Anatomic landmarks of the endonasal transsphenoidal surgery

Objective: To explore valuable anatomic landmarks for endonasal transsphenoidal surgery. Methods: During the microsurgical procedures of 148 cases, the relative anatomic structures were observed and analyzed. Results:The important anatomic landmarks during the surgical approach concerning with middle nasal concha, superior nasal concha, the mucosal aperture of sphenoidal sinus, the posterior naris, the outline of anterior wall of sphenoid sinus viewed within the nasal cavity, the conjunction between the bone part and the cartilage part of the nasal septum, the osseous anterior wall of sphenoid sinus, the nourishing arteries of the anterior wall of sphenoid sinus, the septation of the sphenoidal sinus and the swelling of sellar floor. In spite of variations, above structures were constant landmarks among different individuals, which was valuable for performing endonasal transsphenoidal approach. Conclusions: The gold standard of entering the sphenoid sinus accurately is to find the aperture of sphenoidal sinus. Approaching along the inter-mucoperiosteal gap, the Boat top is an important landmark for targeting the osseous aperture of sphenoidal sinus. For the identification of the flat sellar floor, it is a helpful procedure to explore the planum sphenoidale. Accurate identification and reasonable application of these anatomic landmarks can make the surgery more minimally invasive.