Treatment of tuberculum sellae meningiomas:a long-term follow-up study

Ohta, Kohei; Yasuo, Kensaku; Matsushima, Masashi; Nagashima, Tatsuya; Tamaki, Norihiko

doi:10.1054/jocn.2001.0873

Cited by 62 publications

(33 citation statements)

References 5 publications

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“…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

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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.

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Section: Resultsmentioning

confidence: 99%

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

Bohman¹,

Stein²,

Newman

et al. 2012

ORL

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“…The complication of postoperative visual deterioration has been reported in up to 20% of cases. 10,14,23,29,50,53 Other reported craniotomy-related complications have included olfactory nerve damage resulting in anosmia, CSF leak requiring additional transnasal surgery, hemorrhagic infarction resulting in shuntdependent hydrocephalus, wound infection requiring bone flap removal, cerebral edema, and venous infarction. 43,47 In general, transcranial approaches usually require some degree of brain retraction and manipulation of neurovascular structures to obtain complete removal.…”

Section: Transcranial Approaches For 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

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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.

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“…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. These authors affirmed that skull-base approaches increase the rate of resection without increasing the rate of complications.…”

Section: Discussionmentioning

confidence: 99%

“…The drill power was reduced during this maneuver, and a large amount of irrigation was used. This maneuver allows complete mobilization of the optic nerve, exposure of the carotid artery, and partial devascularization of the tumor 10,11 . Tumor debulking was performed in the piecemeal fashion after identification of the ipsilateral optic nerves.…”

Section: Surgical Procedures -Technical Detailsmentioning

confidence: 99%

Tuberculum sellae meningiomas: surgical considerations

Landeiro

Gonçalves

Guimarães

et al. 2010

Arq. Neuro-Psiquiatr.

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We report our experience on the treatment of tuberculum sellae meningiomas (TSMs) regarding the involvement of the optic canal and clinical outcomes. We reviewed 23 patients who were operated on between January 1997 and December 2008. The surgical approach was unilateral subfrontal supraorbital osteotomy in one piece. Attempts were made to improve visual function via extra/intradural unroofing of the optic canal, which released the optic nerve. Visual symptoms were present preoperatively in 21 patients, and two patients were asymptomatic. Visual acuity remained intact in 6 patients, improved in 10, was unchanged in 5 patients, and worsened in 2 patients. The postoperative visual field was normal or improved in 17 patients, unchanged in four patients, and worsened in two patients. The optic canal and clinoid were drilled extradurally in eight patients and intradurally in nine patients. Total resection of TSMs was achieved in 19 patients. Incomplete resection occurred in two patients. Decompression of the optic canal seemed to increase the visual outcome. Key words: tuberculum sellae meningioma, optic canal, visual symptoms. Meningiomas do tuberculo selar: aspectos cirúrgicos resuMoApresentamos nossa experiência em 23 pacientes operados com meningiomas do tubérculo da sela, com enfoque na descompressão do nervo óptico e nos sintomas visuais do pós-operatório. Vinte e três pacientes com meningiomas do tubérculo da sela foram operados entre janeiro de 1997 e dezembro de 2008, através do acesso subfrontal via ostetomia supraorbital. Remoção do teto do canal óptico por via extra ou intradural foi realizada em 17 pacientes. Sintomas visuais no pré-operatório ocorreram em 21 pacientes, 2 eram assintomáticos. Melhora visual ocorreu em 10, permaneceu inalterada em 5 e piorou em 2 pacientes. No pós-operatório o campo visual normalizou-se em 17 pacientes, permaneceu inalterado em 4 e diminuiu em 2. Descompressão dos nervos ópticos foi realizada em 17 pacientes. Ressecção total dos meningiomas do tubérculo da sela foi possível em 19 pacientes. Abertura do canal óptico permitiu a manipulação do nervo óptico sem novos déficites. Palavras-chave: meningioma, tubérculo selar, nervo óptico, sintomas visuais.

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Treatment of tuberculum sellae meningiomas:a long-term follow-up study

Cited by 62 publications

References 5 publications

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

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

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

Tuberculum sellae meningiomas: surgical considerations

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