Surgical management of tuberculum sellae meningioma: Role of selective extradural anterior clinoidectomy

Abstract

A retrospective analysis of 32 patients with tuberculum sellae meningiomas who underwent surgery via a unilateral pterional approach was performed. A selective extradural anterior clinoidectomy (SEAC) technique was added in 20 patients. All patients had visual dysfunction preoperatively. Macroscopically complete removal with Simpson grade II was performed in 28 patients (87.5%). The postoperative visual function improved in 25 (78.1%), did not change in 3 (9.4%), and worsened in 4 patients (12.5%). The SEAC technique was effective, especially for removal of the tumour extending into the sellae/pituitary stalk (9 patients), the optic canal (4 patients) and hypothalamus (4 patients) with preservation of the visual and endocrinological function. These results were superior to those of surgery without SEAC technique. This technique is therefore recommended for complete resection of the tuberculum sellae meningiomas extending to the surrounding anatomical structures as the SEAC procedure reduces the risk of intraoperative optic nerve injury considerably.

Surgical nuances for removal of tuberculum sellae meningiomas with optic canal involvement using the endoscopic endonasal extended transsphenoidal transplanum transtuberculum approach

“…56 This has led to several authors in recommending early optic nerve decompression and removal of intracanalicular tumor, which has resulted in favorable visual outcomes. 2,5,14,27,29,43,44,49,51,55,56 Visual improvement has been reported as high as 78%-91% in some series. 43,46,55 The technique for early optic nerve decompression and release is generally performed using a frontotemporal pterional, supraorbital, or orbitozygomatic approach that includes a posterior orbitotomy, extradural anterior clinoidectomy, optic canal unroofing, and division of the falciform ligament.…”

Tuberculum sellae meningiomas: surgical considerations

“…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.…”

“…Total removal was possible in 23 cases. Otani et al 24 used selective anterior extradural clinoidectomy to treat 20 cases in a series of 32 patients and achieved improvement of the visual function in 78% of the cases.…”

Stereotactic Radiosurgery for Skull Base Meningioma

“…3) The standard treatment for meningioma is surgical resection through craniotomy, targeted at gross total removal. 2,4,6,9,16,23,24,31,35) The treatment goal is longterm tumor control with minimal neurological morbidity. However, the tumor often extends to important neurovascular structures in the skull base, so total tumor resection (Simpson grades 1-2) is achieved in only 20-87.5% of patients.…”

“…However, the tumor often extends to important neurovascular structures in the skull base, so total tumor resection (Simpson grades 1-2) is achieved in only 20-87.5% of patients. 2,4,23,24,31,35) Unacceptably high incidences of symptomatic recurrence are observed after subtotal resection of meningiomas. 20,33) In addition, postoperative complications occur in 16.1-61.5% of patients, although overall complication rates are not always reported.…”