Bicoronal Subfrontal99 Chokyu I, Goto T, Ishibashi K, Nagata T, Ohata K. Bilateral subfrontal approach for tuberculum sellae meningiomas in long-term postoperative visual outcome. J Neurosurg. 2011;115(4):802-10. DOI: 10.3171/2011.5.JNS101812. https://doi.org/10.3171/2011.5.JNS101812...
,1616 Goel A, Muzumdar D, Desai KI. Tuberculum sellae meningioma: A report on management on the basis of a surgical experience with 70 patients. Neurosurgery. 2002;51(6):1358-64. DOI:10.1227/01.NEU.0000309111.78968.BC https://doi.org/10.1227/01.NEU.000030911...
17 Koutourousiou M, Fernandez-Miranda JC, Stefko ST. Endoscopic endonasal surgery for suprasellar meningiomas: experience with 75 patients. J Neurosurg. 2014;120:1326-39. DOI:10.3171/2014.2.JNS13767. https://doi.org/10.3171/2014.2.JNS13767...
18 Honegger J, Fahlbusch R, Buchfelder M, Huk WJ, Thierauf P. The role of transsphenoidal microsurgery in the management of sellar and parasellar meningioma. Surg Neurol. 1993;39(1):18-24.-1919 Romani R, Laakso A, Kangasniemi M, Niemelä M, Hernesniemi J. Lateral supraorbital approach applied to tuberculum sellae meningiomas: experience with 52 consecutive patients. Neurosurg. 2012;70(6):1504-19. DOI:10.1227/NEU.0b013e31824a36e8 https://doi.org/10.1227/NEU.0b013e31824a...
(Figure 4A) |
> 2,5 cm |
• Presence of bioptic canal involvement; |
• Partial exposure of the tumor height; |
• Wide surgical field |
• The need of some degree of frontal lobe retraction for adequate tumor exposure; |
Unilateral Subfrontal99 Chokyu I, Goto T, Ishibashi K, Nagata T, Ohata K. Bilateral subfrontal approach for tuberculum sellae meningiomas in long-term postoperative visual outcome. J Neurosurg. 2011;115(4):802-10. DOI: 10.3171/2011.5.JNS101812. https://doi.org/10.3171/2011.5.JNS101812...
,1616 Goel A, Muzumdar D, Desai KI. Tuberculum sellae meningioma: A report on management on the basis of a surgical experience with 70 patients. Neurosurgery. 2002;51(6):1358-64. DOI:10.1227/01.NEU.0000309111.78968.BC https://doi.org/10.1227/01.NEU.000030911...
17 Koutourousiou M, Fernandez-Miranda JC, Stefko ST. Endoscopic endonasal surgery for suprasellar meningiomas: experience with 75 patients. J Neurosurg. 2014;120:1326-39. DOI:10.3171/2014.2.JNS13767. https://doi.org/10.3171/2014.2.JNS13767...
18 Honegger J, Fahlbusch R, Buchfelder M, Huk WJ, Thierauf P. The role of transsphenoidal microsurgery in the management of sellar and parasellar meningioma. Surg Neurol. 1993;39(1):18-24.-1919 Romani R, Laakso A, Kangasniemi M, Niemelä M, Hernesniemi J. Lateral supraorbital approach applied to tuberculum sellae meningiomas: experience with 52 consecutive patients. Neurosurg. 2012;70(6):1504-19. DOI:10.1227/NEU.0b013e31824a36e8 https://doi.org/10.1227/NEU.0b013e31824a...
(Figure 2) |
< 2,5 cm |
• Minimally invasive technique for suprasellar meningiomas |
• Limited surgical field; |
• Partial exposure of the tumor height. |
Pterional Transsylvian99 Chokyu I, Goto T, Ishibashi K, Nagata T, Ohata K. Bilateral subfrontal approach for tuberculum sellae meningiomas in long-term postoperative visual outcome. J Neurosurg. 2011;115(4):802-10. DOI: 10.3171/2011.5.JNS101812. https://doi.org/10.3171/2011.5.JNS101812...
,1010 Fahlbusch R, Schott W. Pterional surgery of meningiomas of the tuberculum sellae and planum sphenoidale: Surgical results with special consideration of ophthalmological and endocrinological outcomes. J Neurosurg, 2002;96(2):235-43. DOI:10.3171/jns.2002.96.2.0235 https://doi.org/10.3171/jns.2002.96.2.02...
,1313 Margalit NS, Lesser JB, Moche J, Sen C. Meningiomas involving the optic nerve: Technical aspects and outcomes for a series of 50 patients. Neurosurgery. 2003;53(2):523-33. DOI: 10.1227/01.NEU.0000079506.75164.F4 https://doi.org/10.1227/01.NEU.000007950...
,1616 Goel A, Muzumdar D, Desai KI. Tuberculum sellae meningioma: A report on management on the basis of a surgical experience with 70 patients. Neurosurgery. 2002;51(6):1358-64. DOI:10.1227/01.NEU.0000309111.78968.BC https://doi.org/10.1227/01.NEU.000030911...
,1717 Koutourousiou M, Fernandez-Miranda JC, Stefko ST. Endoscopic endonasal surgery for suprasellar meningiomas: experience with 75 patients. J Neurosurg. 2014;120:1326-39. DOI:10.3171/2014.2.JNS13767. https://doi.org/10.3171/2014.2.JNS13767...
,2121 Schick U, Hassler W. Surgical management of tuberculum sellaemeningiomas: involvement of the optic canal and visual outcome. J Neurol Neurosurg Psychiatry. 2005;76(7):977-83. DOI:10.1136/jnnp.2004.039974. https://doi.org/10.1136/jnnp.2004.039974...
(Figures 4D) |
Any size |
• Early exposure of the ipsilateral supraclinoid carotid artery, optic nerve, and anterior cerebral artery; |
• Inadequate visualization of optic nerve and carotid artery; |
• Absence or decreased need of brain retraction; |
• Higher rates of visual deterioration; |
• Higher rates of gross total resection when compared with other techniques; |
• High degree of difficulty in cases of invasion of the optic canal and intrasellar extension of the tumor |
• Presence of bioptic canal involvement |
|
Anterior Interhemispheric1313 Margalit NS, Lesser JB, Moche J, Sen C. Meningiomas involving the optic nerve: Technical aspects and outcomes for a series of 50 patients. Neurosurgery. 2003;53(2):523-33. DOI: 10.1227/01.NEU.0000079506.75164.F4 https://doi.org/10.1227/01.NEU.000007950...
,1414 Terasaka S, Asaoka K, Kobayashi H, Yamaguchi S. Anterior Interhemispheric approach for Tuberculum Sellae Meningioma. Neurosurgery. 2011 Mar;68(1 Suppl Operative):84-8. DOI:10.1227/NEU.0b013e31820781e1 https://doi.org/10.1227/NEU.0b013e318207...
,1717 Koutourousiou M, Fernandez-Miranda JC, Stefko ST. Endoscopic endonasal surgery for suprasellar meningiomas: experience with 75 patients. J Neurosurg. 2014;120:1326-39. DOI:10.3171/2014.2.JNS13767. https://doi.org/10.3171/2014.2.JNS13767...
,2020 Ganna A, Dehdashti AR, Karabatsou K, Gentili F. Fonto-basal interhemispheric approach for tuberculum sellae meningiomas; long-term outcome. Br J Neurosurg. 2009;23(4):422-30. DOI:10.1080/02688690902968836 https://doi.org/10.1080/0268869090296883...
,2121 Schick U, Hassler W. Surgical management of tuberculum sellaemeningiomas: involvement of the optic canal and visual outcome. J Neurol Neurosurg Psychiatry. 2005;76(7):977-83. DOI:10.1136/jnnp.2004.039974. https://doi.org/10.1136/jnnp.2004.039974...
(Figure 4B) |
Any size |
• Wide surgical field; |
• Long surgical duration; |
• Full exposure of the entire tumor height; |
• Higher rates of anosmia and rhinoliquorrhea; |
• Visualization of the entire optic apparatus and surrounding structures, including the tuberculum sellae; |
• Inadequate access to cases with significant extension into the optic canal; |
• Minimal or no frontal lobe retraction; |
• Very difficult to perform an early unrousing of the optic canal, which is known to improve visual outcome. |
• Preservation of the optic and olfactory nerves; |
|
• Significant surgical results (higher than 80% of visual improvement) associated to absence or low rates of postoperative visual deterioration; |
|
• Higher rate of total excision; |
|
• Preservation of the subdural space; |
|
• In cases of tumor debulking without bleeding this approach is the most reliable method to preserve the arachnoid plane and the small vessels supplying the optic apparatus. |
|
Extended Bifrontal99 Chokyu I, Goto T, Ishibashi K, Nagata T, Ohata K. Bilateral subfrontal approach for tuberculum sellae meningiomas in long-term postoperative visual outcome. J Neurosurg. 2011;115(4):802-10. DOI: 10.3171/2011.5.JNS101812. https://doi.org/10.3171/2011.5.JNS101812...
,1616 Goel A, Muzumdar D, Desai KI. Tuberculum sellae meningioma: A report on management on the basis of a surgical experience with 70 patients. Neurosurgery. 2002;51(6):1358-64. DOI:10.1227/01.NEU.0000309111.78968.BC https://doi.org/10.1227/01.NEU.000030911...
17 Koutourousiou M, Fernandez-Miranda JC, Stefko ST. Endoscopic endonasal surgery for suprasellar meningiomas: experience with 75 patients. J Neurosurg. 2014;120:1326-39. DOI:10.3171/2014.2.JNS13767. https://doi.org/10.3171/2014.2.JNS13767...
18 Honegger J, Fahlbusch R, Buchfelder M, Huk WJ, Thierauf P. The role of transsphenoidal microsurgery in the management of sellar and parasellar meningioma. Surg Neurol. 1993;39(1):18-24.-1919 Romani R, Laakso A, Kangasniemi M, Niemelä M, Hernesniemi J. Lateral supraorbital approach applied to tuberculum sellae meningiomas: experience with 52 consecutive patients. Neurosurg. 2012;70(6):1504-19. DOI:10.1227/NEU.0b013e31824a36e8 https://doi.org/10.1227/NEU.0b013e31824a...
|
> 2,5 cm |
• Wide surgical field; |
• Requires some degree of frontal lobe retraction for adequate tumor exposure; |
• Flexibility of surgical trajectories; |
• Significant potential loss of olfaction; |
• Avoidance of excessive brain retraction; |
• High risk of occlusion of superior sagittal sinus leading to venous infarction; |
• Direct view of both optic nerves, internal carotid and anterior cerebral arteries. |
• Difficulty in reaching the undersurface of the optic nerves or the intrasellar extension of the tumor. |
Endonasal Approach99 Chokyu I, Goto T, Ishibashi K, Nagata T, Ohata K. Bilateral subfrontal approach for tuberculum sellae meningiomas in long-term postoperative visual outcome. J Neurosurg. 2011;115(4):802-10. DOI: 10.3171/2011.5.JNS101812. https://doi.org/10.3171/2011.5.JNS101812...
,2222 Gadgil N, Thomas JG, Takashima M, Yoshor D. Endoscopic Resection of Tuberculum Sellae Meningiomas. J Neurol Surg B Skull Base. 2013;74(4):201-10. DOI:10.1055/s-0033-1342922. https://doi.org/10.1055/s-0033-1342922...
23 Ajlan AM, Choudhri O, Hwang P, Harsh G. Meningiomas of the Tuberculum and Diaphragma Sellae. J Neurol Surg B Skull Base. 2015;76(1):74-9. DOI:10.1055/s-0034-1390400. https://doi.org/10.1055/s-0034-1390400...
24 Clark AJ, Jahangiri A, Garcia RM, George JR, Sughrue ME, McDermott MW, et al. Endoscopic surgery for tuberculum sellae meningiomas: a systematic review and metaanalysis. Neurosurg Rev. 2013;36(3):349-59. DOI:10.1007/s10143-013-0458-x. https://doi.org/10.1007/s10143-013-0458-...
-2525 Nakamura M, Roser F, Struck M, Vorkapic P, Samii M. Tuberculum sellae meningiomas: clinical outcome considering different surgical approaches. Neurosurgery. 2006;59(5):1019-29. DOI:10.1227/01.NEU.0000245600.92322.06. https://doi.org/10.1227/01.NEU.000024560...
|
- |
• Minimally invasive technique for suprasellar meningiomas; |
• This approach is contraindicates in the presence of medial optic canal invasion; |
• Lower rates of complications |
• Limited lateral extensional; |
• Lower rates of complete resection of tumor; |
FTOZ1717 Koutourousiou M, Fernandez-Miranda JC, Stefko ST. Endoscopic endonasal surgery for suprasellar meningiomas: experience with 75 patients. J Neurosurg. 2014;120:1326-39. DOI:10.3171/2014.2.JNS13767. https://doi.org/10.3171/2014.2.JNS13767...
|
Any size |
• Presence of bioptic canal involvement; |
• Limited surgical field; |
• Partial exposure of the tumor height. |