Endoscopic Endonasal Management of Rare Sellar Lesions: Clinical and Surgical Experience of 78 Cases and Review of the Literature

Somma, Teresa; Solari, Domenico; Beer‐Furlan, André; Guida, Lelio; Otto, Bradley A.; Prevedello, Daniel M.; Cavallo, Luigi Maria; Carrau, Ricardo L.; Cappabianca, Paolo

doi:10.1016/j.wneu.2016.11.057

Cited by 24 publications

(20 citation statements)

References 48 publications

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“…11,14 It is also widely used in the resection of other extrasellar extra-axial lesions including craniopharyngiomas, dermoid tumors, meningiomas, and chordomas. [8][9][10]12,13,15,[17][18][19] However, experience with this technique in the treatment of intraaxial lesions with critical neurovascular relationship is limited, so traditionally an open technique is preferred. 14,20 The role of the endoscopic transnasal approach in intra-axial lesions, lesions with intra-axial extension, large tumors, and lesions with peritumoral edema is controversial.…”

Section: Discussionmentioning

confidence: 99%

“…20 Recent reports demonstrated the value of this approach in suprasellar lesions, some with intra-axial extension. [17][18][19][21][22][23][24] One study by Ajayi et al demonstrated a successful gross total resection of a suprasellar germ cell tumor in an 18-year-old girl. 6 The patient had postoperative pituitary dysfunction but a significant improvement in vision, similar to our case.…”

Section: Discussionmentioning

confidence: 99%

“…They demonstrated the feasibility of this approach, achieving gross subtotal resection in most of the reported cases. 18 However, craniopharyngiomas represent a clear example of tumors that can be resected safely by the endoscopic transnasal route, with results that are similar or superior to open traditional approaches. 10,13,18 The value of this technique is also demonstrated in intra-axial brainstem lesions such as brainstem cavernous malformation.…”

Section: Discussionmentioning

confidence: 99%

“…18 However, craniopharyngiomas represent a clear example of tumors that can be resected safely by the endoscopic transnasal route, with results that are similar or superior to open traditional approaches. 10,13,18 The value of this technique is also demonstrated in intra-axial brainstem lesions such as brainstem cavernous malformation. 25,26 Although the endoscopic transnasal approach avoids some of the morbidity of transcranial surgeries, patients undergoing this approach may experience some sinonasal symptoms following surgery.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic Transnasal Resection of Suprasellar Teratoma

Ajlan

Albakr

Alsaleh

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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Background Intracranial teratomas are rare tumors that usually present during the second decade of life. Among intracranial teratomas, suprasellar germ cell tumors in particular are extremely rare. We present the case of an 18-year-old girl who underwent a successful endoscopic transnasal resection of a suprasellar teratoma with a mixed germ cell component. Case Description An 18-year-old girl presented with progressive visual disturbance, headache, weight loss, and fatigue for 2 weeks. She had decreased vision in her right eye and double vision when looking to the right side. On examination, she had right-side complete abducens nerve palsy and partial oculomotor nerve palsy bilaterally. Brain imaging revealed a large suprasellar lesion consistent with a germ cell tumor. The patient underwent a transnasal endoscopic resection of the lesion. Pathology showed a mixed germ cell tumor (80% mature cystic teratoma, 18% yolk sac tumor, and 2% germinoma). The mature teratomatous elements identified included skin with sebaceous material, hair, cartilage, acini, colonic mucosa, muscle, nerve bundles, and adipose tissue. Postoperative magnetic resonance imaging (MRI) showed residual tumor in the left cavernous sinus and anterior clinoid process superiorly. At a 1-year follow-up, the double vision had resolved, and her vision showed progressive improvement. The patient was maintained on treatment for diabetes insipidus, hypothyroidism, and adrenal insufficiency. Her last MRI showed no signs of tumor progression. Conclusions The present case demonstrates a safe endoscopic transnasal surgical resection of a rare suprasellar tumor, mixed teratoma, with intra-axial extension. The endoscopic transnasal approach can be considered a valid option for a suprasellar lesion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Endoscopic Transnasal Resection of Suprasellar Teratoma

Ajlan

Albakr

Alsaleh

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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“…Therefore, one of the major challenges for neurosurgery is how to achieve the maximal resection of tumors and few postoperative complications. [ 1 – 5 ] Different surgical approaches may be used according to different growth directions of sellar region tumors, including frontolateral approach, [ 6 ] endoscopic endonasal approach, [ 7 ] and endoscopic endonasal transspehenoidal approach. [ 8 ] Anterior interhemispheric approach can achieve resection of a variety of large tumors located along the median line of the sellar region by separating the median line structure of the frontal part exposed in the sellar region in a interhemispheric fissure manner.…”

Section: Introductionmentioning

confidence: 99%

Anterior interhemispheric approach for removing large sellar region tumor

et al. 2018

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The aim of the study was to explore anterior interhemispheric approach microsurgery for removing large sellar region tumors.A total of 118 patients with large sellar region tumors were treated with the anterior interhemispheric approach microsurgery. There were 58 craniopharyngioma, 37 pituitary adenoma, 5 hypothalamic glioma, 7 meningioma, and 11 other tumors cases. The maximal tumor diameter ranged from 3.0 to 8.2 cm, with a mean diameter of 4.3 cm. Diabetes insipidus and fluid and electrolyte imbalance were timely controlled after surgery. Postoperative examination of endocrine and of magnetic resonance imaging (MRI) enhancement scanning of the head were performed.Total, subtotal, and partial removal of tumors was, respectively, achieved in 80, 23, and 15 cases. A total of 109 patients had improved vision after surgery. During the hospital stay, 81 had diabetes insipidus, 68 had fluid and electrolyte imbalance, and 9 had hemorrhage and tumidness in the right frontal lobe (3 had frontal lobe contusion, and 6 had frontal lobe hematoma). The postoperative follow-up visit lasted for 3 to 105 months. During the follow-up period, 14 patients had recurrence of tumors, 38 cases had their single or multiple pituitary axis treated with hormonal replacement therapy for a long time after surgery, and 23 cases had to orally take drugs for the purpose of controlling diabetes insipidus.The anterior interhemispheric approach microsurgery is feasible for removing large sellar region tumors without significant sequels. Active postoperative managements of diabetes insipidus and fluid and electrolyte imbalance may help patients with earlier recovery.

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