The expanded endoscopic endonasal approach for treatment of tuberculum sellae meningiomas in a series of 40 consecutive cases

Abstract

Compared with traditional craniotomy, the expanded endoscopic endonasal approach (EEEA) may have some advantages for tuberculum sellae meningioma (TSM) treatment. We described our experience of the therapeutic effect of endoscopic TSM treatment. From August 2015 to December 2019, 40 patients with a TSM were treated by the EEEA in our institution. EEEA outcome in TSM treatment was analyzed. Among 39 patients with visual impairment, 38 (97.4%) improved their visual function to some extent after the EEEA, and one case had no significant change in visual acuity. Among all patients, 38 (95.0%) achieved gross total resection (GTR) and 2 (5.0%) achieved near-total resection (NTR). Cerebrospinal fluid (CSF) leakage occurred in three patients (7.5%) and meningitis (post-CSF leakage) in two patients (5.0%). Eight patients (20.0%) suffered postoperative hyposmia, three of whom developed long-term hyposmia. One patient (2.5%) suffered from bleeding of the branch of the anterior cerebral artery intraoperatively leading to postoperative acute cerebral infarction. The EEEA is a safe and reliable minimally invasive method for TSM removal. Compared with traditional craniotomy, the EEEA may have better visual outcomes and a higher prevalence of GTR, but carries the risk of CSF leakage.

Midline Skull Base Meningiomas: Transcranial and Endonasal Perspectives

“…The “low route” enables early access to the hyperostotic and dural attachment consenting to immediate tumor devascularization, direct exposure of the subchiasmatic area without brain retraction, and a wide decompression of the optic canals without nerve manipulation [ 64 , 72 , 87 , 88 ].…”

“…Moreover, in a limited number of cases with a high degree of pneumatization superolateral decompression can be achieved [ 90 ]. Concerning the removal rates, GTR has been reported in modern series, ranging from 80 to 95% [ 62 , 72 , 87 , 88 ].…”

“…Likewise, the opening of suprasellar and lamina terminalis cisterns via the extended approach exposes a greater amount of CSF leak to be sealed, and in case of repair failure, the risk of pneumocephalus and meningitis increases [ 92 ]. The introduction of multilayer reconstruction techniques accounting for autologous materials (above all, the Hadad–Bassagasteguy flap), along with clinical strategies aimed at counteracting CSF pulsation [ 53 , 93 , 94 ], markedly the reduced rate of complications (from 22% to 4%) [ 44 , 62 , 72 , 87 , 88 , 95 ].…”

“…Ultimately, the major EEA asset is that it translates deep-seated skull base lesions into superficial convexity-like tumors, making the surgical trajectory “coaxial” with the direction of tumor extension [ 88 , 262 , 263 ].…”

Comparison of supraorbital keyhole approach and extended transsphenoidal approach in endoscopic surgery for tuberculum sellae meningioma: A case series

“…Tuberculum sellae meningioma (TSM) originates from tuberculum sellae, sphenoid plateau and optic chiasmatic sulcus ( 1 ), accounting for 4-10% of intracranial meningiomas ( 2 , 3 ). Generally, the incidence rate of TSM is relatively high in middle-aged people and women, meanwhile, it is rather rare in childhood patients ( 2 , 3 ).…”