Transcranial Transsphenoidal Approach for Tuberculum Sellae Meningiomas

Arai, Hajime; Satô, Kiyoshi; Okuda,; Miyajima, Masakazu; Hishii, Makoto; Nakanishi, Hajime; Ishii, Hisato

doi:10.1007/s007010070089

Cited by 105 publications

(46 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…1). The remaining 38 references included 33 involving craniotomy [2,4,6,7,8,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59] and 8 involving endonasal surgery [14,36,37,42,60,61,62,63] (3 articles involved both approaches). None of the articles involved randomized, controlled trials; all were retrospective.…”

Section: Resultsmentioning

confidence: 99%

Endoscopic versus Open Resection of Tuberculum Sellae Meningiomas: A Decision Analysis

Bohman¹,

Stein²,

Newman

et al. 2012

ORL

View full text Add to dashboard Cite

Background/Aims: Tuberculum sellae meningiomas (TSMs) are challenging tumors for surgical resection. Endoscopic endonasal (EE) approaches to these lesions have not been directly compared to open craniotomy in a controlled trial. Methods: We searched Medline and Embase online databases for English-language articles containing key words related to TSMs. Data were pooled, including 5 of our own patients reported here for the first time. Metaregression was used and a decision-analytical model was constructed to compare outcomes between open microsurgery and EE approaches. Results: The overall quality of life (QOL) was not significantly different between the approaches (p = 0.410); however, there were large differences in individual complication rates. The Monte Carlo simulation yielded an overall average QOL in craniotomy patients of 0.915 and in endoscopic patients of 0.952. Endoscopy had a higher CSF leak rate (26.8 vs. 3.5%, p < 0.001) but a lower rate of injury to the optic apparatus (1.4 vs. 9.2%, p < 0.001) compared with craniotomy. The 3-year recurrence rates were not statistically different (p = 0.529). Conclusion: EE resection of TSMs appears to be a comparable alternative to traditional open microsurgical resection with respect to overall QOL based on available publications. A meaningful comparison of recurrence rates will require a longer follow-up.

show abstract

Section: Resultsmentioning

confidence: 99%

Endoscopic versus Open Resection of Tuberculum Sellae Meningiomas: A Decision Analysis

Bohman¹,

Stein²,

Newman

et al. 2012

ORL

View full text Add to dashboard Cite

show abstract

“…2 The bifrontal craniotomy has the advantage of allowing the least amount of retraction on the frontal lobes and providing direct access to almost all sides of the tumor. 6,21,22,29,31,32,40 Disadvantages of the bilateral approach include possible venous infarction due to occlusion of the superior sagittal sinus, potential loss of olfaction, late visualization of vital neurovascular structures, and difficulty in reaching the undersurface of the optic nerves and tuberculum sellae region when the tumor extends posteriorly.…”

Section: Anterior (Subfrontal and Supraorbital) Approachmentioning

confidence: 99%

Endoscopic endonasal surgery for olfactory groove meningiomas: outcomes and limitations in 50 patients

Koutourousiou

Fernández-Miranda

Wang

et al. 2014

FOC

112

View full text Add to dashboard Cite

Object Recently, endoscopic endonasal surgery (EES) has been introduced in the management of skull base tumors, with constantly improving outcomes and increasing indications. The authors retrospectively reviewed the effectiveness of EES in the management of olfactory groove meningiomas. Methods Between February 2003 and December 2012, 50 patients (64% female) with olfactory groove meningiomas underwent EES at the University of Pittsburgh Medical Center. The authors present the results of EES and analyze the resection rates, clinical outcome, complications, and limitations of this approach. Results Forty-four patients presented with primary tumors, whereas six were previously treated elsewhere. The patients’ mean age was 57.1 years (range 27–88 years). Clinical presentation included altered mental status (36%), visual loss (30%), headache (24%), and seizures (20%). The mean maximum tumor diameter was 41.6 mm (range 18–80 mm). All patients underwent EES, which was performed in stages in 18 giant tumors. Complete tumor resection (Simpson Grade I) was achieved in 66.7% of the 45 patients in whom it was the goal, and 13 (28.9%) had near-total resection (> 95% of the tumor). Tumor size, calcification, and absence of cortical cuff from vasculature were significant factors that influenced the degree of resection (p = 0.002, p = 0.024, and p = 0.028, respectively). Tumor residual was usually at the most lateral and anterior tumor margins. Following EES, mental status was improved or normalized in 77.8% of the cases, vision was improved or restored in 86.7 %, and headaches resolved in 83.3 %. There was no postoperative deterioration of presenting symptoms. Complications were increased in tumors > 40 mm and included CSF leakage (30%), which was significantly associated with lobular tumor configuration (p = 0.048); pulmonary embolism/deep vein thrombosis, more commonly in elderly patients (20%); sinus infections (10%); and delayed abscess months or years after EES (6%). One patient had an intraoperative vascular injury resulting in transient hemiparesis (2%). There were no perioperative deaths. During a mean follow-up period of 32 months (median 22 months, range 1–115 months), 1 patient underwent repeat EES for tumor regrowth. Conclusions Endoscopic endonasal surgery has shown good clinical outcomes regardless of patient age, previous treatment, or tumor characteristics. Tumor size > 40 mm, calcification, and absence of cortical vascular cuff limit GTR with EES; in addition, large tumors are associated with increased postoperative complications. Significant lateral and anterior dural involvement may represent indications for using traditional craniotomies for the management of these tumors. Postoperative CSF leakage remains a problem that necessitates innovations in EES reconstruction techniques.

show abstract

“…26,43 However, intracanalicular tumor commonly occupies the inferomedial aspect of the optic canal, 3,53 which is readily accessible via an approach from below. Interestingly, several proponents of pterional approaches have mentioned that the major disadvantage of the pterional approach is the difficulty in dissecting tumor from the inferomedial aspect of the ipsilateral optic nerve.…”

Section: Optic Canal Involvement In Tuberculum Sellae Meningiomasmentioning

confidence: 99%

“…56 Various transcranial surgical approaches to remove tuberculum sellae meningiomas include unilateral or bilateral subfrontal, bifrontal interhemispheric, supraorbital, eyebrow keyhole supraorbital, frontolateral, frontotemporal/pterional, orbitopterional, and orbitozygomatic approaches. 3,5,11,23,24,29,36,43,[46][47][48][49][50]55 More recently, there has been interest in endonasal extended transsphenoidal approaches (microscopic, microscopic with endoscopic assistance, and purely endoscopic) to remove tuberculum sellae meningiomas. 7,8,12,13,15,16,21,25,31,32,35,37,58,59 The purely endoscopic endonasal extended transsphenoidal route via a transplanum transtuberculum corridor offers direct and immediate exposure to the tumor without having to apply brain retraction and manipulation of neurovascular structures.…”

mentioning

confidence: 99%

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

Liu¹,

Christiano²,

Patel³

et al. 2011

FOC

101

View full text Add to dashboard Cite

Tuberculum sellae meningiomas frequently extend into the optic canals. Radical tumor resection including the involved dural attachment, underlying hyperostotic bone, and intracanalicular tumor in the optic canal offers the best chance of a Simpson Grade I resection to minimize recurrence. Decompression of the optic canal with removal of the intracanalicular tumor also improves visual outcome since this portion of the tumor is usually the cause of asymmetrical visual loss. The purely endoscopic endonasal extended transsphenoidal approach offers a direct midline trajectory and immediate access to tuberculum sellae meningiomas without brain retraction and manipulation of neurovascular structures. Although the endoscopic approach has been previously criticized for its inability to remove tumor within the optic canals, complete Simpson Grade I tumor removal including intracanalicular tumor, dural attachment, and involved hyperostotic bone can be achieved in properly selected patients. Excellent visualization of the suprasellar region and the inferomedial aspects of both optic canals allows for extracapsular, extraarachnoid dissection of the tumor from the critical structures using bimanual microsurgical dissection. In this report, the authors describe the operative nuances for removal of tuberculum sellae meningiomas with optic canal involvement using a purely endoscopic endonasal extended transsphenoidal (transplanum transtuberculum) approach. They specifically highlight the technique for endonasal bilateral optic nerve decompression and removal of intracanalicular tumor to improve postoperative visual function, as demonstrated in 2 illustrative cases. Special attention is also given to cranial base reconstruction to prevent CSF leakage using the vascularized pedicled nasoseptal flap.

show abstract

Transcranial Transsphenoidal Approach for Tuberculum Sellae Meningiomas

Abstract: We are confident that our surgical approach has great clinical value in surgical resection of tuberculum sellae meningioma. The good accessibility to a tumour extending inferomedially to the optic nerve should, in particular, be stressed.

Cited by 105 publications

References 7 publications

Endoscopic versus Open Resection of Tuberculum Sellae Meningiomas: A Decision Analysis

Endoscopic versus Open Resection of Tuberculum Sellae Meningiomas: A Decision Analysis

Endoscopic endonasal surgery for olfactory groove meningiomas: outcomes and limitations in 50 patients

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

Contact Info

Product

Resources

About