Skull Base Approaches for Tuberculum Sellae Meningiomas: Institutional Experience in a Series of 34 Patients

Abstract

(1) Background: The aim of the present study was to evaluate our institutional outcome in tuberculum sellae meningioma (TSM) patients treated microsurgically using multiple skull base approaches, including a transcranial approach and an extended endonasal transsphenoidal approach. (2) Materials and Methods: This is a retrospective study that includes 34 patients with TSM. The study aimed to observe the efficacy of the different common approaches used by a single neurosurgeon. All the patients were evaluated preoperatively and during follow-up with campimetry, head CT scan, and post-contrast MRI. (3) Results: After a transcranial approach, visual acuity improved in 86.20%, was stable in 10.34%, and deteriorated in 3.45%. Through transsphenoidal surgery, vision improved in 80%, was static in 20%, and deteriorated in 0%. Transcranial approaches included pterional, mini-bifrontal basal, and supraciliary keyhole microscopic craniotomies. Gross total removal was performed in 58.82%, near total in 10.34%, and partial removal in 3.45%. The transcranial/supraciliary keyhole endoscopic-assisted approach showed a gross total removal rate of 80%, and near total in 20%. The transsphenoidal approach showed a gross total removal rate of 60%, near total in 20%, and partial removal in 20%. (4) Conclusion: Endoscopic-assisted keyhole supraciliary mini craniotomy for resection of tuberculum sellae meningioma offers low morbidity and good visual outcome. The endonasal route is preferred for the removal of TSM when they are small and midline placed. The major limitation of this approach is a narrow surgical corridor and the restriction on midline-placed lesions. Gross total removal was better achieved with mini-bifrontal basal and pterional craniotomies.

Cystic meningiomas: A complex diagnostic challenge and clinicopathological insights from a unique case presentation

“…Although meningiomas are more commonly found in females, the occurrence of the cystic type is more prevalent in males and children, presenting an intriguing aspect of genderbased variation in manifestation. [7][8][9][10][11] Our patient's case epitomized the complexity associated with cystic meningiomas. Her rapid neurological deterioration and worsening clinical state within minutes warranted immediate attention.…”

“…They demand careful consideration to avoid misdiagnosis and ensure appropriate treatment. Although meningiomas are more commonly found in females, the occurrence of the cystic type is more prevalent in males and children, presenting an intriguing aspect of gender‐based variation in manifestation 7–11 …”

Surgical Approaches to Cavernous Sinus: A Narrative Review of the Literature with Anatomical Drawings.

“…In addition to these benefits, this endonasal technique offers greater access across the anterior and medial walls of the CS. 39,40 Cavallo et al 341 conducted a comparative trans nasal and endoscopic transnasal approach study and, comparing different locations of CS, concluded that the endoscopic endonasal technique for CS allows for better observation and identification of surgical platforms. Anand et al 42 , also evaluated this technique and reported that it was a low-morbidity, safe alternative to medial-lateral resection of CS tumors with a variety of reconstructive choices.…”

Long-Term Outcomes of Patients with Primary Brain Tumors after Acute Rehabilitation: A Retrospective Analyses of Factors

“…The size, location and grade of the tumor have a major impact on the type and severity of such impairments. They may be secondarily aggravated by sequelae of surgery, radiation, chemotherapy or secondary disease progression [ 21 , 22 ]. As patients can present with a diversity of impairments, an individualized and multidisciplinary rehabilitative approach is required.…”