The role of transsphenoidal microsurgery in the management of sellar and parasellar meningioma

Honegger, Jürgen; Fahlbusch, Rudolf; Buchfelder, Michael; Huk, W.; Thierauf, P

doi:10.1016/0090-3019(93)90104-9

Cited by 48 publications

(19 citation statements)

References 9 publications

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“…9,13,16,19,25,34,35,37,38,40,58,65 In fact, since the introduction of the extended endonasal approach, 65 wherein the bone of the tuberculum sellae and posterior planum sphenoidale between the optic canals is removed, suprasellar lesions that traditionally have been approached transcranially, such as meningiomas in the tuberculum sellae, Rathke cleft cysts, and craniopharyngiomas, increasingly have been removed transsphenoidally. Provided that the chiasm is not prefixed and located directly between the sphenoidal sinus and tumor, or that a functional pituitary gland is not directly impeding the transsphenoidal route, the most significant advantages of this approach are the following three: 1) brain retraction is obviated, with an indisputable reduction in surgical morbidity and mortality rates; 2) direct manipulation of the optic apparatus is minimized, with the possibility of lower rates of postoperative visual loss; and 3) early identification of the pituitary gland and infundibulum is provided, which increases the likelihood of preserving neuroendocrine function.…”

Section: Neurosurg Focus / Volume 19 / July 2005mentioning

confidence: 99%

“…12,13,16,19,25,31,34,35,[37][38][39][40]45,46,50,58,65 In contrast to traditional cranial base surgical approaches, the endonasal technique offers a direct and minimally invasive approach that allows excellent midline access to and visibility of the suprasellar, retrosellar, and retroclival spaces, while obviating brain retraction. 10,13,14,29,42,45,48,50,54,63,66 Such approaches have recently been integrated and expanded with the use of the endoscope.…”

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confidence: 99%

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Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations

Cavallo

Messina²,

Cappabianca³

et al. 2005

FOC

166

190

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Object The midline skull base is an anatomical area that extends from the anterior limit of the cranial fossa down to the anterior border of the foramen magnum. Resection of lesions involving this area requires a variety of innovative skull base approaches. These include anterior, anterolateral, and posterolateral routes, performed either alone or in combination, and resection via these routes often requires extensive neurovascular manipulation. The goals in this study were to define the application of the endoscopic endonasal approach and to become more familiar with the views and skills associated with the technique by using cadaveric specimens. Methods To assess the feasibility of the endonasal route for the surgical management of lesions in the midline skull base, five fresh cadaver heads injected with colored latex were dissected using a modified endoscopic endonasal approach. Full access to the skull base and the cisternal space around it is possible with this route. From the crista galli to the spinomedullary junction, with incision of the dura mater, a complete visualization of the carotid and vertebrobasilar arterial systems and of all 12 of the cranial nerves is obtainable. Conclusions The major potential advantage of the endoscopic endonasal approach to the skull base is that it provides a direct anatomical route to the lesion without traversing any major neurovascular structures, obviating brain retraction. Many tumors grow in a medial-to-lateral direction, displacing structures laterally as they expand, creating natural corridors for their resection via an anteromedial approach. Potential disadvantages of this procedure include the relatively restricted working space and the danger of an inadequate dural repair with cerebrospinal fluid (CSF) leakage and potential for meningitis resulting. These approaches often require a large opening of the dura mater over the tuberculum sellae and posterior planum sphenoidale, or retroclival space. In addition, they typically involve large intraoperative CSF leaks, which necessitate precise and effective dural closure.

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Section: Neurosurg Focus / Volume 19 / July 2005mentioning

confidence: 99%

mentioning

confidence: 99%

Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations

Cavallo

Messina²,

Cappabianca³

et al. 2005

FOC

166

190

View full text Add to dashboard Cite

show abstract

“…3,6,[29][30][31] Opening of the optic canal and optic nerve decompression have also been described during transsphenoidal surgery for suprasellar lesions. 7,19 Optic nerve decompression with or without mobilization can be performed without compromise of visual outcome, especially if performed by an experienced surgeon. [27][28][29]31 For medial optic nerve mobilization, drilling of a part of the tuberculum sellae is necessary to avoid vigorous stretching of the optic nerve.…”

Section: Discussionmentioning

confidence: 99%

Optic nerve mobilization to enhance the exposure of the pituitary stalk during craniopharyngioma resection: early experience

Metwali¹,

Gerganov²,

Fahlbusch³

2016

JNS

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obJectiVe Preservation of the pituitary stalk and its vasculature is a key step in good postoperative endocrinological outcome in patients with craniopharyngiomas. In this article, the authors describe the surgical technique of medial optic nerve mobilization for better inspection and preservation of the pituitary stalk. Methods This operative technique has been applied in 3 patients. Following tumor exposure via a frontolateral approach, the pituitary stalk could be seen partially hidden under the optic nerve and the optic chiasm. The subchiasmatic and opticocarotid spaces were narrow, and tumor dissection from the pituitary stalk under direct vision was not possible. The optic canal was therefore unroofed, the falciform ligament was incised, and the lateral part of the tuberculum sellae was drilled medial to the optic nerve. The optic nerve could be mobilized medially to widen the opticocarotid triangle, which enhanced visualization of and access to the pituitary stalk. Results By using the optic nerve mobilization technique, the tumor could be removed completely, and the pituitary stalk and its vasculature were preserved in all patients. In 2 patients, vision improved after surgery, while in 1 patient it remained normal, as it was before surgery. The hormonal status remained normal after surgery in 2 patients. In the patient with preoperative hormonal deficiencies, improvement occurred early after surgery and hormonal levels were normal after 3 months. No approach-related complications occurred. coNclusioNs This early experience shows that this technique is safe and could be used as a complementary step during microsurgery of craniopharyngiomas. It allows for tumor dissection from the pituitary stalk under direct vision. The pituitary stalk can thus be preserved without jeopardizing the optic nerve.

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“…Prognosis is also better in younger patients with a short history of symptoms and good preoperative visual function. 3,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Regarding the surgical act, independently of technique, the initial debulking of the tumor should start from its center, where no vital structures are present. The arachnoid plane is then delineated, starting at the contralateral optic nerve and working toward the undersurface of the optic chiasma and then along the ipsilateral nerve.…”

Section: ■ Discussionmentioning

confidence: 99%

Tuberculum sellae meningioma: Is there an ideal approach?

Estevão¹,

Camporeze²,

Matricardi³

et al. 2017

Medical Express

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BACKGROUND:Tuberculum sellae meningiomas is a serious challenge for neurosurgeons. It accounts for up to 10% of all intracranial meningiomas. The difficulty in surgically excising a Tuberculum sellae meningioma comes from its anatomical relationship to the optic nerves and chiasm and to the anterior cerebral and internal carotid arteries and their perforators. The authors discuss the main approaches and the complications based on their experience in comparison to previously reported data. METHODS: We report our personal case series of 38 patients with Tuberculum sellae meningiomas; 36 patients under went craniotomy for tumor resection (12 bifrontal, 12 pterional, 6 supraciliary, 4 unilateral frontals, and 2fronto-orbito-zygomatic); in two patients, the excision was performed through an endoscopic endonasal approach. The Simpson grade of meningioma resection as well as the non-visual morbidity and the mortality rates were analyzed. RESULTS: Thirty-one patients had Simpson grades 1 and 2 excisions, while seven had Simpson grade 4 excisions. The overall rate of non-visual morbidity was 13.15% (5 of 38 patients) and mortality was 5.3% (2 of 38). CONCLUSION: The primary symptom leading to the diagnosis of a Tuberculum sellae meningioma is visual compromise and the main goal of surgery is to achieve improvement of vision. Favorable outcomes were achieved with appropriate selection of surgical approach. More studies are necessary to define the prognostic factors for patients in this scenario.

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The role of transsphenoidal microsurgery in the management of sellar and parasellar meningioma

Cited by 48 publications

References 9 publications

Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations

Endoscopic endonasal surgery of the midline skull base: anatomical study and clinical considerations

Optic nerve mobilization to enhance the exposure of the pituitary stalk during craniopharyngioma resection: early experience

Tuberculum sellae meningioma: Is there an ideal approach?

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