Frontolateral Approach Applied to Sellar Region Lesions

Abstract

Background:Various surgical approaches for the removal of sellar region lesions have previously been described. This study aimed to evaluate the reliability and safety of the frontolateral approach (FLA) to remove sellar region lesions.Methods:We presented a retrospective study of 79 patients with sellar region lesions who were admitted and operated by the FLA approach from August 2011 to August 2015 in Department of Neurosurgery of Beijing Tian Tan Hospital. We classified FLA into three types, compared the FLA types to the areas of lesion invasion, and analyzed operation bleeding volume, gross total resection (GTR) rate, visual outcome, and mortality.Results:Seventy-nine patients were followed up from 2.9 to 50.3 months with a mean follow-up of 20.5 months. There were 42 cases of meningiomas, 25 cases of craniopharyngiomas, and 12 cases of pituitary adenomas. The mean follow-up Karnofsky Performance Scale was 90.4. GTR was achieved in 75 patients (94.9%). Two patients (2.5%) had tumor recurrence. No patients died perioperatively or during short-term follow-up. Three patients (3.8%) with craniopharyngioma died 10, 12, and 23 months, respectively, after surgery. The operative bleeding volume of this study was no more than that of the other approaches in the sellar region (P = 0.783). In this study, 35 patients (44.3%) had visual improvement after surgery, 38 patients (48.1%) remained unchanged, and three patients’ visual outcome (3.8%) worsened.Conclusions:FLA was an effective approach in the treatment of sellar region lesions with good preservation of visual function. FLA classification enabled tailored craniotomies for each patient according to the anatomic site of tumor invasion. This study found that FLA had similar outcomes to other surgical approaches of sellar region lesions.

Short-term Preoperative Octreotide for Thyrotropin-secreting Pituitary Adenoma

“…[ 26 ] The primary therapeutic approach is neurosurgery. [ 4 27 ] If surgery is contraindicated or declined, radiotherapy might be an option. Medically, SST analogs can control hormone hypersecretion for 90% of patients; long-time therapy should cause significant tumor shrinkage for about 45% of patients.…”

Immediate postoperative complications of sellar suprasellar lesions operated via pterional approach

“…A study on sellar suprasellar lesions operated transcranially via pterional approach reported transient Diabetes Mellitus in 23.4%, meningitis in 13%, panhypopituitarism in 6.3, and CSF leak in 4.2% of cases. 11 The literature review had shown many complications, including transient and permanent diabetes mellitus, CSF leak, Worsening of a visual deficit, temporary motor deficit, transient third nerve palsy, intracerebral hematoma, hydrocephalus, infection of CNS, Vasopasm and tearing of anterior circulation arteries, cavernous sinus injury, and panhypopituitarism, etc. in patients undergoing surgical resection for the sellar suprasellar lesion.…”

Anterior interhemispheric approach for removing large sellar region tumor

“…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.…”