From above or below: The controversy and historical evolution of tuberculum sellae meningioma resection from open to endoscopic skull base approaches

Soni, Resha S.; Patel, Smruti; Husain, Qasim; Dahodwala, Mufaddal Q.; Eloy, Jean Anderson; Liu, James K.

doi:10.1016/j.jocn.2013.03.043

Cited by 38 publications

(23 citation statements)

References 104 publications

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“…Nevertheless, with remarkable advances in skull base reconstruction, TS is considered as an important option for TSM resection 8,10–12 . Thus, there is a debate about the approach selection for TSMs 13–15 .…”

Section: Introductionmentioning

confidence: 99%

Transsphenoidal versus Transcranial Approach for Treatment of Tuberculum Sellae Meningiomas: A Systematic Review and Meta-analysis of Comparative Studies

Yang

Fan

Shen

et al. 2019

Sci Rep

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There is controversy regarding the surgical route selection for tuberculum sellae meningiomas (TSMs): the transsphenoidal (TS) or transcranial (TC) approach? We conducted a systematic review and meta-analysis to compare clinical outcomes and postoperative complications between two surgical approaches. Literature search was performed. Relevant articles were selected and evaluated. Data were extracted and analyzed. Eight articles comprising 550 patients met the inclusion criteria. Traditionally, the rates of gross total resection, tumor recurrence, visual improvement, and cerebrospinal fluid leakage were the most common outcomes of interest. We demonstrated that the TS approach was significantly associated with better visual outcomes but more frequent cerebrospinal fluid leakage, while the rates of tumor resection and recurrence showed no significant difference between groups. In addition to surgical results that were consistent with previous studies, we further evaluated the impact of approach selection on common postoperative complications, which were closely related to the recovery course and quality of life. We revealed that the risk of dysosmia was significantly higher in the TS group. There was no significant difference between groups regarding infection, intracranial hemorrhage, and endocrine disorders. Because of the relatively low evidence levels of included retrospective studies, it was difficult to reach a categorical conclusion about the optimal surgical approach for TSMs. Finally, we recommended that the TS approach was an alternative option in patients with smaller TSMs (<30 mm) and limited invasion of optic canals in experienced neurosurgical centers.

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Section: Introductionmentioning

confidence: 99%

Transsphenoidal versus Transcranial Approach for Treatment of Tuberculum Sellae Meningiomas: A Systematic Review and Meta-analysis of Comparative Studies

Yang

Fan

Shen

et al. 2019

Sci Rep

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“…The first reported use of a transphenoidal route for tumor resection was in 1907, and that was carried out by Herman Schloffer for a pituitary adenoma. [ 24 ] The transphenoidal technique re-flourished again after the introduction of the surgical microscope, as it was implemented by Jules Hardy in 1965. [ 13 ] After the transphenoidal microsurgical technique revealed some deficiencies in terms of visualizing the lesions, the endoscope was implemented in the transphenoidal approach with its panoramic view and more adequate illumination.…”

Section: Discussionmentioning

confidence: 99%

“…[ 7 ] The endoscope allows for both early debulking and devascularization of the lesion with early ON decompression, without needing to retract the brain. [ 24 ] Postoperative CSF leak is a disadvantage of this approach, but the reported rates are improving and special emphasis is being directed towards skull base defects reconstruction. [ 24 ]…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic transnasal suprasellar approach for anterior clinoidal meningioma: A case report and review of the literature

Bardeesi¹,

Alsaleh

Ajlan

2017

Surg Neurol Int

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Background:Anterior clinoidal meningiomas (ACM) are traditionally approached through transcranial routes. Due to their tendency to extend laterally and their proximity to vital neurovascular structures, the endoscopic transnasal suprasellar approach is still questionable. We present and describe an ACM case that underwent an endoscopic transnasal suprasellar approach, and provide a review of the literature and operative technique.Case Description:A 56 year-old lady who presented with chronic left-sided decreased vision. Brain imaging revealed a lesion measuring 9 × 10 × 11 mm attached to the left anterior clinoid process (ACP) and extending to the left optic canal. Lesion was compressing the left optic nerve (ON) and abutting the supraclinoid part of the left internal carotid artery (ICA). Utilizing the endoscopic transnasal suprasellar approach, the meningioma was resected and the optic canal was decompressed. Reconstruction was achieved using fascia lata, vomer bone, and nasoseptal flap. A lumbar drain was inserted perioperatively. Patient had no perioperative morbidity and retained vision in the affected eye.Conclusions:Resection of selected ACMs can be safely achieved utilizing the endoscopic transnasal suprasellar approach. Although the literature lacks long-term outcome comparison between the transnasal and the traditional transcranial approaches, specifically addressing ACMs, this technique is becoming more popular over the last decade. More efforts should be directed towards implementing and reporting the endoscopic transnasal suprasellar approach for meningiomas of the anterior clinoid process.

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“…1 As parasellar cavernous haemangiomas are rare, they are frequently misdiagnosed as meningiomas and subsequently resected, 1 but correct preoperative diagnosis allows for more appropriate treatment (radiation therapy rather than surgical resection). [7][8][9][10][11][12] The MRI techniques of diffusion weighted imaging (DWI) and perfusion imaging have added a new dimension of physiological information to the anatomical data provided by conventional diagnostic imaging. 13 When the gross appearance of lesions is similar on DWI, the calculated apparent diffusion coefficient (ADC) is used to provide a more quantitative approach.…”

Section: Introductionmentioning

confidence: 99%

The role of magnetic resonance diffusion-weighted imaging and three-dimensional arterial spin labelling perfusion imaging in the differentiation of parasellar meningioma and cavernous haemangioma

et al. 2014

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Objective: To evaluate the diagnostic value of magnetic resonance diffusion-weighted imaging (DWI) and three-dimensional arterial spin labelling perfusion imaging (3D-ASL) in distinguishing cavernous haemangioma from parasellar meningioma, using histological data as a reference standard. Methods: Patients with parasellar meningioma or parasellar cavernous haemangioma underwent conventional T 1 -and T 2 -weighted magnetic resonance imaging (MRI) followed by DWI and 3D-ASL using a 3.0 Tesla MRI. The minimum apparent diffusion coefficient (minADC) from DWI and the maximal normalized cerebral blood flow (nCBF) from 3D-ASL were measured in each tumour. Diagnosis was confirmed by histology. Results: MinADC was significantly lower and nCBF significantly higher in meningioma (n ¼ 19) than cavernous haemangioma (n ¼ 15). There was a significant negative correlation between minADC and nCBF (r ¼ À0.605). Conclusion: DWI and 3D-ASL are useful in differentiating cavernous haemangiomas from parasellar meningiomas, particularly in situations when the appearance on conventional MRI sequences is otherwise ambiguous.

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From above or below: The controversy and historical evolution of tuberculum sellae meningioma resection from open to endoscopic skull base approaches

Cited by 38 publications

References 104 publications

Transsphenoidal versus Transcranial Approach for Treatment of Tuberculum Sellae Meningiomas: A Systematic Review and Meta-analysis of Comparative Studies

Transsphenoidal versus Transcranial Approach for Treatment of Tuberculum Sellae Meningiomas: A Systematic Review and Meta-analysis of Comparative Studies

Endoscopic transnasal suprasellar approach for anterior clinoidal meningioma: A case report and review of the literature

The role of magnetic resonance diffusion-weighted imaging and three-dimensional arterial spin labelling perfusion imaging in the differentiation of parasellar meningioma and cavernous haemangioma

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