Visual Outcome After Extended Endoscopic Endonasal Transsphenoidal Surgery for Tuberculum Sellae Meningiomas

Wang, Qing; Lu, Xiao‐Jie; Ji, Weiying; Yan, Zhengcun; Xu, Jia; Ding, Yasuo; Zhang, Jie

doi:10.1016/j.wneu.2010.04.007

Cited by 79 publications

(71 citation statements)

References 40 publications

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“…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. Because the dural origin is adjacent to the paranasal sinuses, early devascularization of the tumor and subsequent radical resection of the involved hyperostotic bone, dural attachment, and optic canal involvement can be achieved.…”

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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

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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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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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“…The largest cases series on the expanded endonasal approaches (EEA) for resection of TSMs are summarized in Table 2 [23][24][25][26][27]. These case series selected small TSMs (majority smaller than 3-4 cm) with limited medial optic canal involvement, with or without arterial encasement.…”

Section: Selected Case Series: Extent Of Resection Complications Oumentioning

confidence: 99%

Tuberculum Sellae Meningiomas: Evolving Surgical Strategies

2014

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Tuberculum sella meningiomas represent a unique set of surgical challenges due to their three-dimensional relationship with the optic apparatus, critical vasculature, and the pituitary stalk. These challenges are encountered with the context of a surgical goal that provides long-term tumor control, preservation or improvement of visual function and minimal morbidity. Advancements in skull base surgery with improvements in transcranial (TCR) approaches and endoscopic endonasal approaches have added to the surgical strategies available. We review the modern literature and compare techniques and their outcomes in an effort to determine the relative merits and indications of TCR and endoscopic endonasal approaches in the management of this set of tumors.Keywords Tuberculum sellae Á Meningioma Á Skull base Á Open skull base Á Endoscopic endonasal skull base Á Minimally invasive Á Surgery Abbreviations TSM Tuberculum sella meningiomas TCR Transcranial EEA Expanded endonasal approaches

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“…In particular, tuberculum sellae meningiomas are suprasellar meningiomas, frequently arise from the tuberculum sellae, chiasmatic sulcus, Planum sphenoidale, and diaphragma sellae and comprise 5% to 10% of all intracranial meningiomas (Bassiouni et al, 2006). There are several surgical advantages of the endoscopic endonasal transsphenoidal approach for the improvement of visual outcome and the surgical treatment of tuberculum sellae meningiomas (Wang et al, 2010). First, the most important advantage is the avoidance of manipulation of an ischemic, compressed optic system.…”

Section: Duraplasty After Transsphenoidal Approachmentioning

confidence: 99%