Endoscopic Endonasal Approach for Removal of Tuberculum Sellae Meningiomas

Filho, Leo F. S. Ditzel; Prevedello, Daniel M.; Jamshidi, Ali O.; Dolci, Ricardo Landini Lutaif; Kerr, Edward E.; Campbell, Raewyn; Otto, Bradley A.; Carrau, Ricardo L.

doi:10.1016/j.nec.2015.03.005

Cited by 35 publications

(9 citation statements)

References 52 publications

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“…The chief advantages that the trans-sphenoidal approaches present are lack of brain retraction, early devascularization of tumor supply, early bilateral optic nerve decompression, minimal handling of the optic nerve, and superior hypophyseal artery at the very end of tumor resection and better cosmesis. 14 21 22 On the contrary, the trans-sphenoidal approach has its own fair share of limitations, which include the application of greater force on the surrounding structures in comparison with micro-instruments, difficult access in case of tumors with significant lateral extension, difficulty in achieving Simpson Grade I resection as it is difficult to resect the entire dural attachment, and postoperative CSF leak that has been reported to be as high as 20 to 30%. 21…”

Section: Discussionmentioning

confidence: 99%

Tuberculum Sella Meningioma: Surgical Management and Results with Emphasis on Visual Outcome

Kachhara

Nigam

Nair

2022

JNRP

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Background Tuberculum sella meningioma form a distinct surgical entity with significant morbidity for the patient due to early and profound visual involvement. Surgical treatment of tuberculum sella meningioma is challenging in view of the proximity of vital neuro-vasculature. These lesions may be approached via a high-route (trans-cranial) or a low-route (trans-sphenoidal). Materials and Methods The authors present a consecutive series of 36 patients, operated by the first author from 1996 onward, with an analysis of clinical presentation (emphasizing visual deterioration), imaging features, operative approaches, and outcome with postoperative visual status. Results There were 36 patients (72 eyes) in the series, 75% females and 25% males. The mean age of patients was 48.05 ± 10.02 years. In all, 88.89% had visual diminution, 50% had headache, 5.56% had behavioral changes, and 2.78% had seizures. The mean tumor size was 4.01 ± 1.01 cm. The frontotemporal approach was employed in 66.67% of patients, and all patients underwent a right-sided approach. There was no significant difference between improvement in the vision between the right eye and left eye, despite the fact that right-sided approach was employed in nearly cases. Conclusion While tuberculum sella meningioma have profound morbidity in terms of visual deterioration, timely surgical intervention may help patients gain serviceable vision postoperatively. We advocate the trans-cranial approach and find no difference in visual outcomes on employing right-sided approach, regardless of the side with worse vision.

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Section: Discussionmentioning

confidence: 99%

Tuberculum Sella Meningioma: Surgical Management and Results with Emphasis on Visual Outcome

Kachhara

Nigam

Nair

2022

JNRP

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“…In our data, only 4 out of 14 cases of CSF leakage did not develop subarachnoid invasion. Suprasellar tumors, especially tuberculum sellae meningiomas, were difficult to keep the arachnoid intact after lesion removal because of the tumor consistency, and even accompanied with injury to the brain tissue and perforating vessels ( 19 , 20 ), the risk of CSF leakage is relatively high in these cases. Therefore, we point out that the integrity of the arachnoid is a more influencing factor than the tumor size or suprasellar extension in postoperative CSF leakage, which is consistent with findings of Campero et al described previously ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

Exploration of the causes of cerebrospinal fluid leakage after endoscopic endonasal surgery for sellar and suprasellar lesions and analysis of risk factors

et al. 2022

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ObjectivePostoperative cerebrospinal fluid (CSF) leakage following endoscopic endonasal surgery (EES) is a frequent complication. This study aims to identify potential risk factors of postoperative CSF leakage.MethodsA retrospective review of 360 patients who underwent EES was included. The associations between postoperative CSF leakage and patient demographics, medical history, tumor characteristics, and intraoperative repair techniques were analyzed; the diagnosis and repair of postoperative CSF leakage were also introduced.ResultsPostoperative CSF leakage occurred in 14 patients (3.9%), 2 of them cured by lumbar cistern drainage, 12 underwent endoscopic repair. Among these 12 cases, 3 were repaired twice, and the rest were cured the first time. During the repair surgery, insufficient embedded fat was detected in one case detected, seven with breached inner artificial dura, three had vascularized pedicle nasoseptal flap (VP-NSF) displacement, two with VP-NSF perforation, two with VP-NSF inactivation, and one with imperfect adherence to VP-NSF to the skull base. Eight cases had intracranial infections. Excluding one case who died of severe intracranial infection, the rest were cured and discharged without obvious sequelae. Multivariate analysis revealed that the suprasellar lesion, subarachnoid invasion, and intraoperative grade 3 flow CSF leakage were the risk factors of CSF leakage after operation, while the bone flap was a protective factor.ConclusionBone flap combined with VP-NSF and iodoform gauze for skull base reconstruction is recommended in high-risk patients, while postoperative lumbar cistern drain remains dispensable.

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“…A review article by Ditzel Filho et al . [ 12 ] found 29 studies where the endoscopic transnasal approach to tuberculum sellae meningiomas were reported, with a total of 203 patients operated. The rates of gross total resection ranged from 54% to 100%, with 19% rate of postoperative CSF leak reported as the most common surgical complication.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic transnasal suprasellar approach for anterior clinoidal meningioma: A case report and review of the literature

Bardeesi¹,

Alsaleh

Ajlan

2017

Surg Neurol Int

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Background:Anterior clinoidal meningiomas (ACM) are traditionally approached through transcranial routes. Due to their tendency to extend laterally and their proximity to vital neurovascular structures, the endoscopic transnasal suprasellar approach is still questionable. We present and describe an ACM case that underwent an endoscopic transnasal suprasellar approach, and provide a review of the literature and operative technique.Case Description:A 56 year-old lady who presented with chronic left-sided decreased vision. Brain imaging revealed a lesion measuring 9 × 10 × 11 mm attached to the left anterior clinoid process (ACP) and extending to the left optic canal. Lesion was compressing the left optic nerve (ON) and abutting the supraclinoid part of the left internal carotid artery (ICA). Utilizing the endoscopic transnasal suprasellar approach, the meningioma was resected and the optic canal was decompressed. Reconstruction was achieved using fascia lata, vomer bone, and nasoseptal flap. A lumbar drain was inserted perioperatively. Patient had no perioperative morbidity and retained vision in the affected eye.Conclusions:Resection of selected ACMs can be safely achieved utilizing the endoscopic transnasal suprasellar approach. Although the literature lacks long-term outcome comparison between the transnasal and the traditional transcranial approaches, specifically addressing ACMs, this technique is becoming more popular over the last decade. More efforts should be directed towards implementing and reporting the endoscopic transnasal suprasellar approach for meningiomas of the anterior clinoid process.

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Endoscopic Endonasal Approach for Removal of Tuberculum Sellae Meningiomas

Cited by 35 publications

References 52 publications

Tuberculum Sella Meningioma: Surgical Management and Results with Emphasis on Visual Outcome

Tuberculum Sella Meningioma: Surgical Management and Results with Emphasis on Visual Outcome

Exploration of the causes of cerebrospinal fluid leakage after endoscopic endonasal surgery for sellar and suprasellar lesions and analysis of risk factors

Endoscopic transnasal suprasellar approach for anterior clinoidal meningioma: A case report and review of the literature

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