Surgical management of Tuberculum sellae Meningiomas: Myths, facts, and controversies

Giammattei, Lorenzo; Starnoni, Daniele; Cossu, Giulia; Bruneau, Michaël; Cavallo, Luigi Maria; Cappabianca, Paolo; Meling, Torstein R.; Jouanneau, Emmanuel; Schaller, Karl; Beneš, Vladimı́r; Froelich, Sébastien; Berhouma, Moncef; Messerer, Mahmoud; Daniel, Roy Thomas

doi:10.1007/s00701-019-04114-w

Cited by 36 publications

(38 citation statements)

References 79 publications

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“…2,6,37 Endonasal endoscopic strategies provide theoretical advantages such as reduced brain and nerve retraction; early decompression of the optic canal; better visualization and preservation of the superior hypophyseal artery supplying the chiasma; the absence of a cranial scar, and more rapid patient recovery when compared with traditional craniotomies. 7,25,30,40,41 Likewise, theoretical advantages of contemporary transcranial approaches include lower incidence of endocrine dysfunction, lower rates of arterial injury, and reduced risk of CSF leak. 6,7,41 Only a handful of comparisons of contemporary transcranial approaches for TSM and PM and EEAs have been performed.…”

Section: Surgical Options For Resection Of Tuberculum Sella Meningiommentioning

confidence: 99%

Olfactory Outcomes after Resection of Tuberculum Sella and Planum Sphenoidale Meningiomas via a Transcranial Approach

Ved

Hayhurst

2021

J Neurol Surg B Skull Base

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Objectives Controversy exists surrounding the optimal approaches to tuberculum sella meningioma (TSM) and planum meningioma (PM). Olfaction is infrequently considered within this context but is nonetheless an important quality of life measure. The evolution of olfactory outcomes following contemporary transcranial surgery remains unclear. This study reviews olfactory outcomes after supraorbital craniotomy for TSM or PM and defines temporal trends in its recovery. Study Design A prospective study of a patients who underwent a minimally invasive supraorbital craniotomy for TSM or PM was conducted at a single neurosurgical center. Participants & Main Outcome Measures All patients were questioned about olfaction at presentation 3 months postoperatively, 12 months postoperatively, and annually thereafter (median follow-up = 37 months). The olfactory status of patients was categorized as normosmia, anosmia, hyposmia, parosmia, (altered perception of odours), or phantosmia, (olfactory hallucinations). Results Twenty-two patients were included in the study analysis, (range = 27–76). Precisely, 3 months after surgery, seven patients had normal olfaction (32%). Six patients were anosmic, (27%) four hyposmic, (18%), three parosmic, (14%), and two were phantosmic (9%). At 1-year follow-up, almost half of patients (10; 48%) were normosmic, while two patients (9.5%) were anosmic. There were no further improvements in olfaction between 1 year and long-term follow-up. Conclusion Subfrontal transcranial approaches for TSM or PM appear to be associated with changes in olfaction that can improve with time; these improvements occur within the first year after surgery. Impacts upon olfaction should be considered when selecting a surgical approach and patients counseled appropriately.

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Section: Surgical Options For Resection Of Tuberculum Sella Meningiommentioning

confidence: 99%

Olfactory Outcomes after Resection of Tuberculum Sella and Planum Sphenoidale Meningiomas via a Transcranial Approach

Ved

Hayhurst

2021

J Neurol Surg B Skull Base

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“…Endocrinological assessment is not systematically performed in clinical practice and no clear recommendations exist, but the literature supports a systematic and complete preoperative assessment, particularly in tumors [50,51]. Hyperprolactinemia is probably the most frequently encountered endocrinological disturbance; hypopituitarism remains rare and cases of diabetes insipidus (DI) or syndrome of inappropriate secretion of ADH (SIADH) at diagnosis remain exceptional [52][53][54][55][56].…”

Section: Preoperative Assessmentmentioning

confidence: 99%

“…The transcranial approach was the first historically performed, but recent advances in endoscopic endonasal surgery have opened new perspectives. There is still a debate regarding the best approach, with different transcranial approaches including: the classical pterional approach; the key hole approach; subfrontal unilateral, supra orbital, interhemispheric approaches; and the endoscopic endonasal approach [50,[76][77][78][79]. Recent studies have demonstrated better visual outcomes after the endoscopic endonasal approach but, in contrast, a higher postoperative rate of cerebrospinal fluid leakage and a higher rate of arterial lesion [52,[80][81][82][83].…”

Section: Surgical Approaches Cs Lateral Wall Of the Cs And Clinoid mentioning

confidence: 99%

Parasellar Meningiomas

Graillon¹,

Régis²,

Barlier³

et al. 2020

Neuroendocrinology

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Parasellar spaces remain particularly singular, comprising the most important neurovascular structures such as the internal carotid artery and optic, oculomotor, and trigeminal nerves. Meningiomas are one of the most frequent tumors arising from parasellar spaces. In this location, meningiomas remain mostly benign tumors with WHO grade I and a meningothelial subtype. Progestin intake should be investigated and leads mostly to conservative strategies. In the case of benign nonsymptomatic tumors, observation should be proposed. Tumor growth will lead to the proposition of surgery or radiosurgery. In the case of an uncertain diagnosis and an aggressive pattern, a precise diagnosis is required. For cavernous sinus and Meckel's cave lesions, complete removal is rarely considered, leading to the proposition of an endoscopic endonasal or transcranial biopsy. Optic nerve decompression could also be proposed via these approaches. A case-by-case discussion about the best approach is recommended. A transcranial approach remains necessary for tumor removal in most cases. Vascular injury could lead to severe complications. Cerebrospinal fluid leakage, meningitis, venous sacrifice, visual impairment, and cranial nerve palsies are more frequent complications. Pituitary dysfunctions are rare in preoperative assessment and in postoperative follow-up but should be assessed in the case of meningiomas located close to the pituitary axis. Long-term follow-up is required given the frequent incomplete tumor removal and the risk of delayed recurrence. Radiosurgery is relevant for small and well-limited meningiomas or intra-cavernous sinus postoperative residue, whereas radiation therapy and proton beam therapy are indicated for large, extended, nonoperable meningiomas. The place of the peptide receptor radionuclide therapy needs to be defined. Targeted therapy should be considered in rare, recurrent, and aggressive parasellar meningiomas.

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“…Controversies remain about appropriate case selection, particularly with respect to the extended endoscopic endonasal approaches [57][58][59][60][61] : the supraorbital route can be preferred for meningiomas with significant lateral extension, encroaching the supraclinoid internal carotid artery and its branches and/or extending laterally to the optic nerves that are outside the visibility and maneuverability of the endoscopic endonasal approach. Another criterion to choose the supraorbital approach is the preservation of olfaction that is inevitably lost during endoscopic endonasal approaches to the cribriform plate.…”

Section: Endoscope-assisted Surgerymentioning

confidence: 99%

“…The question of which tuberculum sellae meningioma should be resected transcranially and which should be approached transsphenoidally remains paramount. Several series have compared approaches and attempted to define which patients are best suited for each approach [61,68,[85][86][87][88][89] . Larger tumors (> 3 cm) usually extend into multiple areas, making complete removal through the transsphenoidal route challenging.…”

Section: Endoscopic Endonasal Surgerymentioning

confidence: 99%

Meningiomas: criteria for modern surgical indications

Cappabianca¹,

d’Avella²,

Cavallo³

et al. 2020

Mini-invasive Surg

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The contemporary management of meningiomas is the result of the continuous evolution of neurosurgical techniques, along with the refinement of dedicated instrumentations. Above all, it is the magnification of the surgical view, thanks to the microscope and the endoscope, and their advancements, which allowed the improvement of surgical outcomes, in terms of both extent of resection and morbidity rates. Because of the benign nature of the vast majority of meningiomas, complete tumor resection is curative, and it is the gold-standard treatment. However, in the case of high risk of surgical morbidity, a less aggressive surgical treatment may be justified, also upon tailored analysis of the meningiomas’ biological behavior and the improvements in postoperative strategies. The endoscopic technique plays a role, as a unique visualization tool or in combination with the microscope, in granting so-called maximum allowed resection. Considering the above, the most challenging task confronting modern meningioma surgery remains the selection of the most appropriate surgical approach, the latter greatly depending on location, anatomic tumor features, and relationships with critical neurovascular structures. Herein, we present a cogent analysis of the modern multifaceted indications for the endoscopic treatment of meningiomas, with a glimpse into the adjacent fields.

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Surgical management of Tuberculum sellae Meningiomas: Myths, facts, and controversies

Cited by 36 publications

References 79 publications

Olfactory Outcomes after Resection of Tuberculum Sella and Planum Sphenoidale Meningiomas via a Transcranial Approach

Olfactory Outcomes after Resection of Tuberculum Sella and Planum Sphenoidale Meningiomas via a Transcranial Approach

Parasellar Meningiomas

Meningiomas: criteria for modern surgical indications

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