A Multi-institutional Comparison of Transcranial versus Endoscopic Endonasal Approaches for Planum and Tuberculum Sellae Meningiomas

Chen, Stephanie H.; Zenonos, Georgios A.; Goldschmidt, Ezequiel; Sprau, Annelise C.; Sedighim, Shaina; Sur, Samir; Cabral, David Fernandez; Algattas, Hanna; Jacobs, Rachel; Wang, Eric; Snyderman, Carl H.; Miranda, Juan F.; Ivan, Michael E.; Komotar, Ricardo J.; Gardner, Paul A.; Morcos, Jacques J.

doi:10.1055/s-0039-1679481

Cited by 2 publications

(4 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[100][101][102] Tumor characteristics, risk profile, patient preference, and surgeon experience often guide the choice of surgical approach to the suprasellar space. 103…”

Section: Transtuberculum/transplanum Approachmentioning

confidence: 99%

Sellar, suprasellar, and parasellar masses: Imaging features and neurosurgical approaches

et al. 2021

View full text Add to dashboard Cite

The sellar, suprasellar, and parasellar space contain a vast array of pathologies, including neoplastic, congenital, vascular, inflammatory, and infectious etiologies. Symptoms, if present, include a combination of headache, eye pain, ophthalmoplegia, visual field deficits, cranial neuropathy, and endocrine manifestations. A special focus is paid to key features on CT and MRI that can help in differentiating different pathologies. While most lesions ultimately require histopathologic evaluation, expert knowledge of skull base anatomy in combination with awareness of key imaging features can be useful in limiting the differential diagnosis and guiding management. Surgical techniques, including endoscopic endonasal and transcranial neurosurgical approaches are described in detail.

show abstract

“…[100][101][102] Tumor characteristics, risk profile, patient preference, and surgeon experience often guide the choice of surgical approach to the suprasellar space. 103…”

Section: Transtuberculum/transplanum Approachmentioning

confidence: 99%

Sellar, suprasellar, and parasellar masses: Imaging features and neurosurgical approaches

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Several studies have reported on the extent of tumor resection, visual outcomes, and complication rates associated with each approach. However, the absence of a recent systematic review and meta-analysis hinders the synthesis of these findings into a comprehensive understanding of the relative merits of MTAs and EEAs for TSMs [1,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22].…”

Section: Introductionmentioning

confidence: 99%

“…A total of 16 studies comprising 1053 patients were included for the random-effects meta-analysis [1,[6][7][8][9][10][11][12][13][14][15][17][18][19][20]. The rate of CSF leak in the EEA group was 43/436 (9.8%), and it was 13/617 (2.1%) in the MTA group.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Comparative Efficacy of Transsphenoidal and Transcranial Approaches for Treating Tuberculum Sellae Meningiomas: A Systematic Review and Meta-Analysis

Agosti,

Alexander,

Antonietti

et al. 2024

JCM

View full text Add to dashboard Cite

Background/Objectives: Tuberculum sellae meningiomas (TSMs) constitute 5–10% of intracranial meningiomas, often causing visual impairment. Traditional microsurgical transcranial approaches (MTAs) have been effective, but the emergence of innovative surgical trajectories, such as endoscopic endonasal approaches (EEAs), has sparked debate. While EEAs offer advantages like reduced brain retraction, they are linked to higher cerebrospinal fluid leak (CSF leak) risk. This meta-analysis aims to comprehensively compare the efficacy and safety of EEAs and MTAs for the resection of TSMs, offering insights into their respective outcomes and complications. Methods: A comprehensive literature review of the databases PubMed, Ovid MEDLINE, and Ovid EMBASE was conducted for articles published on TSMs treated with either EEA or MTA until 2024. The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Meta-analysis was performed to estimate pooled event rates and assess heterogeneity. Fixed- and random-effects were used to assess 95% confidential intervals (CIs) of presenting symptoms, outcomes, and complications. Results: A total of 291 papers were initially identified, of which 18 studies spanning from 2000 to 2024 met the inclusion criteria. The exclusion of 180 articles was due to reasons such as irrelevance, non-reporting of selected results, systematic literature review or meta-analysis, and a lack of details on method/results. The 18 studies comprised a total sample of 1093 patients: 444 patients who underwent EEAs and 649 patients who underwent MTAs for TSMs. Gross total resection (GTR) rates ranged from 80.9% for EEAs to 79.8% for MTAs. The rate of visual improvement was 86.6% in the EEA group and 65.4% in the MTA group. The recurrence rate in the EEA group was 6.9%, while it was 5.1% in MTA group. The postoperative complications analyzed were CSF leak, infections, dysosmia, intracranial hemorrhage (ICH), and endocrine disorders. The rate of CSF leak was 9.8% in the EEA group and 2.1% in MTA group. The rate of infections in the EEA group was 5.7%, while it was 3.7% in the MTA group. The rate of dysosmia ranged from 10.3% for MTAs to 12.9% for EEAs. The rate of ICH in the EEA group was 0.9%, while that in the MTA group was 3.8%. The rate of endocrine disorders in the EEA group was 10.8%, while that in the MTA group was 10.2%. No significant difference was detected in the rate of GTR between the EEA and MTA groups (OR 1.15, 95% CI 0.7–0.95; p = 0.53), while a significant benefit in visual outcomes was shown in EEAs (OR 3.54, 95% CI 2.2–5.72; p < 0.01). There was no significant variation in the recurrence rate between EEA and MTA groups (OR 0.92, 95% CI 0.19–4.46; p = 0.89). While a considerably increased chance of CSF leak from EEAs was shown (OR 4.47, 95% CI 2.52–7.92; p < 0.01), no significant difference between EEA and MTA groups was detected in the rate of infections (OR 1.92, 95% CI 0.73–5.06; p = 0.15), the rate of dysosmia (OR 1.25, 95% CI 0.31–4.99; p = 0.71), the rate of ICH (OR 0.61, 95% CI 0.20–1.87; p = 0.33), and the rate of endocrine disorders (OR 1.16, 95% CI 0.69–1.95; p = 0.53). Conclusions: This meta-analysis suggests that both EEAs and MTAs are viable options for TSM resection, with distinct advantages and drawbacks. The EEAs demonstrate superior visual outcomes in selected cases while GTR and recurrence rates support the overall effectiveness of MTAs and EEAs. Endoscopic endonasal approaches had a higher chance of CSF leaks, but there are no appreciable variations in other complications. These results provide additional insights regarding patient outcomes in the intricate clinical setting of TSMs.

show abstract

A Multi-institutional Comparison of Transcranial versus Endoscopic Endonasal Approaches for Planum and Tuberculum Sellae Meningiomas

Cited by 2 publications

References 0 publications

Sellar, suprasellar, and parasellar masses: Imaging features and neurosurgical approaches

Sellar, suprasellar, and parasellar masses: Imaging features and neurosurgical approaches

Comparative Efficacy of Transsphenoidal and Transcranial Approaches for Treating Tuberculum Sellae Meningiomas: A Systematic Review and Meta-Analysis

Contact Info

Product

Resources

About