Tuberculum sellae meningiomas: surgical considerations

Landeiro, José Alberto; Gonçalves, Mariângela Barbi; Guimarães, Rodrigo Dias; Klescoski, João; Corrêa, Jane; Lapenta, Mário Alberto; Maia, Orlando

doi:10.1590/s0004-282x2010000300019

Cited by 28 publications

(21 citation statements)

References 27 publications

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“…1). The remaining 38 references included 33 involving craniotomy [2,4,6,7,8,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59] and 8 involving endonasal surgery [14,36,37,42,60,61,62,63] (3 articles involved both approaches). None of the articles involved randomized, controlled trials; all were retrospective.…”

Section: Resultsmentioning

confidence: 99%

“…Among series with adequate reporting of data, gross total resection was achieved in 85% (845/992) of open cases and 84% (48/57) of endoscopic cases [2,4,7,8,14,33,34,35,36,37,38,40,41,43,44,46,47,48,49,50,51,52,53,54,56,57,59,60,61,62,63,64]. At last follow-up total recurrence was 6% (65/1,008) for open cases and 4% (3/72) for endoscopic cases [2,4,7,8,14,32,33,34,35,36,37,38,40,41,42,43,46,47,48,49,50,51,52,53,54,56,57,59,60,62,63].…”

Section: Resultsmentioning

confidence: 99%

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Endoscopic versus Open Resection of Tuberculum Sellae Meningiomas: A Decision Analysis

Bohman¹,

Stein²,

Newman

et al. 2012

ORL

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Background/Aims: Tuberculum sellae meningiomas (TSMs) are challenging tumors for surgical resection. Endoscopic endonasal (EE) approaches to these lesions have not been directly compared to open craniotomy in a controlled trial. Methods: We searched Medline and Embase online databases for English-language articles containing key words related to TSMs. Data were pooled, including 5 of our own patients reported here for the first time. Metaregression was used and a decision-analytical model was constructed to compare outcomes between open microsurgery and EE approaches. Results: The overall quality of life (QOL) was not significantly different between the approaches (p = 0.410); however, there were large differences in individual complication rates. The Monte Carlo simulation yielded an overall average QOL in craniotomy patients of 0.915 and in endoscopic patients of 0.952. Endoscopy had a higher CSF leak rate (26.8 vs. 3.5%, p < 0.001) but a lower rate of injury to the optic apparatus (1.4 vs. 9.2%, p < 0.001) compared with craniotomy. The 3-year recurrence rates were not statistically different (p = 0.529). Conclusion: EE resection of TSMs appears to be a comparable alternative to traditional open microsurgical resection with respect to overall QOL based on available publications. A meaningful comparison of recurrence rates will require a longer follow-up.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Endoscopic versus Open Resection of Tuberculum Sellae Meningiomas: A Decision Analysis

Bohman¹,

Stein²,

Newman

et al. 2012

ORL

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“…56 Various transcranial surgical approaches to remove tuberculum sellae meningiomas include unilateral or bilateral subfrontal, bifrontal interhemispheric, supraorbital, eyebrow keyhole supraorbital, frontolateral, frontotemporal/pterional, orbitopterional, and orbitozygomatic approaches. 3,5,11,23,24,29,36,43,[46][47][48][49][50]55 More recently, there has been interest in endonasal extended transsphenoidal approaches (microscopic, microscopic with endoscopic assistance, and purely endoscopic) to remove tuberculum sellae meningiomas. 7,8,12,13,15,16,21,25,31,32,35,37,58,59 The purely endoscopic endonasal extended transsphenoidal route via a transplanum transtuberculum corridor offers direct and immediate exposure to the tumor without having to apply brain retraction and manipulation of neurovascular structures.…”

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confidence: 99%

Surgical nuances for removal of tuberculum sellae meningiomas with optic canal involvement using the endoscopic endonasal extended transsphenoidal transplanum transtuberculum approach

Liu¹,

Christiano²,

Patel³

et al. 2011

FOC

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Tuberculum sellae meningiomas frequently extend into the optic canals. Radical tumor resection including the involved dural attachment, underlying hyperostotic bone, and intracanalicular tumor in the optic canal offers the best chance of a Simpson Grade I resection to minimize recurrence. Decompression of the optic canal with removal of the intracanalicular tumor also improves visual outcome since this portion of the tumor is usually the cause of asymmetrical visual loss. The purely endoscopic endonasal extended transsphenoidal approach offers a direct midline trajectory and immediate access to tuberculum sellae meningiomas without brain retraction and manipulation of neurovascular structures. Although the endoscopic approach has been previously criticized for its inability to remove tumor within the optic canals, complete Simpson Grade I tumor removal including intracanalicular tumor, dural attachment, and involved hyperostotic bone can be achieved in properly selected patients. Excellent visualization of the suprasellar region and the inferomedial aspects of both optic canals allows for extracapsular, extraarachnoid dissection of the tumor from the critical structures using bimanual microsurgical dissection. In this report, the authors describe the operative nuances for removal of tuberculum sellae meningiomas with optic canal involvement using a purely endoscopic endonasal extended transsphenoidal (transplanum transtuberculum) approach. They specifically highlight the technique for endonasal bilateral optic nerve decompression and removal of intracanalicular tumor to improve postoperative visual function, as demonstrated in 2 illustrative cases. Special attention is also given to cranial base reconstruction to prevent CSF leakage using the vascularized pedicled nasoseptal flap.

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“…Unroofing of the optic canal is a well-established procedure, especially during resection of tuberculum sellae meningiomas for decompression of the optic nerve and removal of the tumor extension into the optic canal. 22,25 Anterior clinoidectomy and resection of the optic strut are also well established for resection of clinoidal meningioma or during clipping of aneurysms related to the paraclinoidal internal carotid artery. 3,6,[29][30][31] Opening of the optic canal and optic nerve decompression have also been described during transsphenoidal surgery for suprasellar lesions.…”

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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Tuberculum sellae meningiomas: surgical considerations

Cited by 28 publications

References 27 publications

Endoscopic versus Open Resection of Tuberculum Sellae Meningiomas: A Decision Analysis

Endoscopic versus Open Resection of Tuberculum Sellae Meningiomas: A Decision Analysis

Surgical nuances for removal of tuberculum sellae meningiomas with optic canal involvement using the endoscopic endonasal extended transsphenoidal transplanum transtuberculum approach

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

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