Transpalpebral approach for microsurgical removal of tuberculum sellae meningiomas

Abstract

Background: The evolution of skull base approaches associated with individualization of surgical corridor and minimizing the collateral damage. Achieving the radical removal of tumor and preserving the neurological status of the patient is possible, both with the traditional approaches and keyhole approaches. Our work presents experience using the transpalpebral approach (TPA) for microsurgical removal of tuberculum sellae meningioma (TSM). Materials and Methods: A total of 15 patients with meningiomas underwent microsurgical removal of TSM through TPA. Ten patients were women and five were men. The standard preoperative diagnostic protocol includes magnetic resonance imaging with contrast enhancement, brain computed tomography for neuronavigation. We assess surgical complications, functional and cosmetic outcomes, and surgical parameters, including the time of surgery and intraoperative blood loss. Results: Visual impairment was finding in 100% patients, including slight decrease of vision (46,7%, seven patients), partial vision field loss (six patients, 40%), and serious visual impairment (two patients 13.3%). Visual improvement was noted in ten cases (66.7%), there was no improvement in four cases (26.7%), and one case (6.6%) had transient visual worsening for 4 days and slow improvement in 1 month. Headache disappeared in three patients (50%). There were no cases of cerebrospinal fluid leak. Transient frontal hypoesthesia was noted in all patients (100%) without permanent deficit. Transient palsy of the frontal muscle was noted in four patients for 4–6 months. Histological examination revealed WHO Grade I meningioma in 14 cases and in 1 case WHO Grade II meningioma. No deaths were identified in follow-up at 12 months. The average value of the Modified Rankin Scale was 1.4. The mean length of stay in hospital was 5. Conclusion: TPA is technically difficult and requires some experience to work in deep structures in a small surgical corridor. This technique can be good alternative to traditional fronto-lateral, supraorbital keyhole craniotomies, and endoscopic endonasal approaches.

Comparative analysis of outcomes following craniotomy and expanded endoscopic endonasal approach resection of tuberculum sellae meningiomas: a single-institution study

“…In our cohort, 71 (84.52%) patients presented with blurred vision and visual field. The ratio was similar to previous reports (5,6,16,17). The majority of patients could achieve improvement in visual function after surgery.…”

“…Although a more excellent visual prognosis could be harvested in the endoscopic group, the extent of tumor resection seemed to be similar between the two groups based on the previous reports (5,6,11,16,20). Bander et al (17) reported that the average extent of resection achieved was not significantly different between the two groups (98.80% ± 3.32% vs. 95.13% ± 11.69%, p = 0.206).…”

The Supraorbital Approach via an Eyebrow Incision: Analysis of Cosmetic Outcomes Using the Scar Cosmesis Assessment Rating Scale

“…The incision is made within the supratarsal fold extending to the lateral canthal line 32 . The surgical complications of the transpalpebral approach vary among studies but may include transient frontal hypoesthesia, transient frontal muscle palsy, and visual disturbances among other universal surgical complications such as infection 33,34 . This approach, often performed with the expertise of an oculoplastic or craniofacial surgeon present, offers good cosmetic outcomes with the scar hidden in the eyelid crease 32,33 .…”

“…32 The surgical complications of the transpalpebral approach vary among studies but may include transient frontal hypoesthesia, transient frontal muscle palsy, and visual disturbances among other universal surgical complications such as infection. 33,34 This approach, often performed with the expertise of an oculoplastic or craniofacial surgeon present, offers good cosmetic outcomes with the scar hidden in the eyelid crease. 32,33 Rychen et al 35 compare the transpalpebral and supraciliary approach with the use of cadavers and virtual craniotomies, finding that the transpalpebral approach restricts the craniocaudal working angle during surgery.…”

Differentiating between non-functioning pituitary macroadenomas and sellar meningiomas using ADC

“…However, precise preoperative distinction between these two tumors may aid the determination of a suitable surgical planning. Most sellar meningiomas may require a craniotomy and Dzhindzhikhadze et al ., have reported that a transpalpebral approach may be followed, whereas most supra- and intrasellar macroadenomas are resected via the trans-sphenoidal route ( 8 , 9 , 10 , 11 ).…”