Endoscopic endonasal transsphenoidal approach for resection of tuberculum sella and planum sphenoidale meningiomas: A snapshot of our institutional experience

Abstract

Introduction: Meningiomas of the tuberculum sellae and planum sphenoidale represent a subgroup of anterior skull base tumors that comprise approximately 5%–10% of all intracranial meningiomas. Most of the patients report with failing vision, so early surgical decompression either transcranial and/or endonasal approach is recommended. The endonasal route allows for direct coagulation of the tumor meningeal supply and extensive resection of dural attachments, and importantly, provides an inferior to superior access to the infrachiasmatic region that facilitates complete tumor removal without encountering the optic nerve. This article describes our institutional experience for the endonasal resection of tuberculum sellae and planum sphenoidale meningiomas. Materials and Methods: We retrospectively analyzed eight cases of tuberculum sellae and planum sphenoidale meningiomas who selectively underwent endoscopic endonasal transsphenoidal resection between 2015 and 2018. All patients had ophthalmological, endocrinological, and radiological evaluation both preoperatively and postoperatively. Results: Among the study group, we found age range 22–68 years, male:female 1:2. Among the radiological findings, there were five cases of tuberculum sellae meningioma, while three cases were of planum sphenoidale meningioma. In tumor resection status, we found gross total resection in six cases and debulking in two cases. Postoperative analysis of visual outcome revealed improvement in four cases, constant in three cases, and worsening in one case. We also found the post of nasal complications in four cases, cerebrospinal fluid leak in two cases and transient diabetes insipidus in one case. Conclusion: In this study, we highlighted our experience of a very small group of patients with anterior fossa meningioma specific to tuberculum sella and planum sphenoidale origin.

The endoscope-assisted supraorbital “keyhole” approach for anterior skull base meningiomas: an updated meta-analysis

“…Importantly, studies that did not report specific outcomes for OGM/TSM and approach combination were excluded from the final meta-analysis. These studies were considered for qualitative analysis if the relevant the tumour (TSM or OGM) and approach (mTCA, EEA, or eSKA) combination of interest was > 50% of the study population [9,48,98,105,111]. Similarly, articles that grouped TSM cases with planum sphenoidale meningiomas [3,92] were considered for qualitative review only (owing to the similarity of these tumour groups) but not included in the final meta-analysis.…”

Endoscopic endonasal surgery for anterior skull base meningiomas

“…Recent series have indicated overall excellent visual outcomes for tuberculum sellae meningiomas approached by the endonasal route [Table 1] [13,24,26,[36][37][38][39][40][41][42][43] . Yang et al [19] performed a meta-analysis of studies assessing the endonasal endoscopic route vs. transcranial approaches for tuberculum sellae meningiomas and found higher rates of visual improvement (85.7% vs. 55.1%) in the endoscopic cohort with similar rates of gross total resection (74.5% vs. 76.1%).…”

“…An endonasal approach provides direct access to the medial 180° of the optic canals, enabling the opportunity for effective decompression and tumor removal. A summary of recent case series is presented in Table 2 [39,42,43,[55][56][57]62] .…”

“…Meticulous dissection of the optic nerves and chiasm, including careful preservation of small perforators to the optic apparatus, including the superior hypophyseal arteries, is required to prevent post-operative vision decline. Endoscopic endonasal series have reported worsening vision in up to 36%, with more recent series reporting much lower rates of less than 5% [Table 1] [11,13,23,24,26,[36][37][38][39][40][41][42][43][45][46][47][48][49][50][51] . CSF leaks from this approach are high flow (Grade 3 leaks) requiring a robust reconstruction, ideally with a nasoseptal flap.…”

Extended endoscopic endonasal approach to the chiasmatic cistern: An anatomical study of the arachnoid

“…Neurosurgical operations can be performed via the subarachnoid cistern, which provides a surgical corridor for anatomical separation (Yasargil et al, 1976). Due to technological advances and increasing surgical experience, the endoscopic endonasal approach has become a routine surgical route for suprasellar lesions (Cavallo et al, 2019; Ceylan et al, 2021; Mohyeldin et al, 2020; Salek et al, 2020; Yilmaz et al, 2022).…”