Meningiomas del surco olfatorio. Consideraciones del abordaje endonasal endoscópico extendido transcribiforme

Abstract

Los meningiomas del surco olfatorio representan el 10% de los meningiomas intracraneales, se originan de la lámina cribosa del etmoides, la sutura fronto-esfenoidal y el plano esfenoidal. Son tumores en su mayoría benignos y potencialmente curables, la recurrencia ocurre en grado variable siendo el grado de resección quirúrgica el predictor más importante de recurrencia. En este artículo se exponen los resultados alcanzados con el abordaje endonasal endoscópico extendido transcribiforme en pacientes con meningiomas del surco olfatorio en el servicio de neurocirugía del hospital clínico quirúrgico Hermanos Ameijeiras. La serie fue de 12 pacientes donde la cefalea, la anosmia y los trastornos neuropsicológicos fueron los síntomas predominantes. Los tumores tuvieron un tamaño ≥ a 6 cm en el 50% de los casos y con el abordaje endonasal endoscópico extendido transcribiforme se alcanzó una resección total con Simpson I en el 92% de los enfermos. Los límites del abordaje endonasal endoscópico en la fosa anterior se encuentran en constante extensión, siendo el abordaje endonasal endoscópico extendido transcribiforme la opción ideal y prometedora para los pacientes con Meningiomas del surco olfatorio.

Pterional Approach for A Tuberculum Sellae Meningioma: A Case Report

“…To access this suprasellar region, the unilateral frontal, extended frontotemporal approach, the bifrontal, subfrontal are mostly used but in this case the classic most frequently used Pterional approach was described. Also, among other techniques includes minimally invasive Key Hole surgeries such as mini-supraorbital craniotomy, and the extended transplanum-transtubercular endoscopic endonasal approach, which show notable results in these patients, increasing their efficacy and reducing their morbidity and mortality, [1,2,6,5,9,11]. Taking into account the two pillars of meningioma surgery: maximizing the extent of resection (EOR) and reducing the risk of recurrence while preserving neurological functions [12].…”

“…Likewise Ogawa and Tominaga, 2012 state that the ideal way to perform the excision of these lesions is the extended Transsphenoidal endoscopic approach, which has a potential equivalent to transcranial surgery for meningiomas with a maximum diameter of less than 30 mm plus tumors with lateral extension towards the internal carotid artery are less likely to be removed completely [15]. Authors also suggest that because the dural feeding branches of McConnell and the posterior ethmoid arteries follow their course from below, tumor devascularization can be performed more effectively through the transplanum-transtubercle extended endonasal route, being similarly a relatively less invasive procedure with faster postoperative recovery and shorter hospital stay [2,5].…”

“…Stains such as indocyanine green have been used with good results when guiding surgery, greatly limiting the edges of the lesion, achieving maximum safe resection [2,6].…”

“…They originate from the arachnoid that covers the sellar tubercle, sphenoid plane and chiasmatic groove. They are slow-growing lesions, and whose symptoms become evident when they cause compression of the structures adjacent to the lesion, with the ones located before them being the most involved, that is, those that pertain to the optic chiasm and optic nerve, that is why bitemporal hemianopsia, associated with optic atrophy represent the most frequently found clinical presentation, among the neuro-ophthalmological clinical findings [1,2,3,4,5], because the only route for the extension of the tumor is anterior, on the sphenoid plane, on the optic nerves or between the chiasm around the anterior cerebral artery complex. [6,7,8].…”

“…The incarceration of the internal carotid that is exposed in the images determines to a great extent the degree of resection of this tumor together with the presence of effacement of the interface of the tumor with the brain. [2] Treatment is usually surgical resection of the tumor either transcranially endoscopically endonasal, although another option is radiation. Some studies show recurrences 5 years after surgery, even with total resections, so annual follow-up with neuroimaging is indicated.…”