Visual Outcome of Tuberculum Sellae Meningiomas after Extradural Optic Nerve Decompression

Mathiesen, Tiit; Kihlström, Lars

doi:10.1227/01.neu.0000228683.79123.f9

Cited by 133 publications

(125 citation statements)

References 17 publications

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“…Endonasal approaches have been recently used for treating fronto-basal meningiomas 9-11 but, despite of its advantages, most authors prefers intracranial approaches for resecting olfactory meningiomas 3,4,6,[12][13][14][15] . We have used bifrontal craniotomy with or without unilateral orbital rim resection for resection of these tumors.…”

Section: Discussionmentioning

confidence: 99%

“…Infection and cerebrospinal fluid leak are potential risks for entering the frontal sinus or the etmoidal cells. Exenterates the sinus mucosa, resection of the posterior wall of the frontal sinus and packing the sinus with muscle are important precautions to avoid these complications 4,13 . In our series, local postoperative complications were observed in 23.5% of patients with olfactory groove meningiomas (soft tissue infection, epidural empiema/osteomyelitis, and osteomyelitis).…”

Section: Discussionmentioning

confidence: 99%

“…In this study, the clinical outcome of patients with olfactory groove meningiomas surgically treated was analyzed. Method: 17 patients operated on from 1988-2006. Follow-up: 1-209 months (mean=51.07±12.73.…”

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confidence: 99%

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Olfactory groove meningiomas: surgical technique and follow-up review

Colli

Carlotti

Assirati

et al. 2007

Arq. Neuro-Psiquiatr.

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-Background: Olfactory groove meningiomas comprise 4-10% of the intracranial meningiomas. Generally they give signs of brain compression due to great size they reach before diagnosis. In this study, the clinical outcome of patients with olfactory groove meningiomas surgically treated was analyzed. Method: 17 patients operated on from 1988-2006. Follow-up: 1-209 months (mean=51.07±12.73. Bifrontal/bifrontal-bi-orbital approaches were used. Outcome was analyzed using survival/recurrence-free Kaplan-Mayer curves. Results: 16 had WHO grade 1; one grade 2 meningiomas. resection Simpson's grade 1 was in achieved in 64.7%, grade 2 in 29.4% and grade 3 in 5.9%. there was no recurrence during the follow-up. Global and operative mortality were 11.8%. Main postoperative complications were osteomielitis (11.8%) and pneumonia (5.9%). Conclusion: Extensive approaches allowed total resection of most olfactory groove meningiomas with no recurrence during the follow-up, but operative mortality and local complications were high.KEy WOrdS: olfactory groove meningiomas, surgical treatment, survival curves.Meningiomas da goteira olfatória: técnica cirúrgica e resultados rESuMO -Introdução: Os meningiomas da goteira olfatória constituem 4-10% dos meningiomas intracranianos. Geralmente eles causam sinais de compressão do tronco cerebral porque atingem grandes tamanhos antes do diagnóstico. Neste estudo foram analisadas os resultados do tratamento cirúrgico de pacientes com meningiomas da goteira olfatória. Método: 17 pacientes operados de 1988-2006. Mulheres: 16. Homens: 1. Idade: 19-76 anos (média=53,12±13,11). Seguimento: 1-209 meses (média=51,07±12,73. Foram utilizados acessos bifrontal/bifrontal bi-orbital. A evolução clinica foi analisada usando curvas de sobrevida e de sobrevida livre de doença de Kaplan-Mayer. Resultados: 16 pacientes tinham meningioma WHO grau 1; um tinha meningioma grau 2. ressecção Simpson grau 1 foi obtida em 64.7%, grau 2 em 29.4% e grau 3 em 5.9%. Não houve recidiva durante o seguimento. A mortalidade global e a pós-operatória foram 11.8%. As principais complicações pós-operatórias foram osteomielite (11.8%) e pneumonia (5.9%). Conclusão: Abordagens extensas possibilitaram ressecção total da maioria dos meningiomas da goteira olfatória sem recidiva durante o seguimento, mas a mortalidade operatória e as complicações locais foram altas.PAlAvrAS-cHAvE: meningiomas da goteira olfatória, tratamento cirúrgico, curvas de sobrevida.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Olfactory groove meningiomas: surgical technique and follow-up review

Colli

Carlotti

Assirati

et al. 2007

Arq. Neuro-Psiquiatr.

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“…Together with the removal of the orbital bar and orbital roof, the decompression of the optic nerve via clinoidectomy, the unroofing of the optic canal, and the opening of the falciform ligament have contributed to the significant postoperative improvement of the visual function of these patients 11,17,18,21,[23][24][25] . Ohta et al 10 reported on 21 cases of complete resection of TSMs in a series of 33 patients.…”

Section: Discussionmentioning

confidence: 99%

“…Mathiesen and Kihlström 23 reported on a series of 29 patients with TSMs, which included 23 primary cases and six recurrences. These authors reported on extradural clinoidectomy and unroofing of the optic nerve and of the optic canal followed by intradural release of the optic nerve.…”

Section: Discussionmentioning

confidence: 99%

Tuberculum sellae meningiomas: surgical considerations

Landeiro

Gonçalves

Guimarães

et al. 2010

Arq. Neuro-Psiquiatr.

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We report our experience on the treatment of tuberculum sellae meningiomas (TSMs) regarding the involvement of the optic canal and clinical outcomes. We reviewed 23 patients who were operated on between January 1997 and December 2008. The surgical approach was unilateral subfrontal supraorbital osteotomy in one piece. Attempts were made to improve visual function via extra/intradural unroofing of the optic canal, which released the optic nerve. Visual symptoms were present preoperatively in 21 patients, and two patients were asymptomatic. Visual acuity remained intact in 6 patients, improved in 10, was unchanged in 5 patients, and worsened in 2 patients. The postoperative visual field was normal or improved in 17 patients, unchanged in four patients, and worsened in two patients. The optic canal and clinoid were drilled extradurally in eight patients and intradurally in nine patients. Total resection of TSMs was achieved in 19 patients. Incomplete resection occurred in two patients. Decompression of the optic canal seemed to increase the visual outcome. Key words: tuberculum sellae meningioma, optic canal, visual symptoms. Meningiomas do tuberculo selar: aspectos cirúrgicos resuMoApresentamos nossa experiência em 23 pacientes operados com meningiomas do tubérculo da sela, com enfoque na descompressão do nervo óptico e nos sintomas visuais do pós-operatório. Vinte e três pacientes com meningiomas do tubérculo da sela foram operados entre janeiro de 1997 e dezembro de 2008, através do acesso subfrontal via ostetomia supraorbital. Remoção do teto do canal óptico por via extra ou intradural foi realizada em 17 pacientes. Sintomas visuais no pré-operatório ocorreram em 21 pacientes, 2 eram assintomáticos. Melhora visual ocorreu em 10, permaneceu inalterada em 5 e piorou em 2 pacientes. No pós-operatório o campo visual normalizou-se em 17 pacientes, permaneceu inalterado em 4 e diminuiu em 2. Descompressão dos nervos ópticos foi realizada em 17 pacientes. Ressecção total dos meningiomas do tubérculo da sela foi possível em 19 pacientes. Abertura do canal óptico permitiu a manipulação do nervo óptico sem novos déficites. Palavras-chave: meningioma, tubérculo selar, nervo óptico, sintomas visuais.

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Cavernous Sinus Meningiomas: Imaging and Surgical Strategy

Sindou

Nebbal

Güçlü

2014

Advances and Technical Standards in Neurosurgery

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Cavernous sinus (CS) meningiomas which are by definition those meningiomas which originate from the parasellar region are difficult skull base tumors to deal with. For deciding the most appropriate surgical strategy, surgeons need detailed preoperative neuroimaging. The vicinity of the tumor with the vital and highly functional neurovascular structures, tumor extensions into the basal cisterns and skull base structures, and the arterial vascularization and venous drainage pathways, as they shape operative strategy, are important preoperative data to take into account. Thin section CT scan with bone windows, 3D spiral CT reconstruction, MRI, MR angiography, and DSA performed with selective arteriography including late venous phases give those required detailed informations about the tumor and its relation with neurovascular and bony structures. The type of craniotomy and complementary osteotomy and the usefulness of an extradural anterior clinoidectomy with unroofing the optic canal can be decided from preoperative neuroimaging. Data collected also help in determining whether extensive exposure of the middle cranial fossa is necessary to ensure substantial devascularization of the tumor and whether proximal control of the internal carotid artery (ICA) at its intrapetrosal portion might be useful. Study of the capacity of blood supply of the Willis circle is wise for deciding the need and way of performing an extra-intracranial bypass together with tumor removal. Currently the concept of operating only the tumors with extracavernous extensions and to limit resection to only their extracavernous portions is the most accepted way of treating these tumors. It was that strategy that was adopted in the senior author's 220-patient series.Radiosurgery or stereotactic fractionated radiotherapy may complement surgery or can be only reserved for growing remnants.

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Visual Outcome of Tuberculum Sellae Meningiomas after Extradural Optic Nerve Decompression

Cited by 133 publications

References 17 publications

Olfactory groove meningiomas: surgical technique and follow-up review

Olfactory groove meningiomas: surgical technique and follow-up review

Tuberculum sellae meningiomas: surgical considerations

Cavernous Sinus Meningiomas: Imaging and Surgical Strategy

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