Extended Endoscopic Transsphenoidal Approach for Tuberculum Sellae Meningiomas

Divitiis, Enrico de; Cavallo, Luigi Maria; Esposito, Felice; Stella, L; Messina, A.

doi:10.1227/01.neu.0000333785.04435.2c

Cited by 61 publications

(56 citation statements)

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“…With the introduction of endoscopic nasal approaches and the collaboration of neurosurgeons with otolaryngologists, surgery has evolved to allow safe removal of intrasellar tumors with minimal morbidity (Carrau et al, 1996). Since that time, several groups have advocated the use of an extended approach to the suprasellar region, including the tuberculum sellae and planum sphenoidale (Cappabianca et al, 2003; de Divitis et al, 2007; Kassam etal., 2008). The corresponding exocranial view can also be considered; doing so is essential before approaching tumors in this location, given the increased utility of endoscopic, endonasal approaches to the sella and suprasellar regions.…”

Section: Discussionmentioning

confidence: 99%

Anatomic study of the prechiasmatic sulcus and its surgical implications

et al. 2010

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To address a lack of anatomical descriptions in the literature regarding the prechiasmatic sulcus, we conducted an anatomical study of this sulcal region and discuss its clinical relevance to cranial base surgery. Our systematic morphometric analysis includes the variable types of chiasmatic sulcus and a classification schema that has surgical implications. We examined the sulcal region in 100 dry skulls; bony relationships measured included the interoptic distance, sulcal length/width, planum sphenoidale length, and sulcal angle. The varied anatomy of the prechiasmatic sulcii was classified as four types in combinations of wide to narrow, steep to flat. Its anterior border is the limbus sphenoidale at the posterior aspect of the planum sphenoidale. The sulcus extends posteriorly to the tuberculum sellae and laterally to the posteromedial aspect of each optic strut. Averages included an interoptic distance (19.3 +/- 2.4 mm), sulcal length (7.45 +/- 1.27 mm), planum sphenoidale length (19 +/- 2.35 mm), and sulcal angle (31 +/- 14.2 degrees). Eighteen percent of skulls had a chiasmatic ridge, a bony projection over the chiasmatic sulcus. The four types of prechiasmatic sulcus in our classification hold potential surgical relevance. Near the chiasmatic ridge, meningiomas may be hidden from the surgeon's view during a subfrontal or pterional approach. Preoperative evaluation by thin-cut CT scans of this region can help detect this ridge.

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Section: Discussionmentioning

confidence: 99%

Anatomic study of the prechiasmatic sulcus and its surgical implications

et al. 2010

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“…Craniopharyngiomas and tuberculum sellae meningiomas arising in the chiasmatic cistern are considered ideal candidates for extended endoscopic endonasal surgery (3,4,13). Supra-diaphragmatic ectopic pituitary adenomas that arise from the same area, especially those localized in the pre-infundibular area without lateral extension beyond the internal carotid artery, would also be considered appropriate indications for extended endoscopic endonasal surgery.…”

Section: A B Fuminari K Et Al: 3d Endoscopic Endonasal Surgery In Mrmentioning

confidence: 99%

“…This enables the resection of suprasellar tumors including craniopharyngioma, pituitary adenoma and tuberculum sellae meningioma (3,4,13). However, the endoscopic view lacks steric sense, and wide opening of the dura mater could result in postoperative cerebrospinal fluid leakage.…”

Section: Introductionmentioning

confidence: 99%

Extended endoscopic endonasal surgery using three-dimensional endoscopy in the intra-operative MRI suite for supra-diaphragmatic ectopic pituitary adenoma

Komatsu¹,

Aoki²,

Osakabe³

et al. 2014

Turkish Neurosurgery

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We describe a supra-diaphragmatic ectopic pituitary adenoma that was safely removed using the extended endoscopic endonasal approach, and discuss the value of three-dimensional (3D) endoscopy and intra-operative magnetic resonance imaging (MRI) to this type of procedure.A 61-year-old-man with bitemporal hemianopsia was referred to our hospital, where MRI revealed an enhanced suprasellar tumor compressing the optic chiasma. The tumor extended on the planum sphenoidale and partially encased the right internal carotid artery. An endocrinological assessment indicated normal pituitary function. The extended endoscopic endonasal approach was taken using a 3D endoscope in the intraoperative MRI suite. The tumor was located above the diaphragma sellae and separated from the normal pituitary gland. The pathological findings indicated non-functioning pituitary adenoma and thus the tumor was diagnosed as a supra-diaphragmatic ectopic pituitary adenoma. Intra-operative MRI provided useful information to minimize dural opening and the supra-diaphragmatic ectopic pituitary adenoma was removed from the complex neurovascular structure via the extended endoscopic endonasal approach under 3D endoscopic guidance in the intra-operative suite. Safe and effective removal of a supra-diaphragmatic ectopic pituitary adenoma was accomplished via the extended endoscopic endonasal approach with visual information provided by 3D endoscopy and intra-operative MRI.KEywords: Chiasmatic cistern, Intraoperative MRI, Suprasellar tumor, Tuberculum sellae ÖZGenişletilmiş endoskopik endonazal yaklaşım kullanılarak güvenli bir şekilde çıkartılan bir supra-diyafragmatik ektopik hipofiz adenomu tanımlanmakta ve bu tür işlemde üç boyutlu (3B) endoskopi ve intraoperatif manyetik rezonans görüntülemenin (MRG) değeri tartışılmaktadır.Bitemporal hemianopsili, 61 yaşında bir erkek hasta hastanemize sevk edildi ve MRG'de optik kiazmayı sıkıştıran, kontrast tutan bir suprasellar tümör görüldü. Tümör, planum sfenoidale üzerine uzanmaktaydı ve sağ internal karotid arteri kısmen çevrelemişti. Endokrin değerlendirme normal pitüiter işlev gösterdi. İntraoperatif manyetik rezonans görüntüleme (MRG) odasında bir 3D endoskop kullanılarak genişletilmiş endoskopik endonazal yaklaşım gerçekleştirildi. Tümör diyafragma sella üzerinde bulunuyordu ve normal hipofiz bezinden ayrılmıştı. Patolojik bulgular işlev görmeyen bir hipofiz adenom düşündürüyordu ve tümöre bu şekilde bir supra-diyafragmatik ektopik hipofiz adenom tanısı konuldu. İntraoperatif MRG dural açıklığı minimuma indirmek için faydalı bilgiler sağladı ve supra-diyafragmatik ektopik hipofiz adenom intraoperatif MRG odasında 3B endoskopi kılavuzluğu altında genişletilmiş endoskopik endonazal yaklaşımla kompleks nörovasküler yapıdan çıkarıldı. Supra-diyafragmatik ektopik hipofiz adenomun güvenli ve etkin bir şekilde çıkarılması 3B endoskopi ve intraoperatif MRG tarafından sağlanan görsel bilgiler ve genişletilmiş endoskopik endonazal yaklaşım yoluyla gerçekleştirildi.

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“…Some surgeons advocate two-surgeon technique as the only realistic method for performing these procedures, particularly while performing expanded endonasal operations requiring wider exposures and intracranial dissection. [14][15][16][17][18] We believe this is true for most of the skull base cases, as the binostril bimanual technique with two surgeons provides better visualization, lower complication rate with improved surgical resection and outcomes. The main advantages of the endoscopic transseptal approach for resecting pituitary tumors are the possibility of a binostril approach that allows for a twosurgeon, four-hand surgery and maximal preservation of sinonasal function.…”

Section: Discussionmentioning

confidence: 99%

“…Most groups who have promoted a fully endoscopic technique have strongly emphasized the requirement of a two-surgeon, three, or preferably four-hand approach. [6,14,16,17] The most common scenario of this binostril technique consists of an otorhinolaryngologist performing the initial sphenoid exposure, followed by the neurosurgeon removing the bony structures of the skull base and the lesion while the otorhinolaryngologist operates the endoscope.…”

mentioning

confidence: 99%

Endoscopic endonasal transsphenoidal surgery: Analysis of the first 120 cases in the training hospital setting

Müderris¹,

Türkoğlu²,

Sevil³

et al. 2019

KBB Uygulamaları

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Bu çalışmada ilk 120 ardışık hastada endoskopik endonazal transsfenoidal cerrahi deneyimimiz sunuldu ve endoskopik iki cerrah, dört el tekniğinin etkinliği ve güvenliliği değerlendirildi. Hastalar ve Yöntemler: Ocak 2011-Ocak 2015 tarihleri arasında Ankara Atatürk Eğitim ve Araştırma Hastanesi'nde tamamen endoskopik endonazal transsfenoidal cerrahi yaklaşımı ile ameliyat edilen ilk 120 ardışık hasta (67 kadın, 53 erkek; ort. yaş 43.14 yıl; dağılım, 16-79 yıl) retrospektif olarak incelendi. Tümör endoskopik binostril bimanuel teknik ile çıkarıldı. Cerrahi teknik, patoloji, ameliyat sırası ve sonrası komplikasyonlar ve cerrahi sonuçlar analiz edildi. Bulgular: Toplam 91 lezyon (%76) makroadenom olarak bildirildi. Fonksiyonel hipofiz adenomları 81 hastada (%68) tespit edildi. Bu olguların 28'i prolaktinom (35%), 35'i büyüme hormonu (GH) salgılatıcı tümör (%44) ve geri kalanı adrenokortikotropik hormon (ACTH), folikül stimülan hormon (FSH), luteinizan hormon (LH) ve tiroid stimülan hormon (TSH) salgılatıcı adenomlardı. Ameliyat sonrası komplikasyonlar dört hastada (%3) geçici hiposmi ve sekiz hastada (%6) diabetes insipidus olup, bunların ikisinde kalıcı vazopresin tedavisi gerekli oldu. Dört hastada (%3) ön hipofiz fonksiyon bozukluğu ve altı hastada (%5) ameliyat sonrası beyin omurilik sıvısı kaçağı görüldü. Bunların birinde menenjit saptandı. Sonuç: Çalışma sonuçlarımız, hipofiz tümörlerinin tedavisinde iş birliği ile gerçekleştirilen endoskopik endonazal yaklaşımın güvenli ve etkili bir işlem olarak rolünü vurgulamaktadır. En iyi sonuçları yakalayabilmek için deneyimli bir ekip gerekli olmakla birlikte, yeni kafa tabanı programlarında dahi, iki cerrah, dört el tekniği ile mükemmel sonuçlar elde edilebilir.

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Extended Endoscopic Transsphenoidal Approach for Tuberculum Sellae Meningiomas

Cited by 61 publications

References 1 publication

Anatomic study of the prechiasmatic sulcus and its surgical implications

Anatomic study of the prechiasmatic sulcus and its surgical implications

Extended endoscopic endonasal surgery using three-dimensional endoscopy in the intra-operative MRI suite for supra-diaphragmatic ectopic pituitary adenoma

Endoscopic endonasal transsphenoidal surgery: Analysis of the first 120 cases in the training hospital setting

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