2013
DOI: 10.3171/2013.8.focus13338
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Endoscopic extended transsphenoidal resection of tuberculum sellae meningiomas: nuances of neurosurgical technique

Abstract: Over the past decade, advances in endoscopic microsurgical techniques have resulted in an increasingly aggressive endonasal approach to tumors of the midline skull base. Meningiomas of the tuberculum sellae are often closely associated with cerebrovascular structures, and their removal has traditionally required a transcranial approach. An endonasal approach offers many advantages, including early tumor devascularization and tumor debulking (without manipulation of the optic apparatus), direct access t… Show more

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Cited by 54 publications
(37 citation statements)
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References 34 publications
(49 reference statements)
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“…2,[32][33][34]43 However, there are certain specifics that are worth discussing with respect to patient selection and technique that inform our results. Meningiomas are given 3 antibiotics preoperatively: vancomycin, ceftriaxone, and metronidazole.…”
Section: Operative Approachmentioning
confidence: 99%
“…2,[32][33][34]43 However, there are certain specifics that are worth discussing with respect to patient selection and technique that inform our results. Meningiomas are given 3 antibiotics preoperatively: vancomycin, ceftriaxone, and metronidazole.…”
Section: Operative Approachmentioning
confidence: 99%
“…(34,35,53,54) Clark et al (55) performed a meta-analysis assessing the endonasal endoscopic route vs transcranial approaches for tuberculum sellae meningiomas, and found higher rates of visual improvement (87% vs 59%) in the endoscopic cohort but with significantly higher CSF leak rates (21% vs 5%). The meta-analysis showed no significant difference in gross total resection rates between the endoscopic and open cohorts (88% vs 87%, respectively).…”
Section: Tuberculum Sellae Meningiomamentioning
confidence: 97%
“…2). The most commonly used endonasal endoscopic approaches for lesions that affect vision or cause diplopia are the following: 1) the trans-sellar route for sellar lesions, most commonly for pituitary adenomas and Rathke cleft cysts, 2) trans-sellar, trans-tubercular and trans-planum route for lesions that extend into the suprasellar, prechiasmatic and retrochiasmatic cisterns, most commonly for large or giant pituitary adenomas, tuberculum meningiomas, and craniopharyngiomas, 3) trans-sellar and extended approach to cavernous sinus and Meckel cave most commonly used for invasive pituitary adenomas, invasive parasellar meningiomas, schwannomas, and clival chordomas, 4) trans-clival approach most commonly used for invasive parasellar meningiomas and clival chordomas, and 5) endonasal approach to medial optic canal, orbital apex and orbit, most commonly used for meningiomas, hemangiomas, fibrous dysplasia, malignancies, and inflammatory processes (32)(33)(34)(35)(36)(37)(38)(39)(40)(41).…”
Section: Common Parasellar Endoscopic Approachesmentioning
confidence: 99%
“…This maneuver also allows the endoscope to provide better superior and lateral views without a frequent need to exchange 0° and 30° endoscopes. 22,26 A wide sphenoidotomy is important for the remainder of the operation as it allows greater degrees of freedom for passage and manipulation of instruments in the deep operative field above the chiasm and minimizes the potential for instrument/endoscope collision. If both opticocarotid recesses cannot be seen with a 0° scope, the lateral exposure is inadequate.…”
Section: Approachmentioning
confidence: 99%
“…22 This method of closure has proven effective, with reported CSF leak rates of less than 5% 11 and even as low as 0%. 29,36 Bilateral nasoseptal flaps can also be used for larger skull base defects.…”
Section: Closurementioning
confidence: 99%