beiträge zur Operation der Hypophyse. Verh dtsch Laryng. 1913; 20:51. 104. Ramina R, Coelho Neto M, Meneses MS, Pedroso AA. Manegement of chordomas and chondrosarcomas of the skull base. Critical Review in Neurosurgery. 1997;7:141-8. 105. Rhoton AL, Hardy DG, Chambers SM. Microsurgical Anatomy and Dissection of the Sphenoid Bone, Cavernous Sine and Sellar Rion. 1979; 12:63-104. 106. Rhoton AL Jr. Crânio - Anatomia e Acessos Cirúrgicos - Bases cranianas anterior e média. Di Livros Editora Ltda. Rio de Janeiro, RJ, 2009.p.303-330. 107. Rhoton AL Jr. Crânio - Anatomia e Acessos Cirúrgicos - Região Selar . Di Livros Editora Ltda. Rio de Janeiro, RJ, 2009.p.363-401. 108. Rose-Innes AP, Oosthuizen HC. The Transoral Transpalatal Approach to the Pituitary Fossa. Minim. lnvas. Neurosurg. 1995; 38:22-26. 109. Samii M, Draft, W. Surgery of space-occupying lesions of the anterior skull base. In: Samii M, Draft W editors. Surgery of the Skull Base. An Interdisciplinary Approach. Berlin: Springer-Verlag; 1989.p.159-232. 110. Samii M, Draft, W. Surgery of space-occupying lesions of the middle skull base. In: Samii M, Draft W editors. Surgery of the Skull Base. An Interdisciplinary Approach. Berlin: Springer-Verlag; 1989.p.273-296. 111. Santos RP, Zymberg ST, Abucham Filho JK, Gregório LC, Weckx LLM. Endoscopic transnasal approach to sellar tumors. Rev.Bras. Otorrinolaringol. São Paulo. 2007;73(4):463-75. 112. Schloffer H. Erfolgreiche Operation eines hypophysentumors auf nasalem Wege. Wein Klin Wochenschr 20:621-624, 1907. 113. Segura EV. Contribución a la Cirugía de la Hipófisis. Buenos Aires: Imprenta Flaiban y Camilloni; 1916. p. 9-57. 114. Sethi DS, Pillay PK. Endoscopic management of lesion of the sella turcica. J Otolaryngol 1995;109:956-62. 115. Shinzato IG, Vargas KSM, Daroz JB, Ribeiro V, Mendez DRP, Kobayashi F. Transpalate-Sphenoidal Hypophysectomy. Annals of the 2nd Annual Dandy Meeting. Friendship meeting with Italian neurosurgeons and the Swiss Neurosurgical Society. Milan-Lugano, 2013. 116. Spalteholz W. Atlas de Anatomia Humana. Rio de Janeiro: Editora Guanabara Koogan AS; 1956. 117. Spaziante R, Divitiis E, Cappabianca P. Techniques of Reconstruction of the Sella and Related Structures. In: Schimidek HH and Sweet WH editor. Operative Neurosurgical Techniques, vol 1. Florida: Grune & Stratton; 1988.p.321-337. 118. Stamm AC, Pignatari SSN, Timperley D et al. Seio Esfenoidal em Cirurgia da Base de Crânio. In: Stamm AC editor. Cirurgia Endoscópica Transnasal da Base do Crânio e do Cérebro. Rio de Janeiro, RJ. Livraria e Editora Revinter; 1913.p.127-135. 119. Stone JL. Sir Charles Balance: pioneer British neurological surgeon. Neurosurgery. 1999; 44(3):610-31. 120. Tedeschi H, Rhoton AL. Lateral approaches to the petroclival region. Surg Neurology. 1994; 41/3:180-216. 121. Tessier P, Guiot G, Derome P. Orbital hypertelorism. II. Definite treatment of orbital hypertelorism by craniofacial or by extracranial osteotomies. Scand Plast Reconstr Surg 7. 1973; 7:39. 122. Testut L, Latarget A. Tratado de Anatomia Humana. Tomos 1-4. Salvat Editores, 1960. 123. Tiefenthal. Technik der Hypophysenoperation. Münch Med Wschr. 1920; 67:794. 124. Trible WM, Morse AE: Transpalatal hypophysectomy. Laryngoscope. 1965; 75:1116-1122. 125. Waldman EH, Lustig LR. Sir Charles Alfred Balance: contributions to otology and neurotology. Otol Neurotol. 2005; 26(5):1073-82. 126. Walker, AE. A History of neurological surgery. Williams & Wilkins. 1951. 127. Weiss MH. The transnasal transsfenoidal approach. In: Apuzzo MJL editor. Surgery of the Third Ventricle. Baltimore: Williams & Wilkins; 1987.p.476-494. 128. Welbourne, RB. The evolution of transsphenoidal pituitary microsurgery. Surgery. 1986; 100: 1185-1190. 129. Wen HT, Oliveira E, Tedeschi H, et al. The pterional approach: Surgical anatomy, operative technique, and rationale. In: Operative Techniques in Neurosurgery, vol 4, issue 2. Elsevier Inc. 2001.p.60-72. 130. Yasargil MG, Fox LJ. The microsurgical approach to intracranial aneurysms. Sug Neurolol 1975; 3:7-14. 131. Yasargil MG, Fox JL, Ray MW. The operative approach to aneurysms of the anterior communicating artery, in Krayembühl H. (ed): Advances and Technical Standards in Neurosurgery. Vienna-New York, Springer-Verlag. 1975;p.113-170. 132. Yasargil MG, Antic J, Laciga R, Jain KK, Hodosh RM, Smith RD. Microsurgical pterional approach to aneurysms of the basilar bifurcation. Surg Neurol 1976; 6:83-91. 133. Yasargil MG, Reichman MV, Kublik S. Preservation of the frontotemporal branch of the facial nerve using the interfascial temporalis flap for pterional craniotomy. Technical article. J Neurosurg. 1987; 67:463-466.

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy