Extended Transsphenoidal Microsurgical Approach for Diaphragma Sellae and Tuberculum Meningiomas

Fraioli, Mario Francesco; Moschettoni, Laura; Floris, R; Catena, Elisabetta; Fraioli, Bernardo

doi:10.1055/s-0028-1104612

Cited by 5 publications

(1 citation statement)

References 8 publications

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“…New technologies are being used to resect TSMs of a hard consistency, but we recommend switching to a TCR if this situation is encountered intraoperatively. 8 The disadvantage of using the ETSA for such hard tumors is that there is no opportunity to remove the tumor under direct bimanual endoscopic control if the tumor is so hard or calcified that it does not allow deformation during the dissection process. In the senior author's opinion, proceeding with the ETSA in such circumstances increases the risk for cranial nerve deficit.…”

Section: Choice Of Surgical Approachmentioning

confidence: 99%

Surgical decision-making strategies in tuberculum sellae meningioma resection

Bowers

Altay²,

Couldwell³

2011

FOC

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Object Although the transcranial route (TCR) has been the traditional approach for removing tuberculum sellae meningiomas (TSMs), the use of the microscopic and/or more recently the endoscopic transsphenoidal approach (ETSA) has gained acceptance for selected cases. In this study, the authors present their experience with the ETSA and the TCR and examine the criteria most important for deciding the optimal approach in a particular case. Methods The authors retrospectively reviewed recent cases of TSMs treated surgically by the senior author via either the TCR or the ETSA or both. Demographic information, clinical presentation, and clinical and radiological outcomes of the patients were evaluated. Results Twenty-seven patients underwent removal of a TSM during a recent period. Gross-total or near-total resection was achieved in 20 (91%) of 22 patients who underwent resection via the TCR and in 3 (60%) of 5 patients who underwent the ETSA. Among the patients in whom gross- or near-total resection was achieved, recurrence was observed in only 1 patient, whose tumor was removed via the ETSA. Conclusions In the majority of patients, the TCR provided complete resection of the tumor without compromising the safety of the procedure. In select cases of tumors with a reasonable size and location (midline and/or extending into the sphenoid sinus) as well as no involvement of inaccessible neurovascular and bony elements via this approach, the ETSA could also be a viable option.

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Section: Choice Of Surgical Approachmentioning

confidence: 99%

Surgical decision-making strategies in tuberculum sellae meningioma resection

Bowers

Altay²,

Couldwell³

2011

FOC

View full text Add to dashboard Cite

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Fascia patchwork closure for endoscopic endonasal skull base surgery

et al. 2015

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With the development of endoscopic technology and surgery, resection of midline skull base tumors has been achieved using endoscopic endonasal skull base (EESB) approaches. EESB approaches reportedly have a greater risk of postoperative cerebrospinal fluid (CSF) leakage. Recently, the introduction of the nasoseptal flap (NSF) decreased dramatically the incidence of CSF leakage, but the use of an NSF increases the risk of disturbing the function of the nose. Here, we report our new technique called "fascia patchwork closure" for closure after EESB surgery and its outcome. All 48 cases involved midline skull base tumors resected via EESB approaches. Of them, 32 cases were closed by the fascia patchwork technique after tumor resection, and there was no incidence of CSF leakage. Moreover, 6 of the 32 cases were closed without the use of an NSF, indicating that the fascia patchwork closure approach is effective as part of a multilayer closure for the prevention of CSF leakage. The establishment and popularization of this technique might result in the further development of EESB surgery and also an improvement of postoperative nasal function.

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