The expanded endoscopic endonasal approach for suprasellar meningiomas: long-term outcomes in a single-center series of 27 patients

Yang, Kaiyun; Ellenbogen, Yosef; Dong, Shaowei; Kim, Jeehyun; Larrazabal, Ramiro; Rodriguez, Amadeo R.; Algird, Almunder; Sommer, Doron D.; Reddy, Kesava

doi:10.1007/s00701-019-04113-x

Cited by 2 publications

(3 citation statements)

References 20 publications

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“…Several researchers have agreed that TSMs involving the OC can be resected safely through the EEA by decompressing the ON to 270°, thereby improving visual outcome. EEA eliminates brain retraction, which reduces the risk of postoperative seizures and provides direct visualization of the suprasellar, subchiasmatic perforators, and inferomedial OC region to recognize the neurovascular structures clearly, particularly the branches of the superior hypophyseal artery (SHA); this allows to perform GTR with minimal neurovascular manipulations and reduces the tumor recurrence rate [ 3 , 19 , 20 ]. Recently, Abhinav et al proved that decompression of the OC and division of the falciform ligament with the extensive endonasal approach was feasible and safe.…”

Section: Discussionmentioning

confidence: 99%

Efficiency and safety of optic canal unroofing in tuberculum sellae meningiomas: a meta-analysis and systematic review

Lin,

You,

Guo

et al. 2023

Neurosurg Rev

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Optic canal unroofing (OCU) has gradually become a routine technique for tuberculum sellae meningiomas (TSMs) resection. This meta-analysis aimed to evaluate the efficacy and safety of OCU. A systematic review and meta-analysis of the published literature on this topic from 2003 to 2023 were conducted in accordance with the PRISMA guidelines. Rigorous statistical analysis with a p-value was performed for related change in visual improvement, gross total resection (GTR), visual deterioration, and olfactory nerve damage. The study included 15 articles with 384 patients in whom OCU was performed by the transcranial approach (TCA) or the endoscopic endonasal approach (EEA). Of these, 341 patients had preoperative visual loss, and 266 patients had postoperative visual recovery. The overall rate of visual improvement was 0.803 (95% CI: 0.733–0.874, p < 0.01). The rate of visual improvement in the EEA and TCA groups was 0.884 (95% CI: 0.803–0.965, p < 0.01) and 0.788 (95% CI: 0.700–0.875, p < 0.01). Further analysis of classification shows that the rate of visual improvement in Type I: < 2 cm was 0.889(95% CI: 0.739–0.969), Type II:2-4 cm was 0.844(95% CI: 0.755–0.910), Type III: > 4 cm was 0.500(95% CI: 0.068–0.932) and the total was 0.853(95% CI: 0.779–0.927 p < 0.01) with low heterogeneity of I2 = 20.80%.Twelve studies separately reported GTR with OCU was 293; the rate of GTR was 0.911 (95% CI: 0.848–0.961, p < 0.01). And the rate of GTR in Type I: < 2 cm was 0.933(95% CI: 0.817–0.986), Type II:2-4 cm was 0.880(95% CI: 0.800–0.936), Type III: > 4 cm was 0.600(95% CI: 0.147–0.947). The total was 0.897(95% CI: 0.830–0.965 p < 0.01) with low heterogeneity of I2 = 34.57%. The related complications of OCU were visual deterioration and olfactory nerve damage. Visual decline was reported in nine studies, and the rate was 0.077 (95% CI: 0.041–0.113, p < 0.01). Six studies reported olfactory nerve damage, and the overall rate was 0.054 (95% CI: 0.019–0.090, p < 0.01). OCU could significantly recover preoperative impaired vision and make GTR easier to achieve, which was also a safe and effective technique in TSM.

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Section: Discussionmentioning

confidence: 99%

Efficiency and safety of optic canal unroofing in tuberculum sellae meningiomas: a meta-analysis and systematic review

Lin,

You,

Guo

et al. 2023

Neurosurg Rev

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“…As a result, they sometimes necessitate a unique surgical strategy, which may include pre-operative endovascular embolization of the tumor vasculature. If a reliable pre-operative diagnosis of sellar/suprasellar meningioma was available, such a procedure could be implemented more efficiently [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Most intrasellar and suprasellar macroadenomas can be reached by the transsphenoidal approach according to Cappabianca et al, but diaphragm sellae meningiomas may necessitate a craniotomy [ 12 ]. The transsphenoidal approach, on the other hand, is recommended or should be tried first for all subdiaphragmatic meningiomas, regardless of whether the lesion is pituitary adenoma or meningioma, even if it has a minor suprasellar extension [ 11 ]. Intrasellar meningiomas are difficult to distinguish from intrasellar tumors such as pituitary adenoma, pituicytomas, intrasellar germinomas, craniopharyngiomas, aneurysms, and metastases [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

A Case of Suprasellar, Intrasellar, and Infrasellar Meningioma Presenting as a Visual Field Defect in an Obese Female

Sagar¹,

Acharya²,

Andhale³

et al. 2022

Cureus

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Bitemporal hemianopia is the most common visual field defect encountered in suprasellar meningiomas compressing the optic chiasma and its vascular supply. It is hard to distinguish between meningioma and tumors that arise from suprasellar, intrasellar, and infrasellar extensions. Clinical findings, hormonal levels, and radiological findings could help in labeling it as meningioma. A 53-year-old obese woman with a history of blurred vision more in the right eye, loss of smell, and a headache was diagnosed with meningioma having suprasellar, intrasellar, and infrasellar extension on neuroimaging. She developed bitemporal hemianopia, which gradually worsened over the course of six months with concomitant headaches and dizziness that was treated with analgesics leading to a delayed diagnosis. As she was symptomatic, it was decided to resect her tumor. The patient underwent an endoscopic transsphenoidal approach for tumor resection. Successful excision of the tumor was accomplished. Postoperatively on further evaluation, the patient's anosmia and the visual deficit were resolved. This instance shows that meningioma located in the sella can cause symptoms like anosmia and visual field loss, which should not be neglected. It also underlines the significance of visual field evaluation on a regular basis as this might predict radiological and symptomatic progression.

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The expanded endoscopic endonasal approach for suprasellar meningiomas: long-term outcomes in a single-center series of 27 patients

Cited by 2 publications

References 20 publications

Efficiency and safety of optic canal unroofing in tuberculum sellae meningiomas: a meta-analysis and systematic review

Efficiency and safety of optic canal unroofing in tuberculum sellae meningiomas: a meta-analysis and systematic review

A Case of Suprasellar, Intrasellar, and Infrasellar Meningioma Presenting as a Visual Field Defect in an Obese Female

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