scholarly journals Modified One-Piece Extended Transbasal Approach for Endoscopic-Assisted Microsurgical Resection of Tuberculum Sellae Meningioma: Operative Video and Technical Nuances

2017 ◽  
Vol 79 (S 02) ◽  
pp. S213-S214 ◽  
Author(s):  
James Liu ◽  
Kentaro Watanabe
Keyword(s):  
Optic Nerve ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Falciform Ligament ◽  
Tuberculum Sellae Meningioma ◽  
Nerve Decompression ◽  
Optic Nerve Decompression ◽  
Microsurgical Resection ◽  
Tuberculum Sellae

AbstractThe optimal approach for surgical resection of tuberculum sellae meningiomas remains controversial. Approach selection is largely based on a variety of factors, such as tumor size, extent and location relative to the optic canal and internal carotid artery, the presence of vascular encasement, and surgeon's preference. In this operative video manuscript, the authors demonstrate the importance of an open transcranial approach when the tumor extends lateral to the optic nerve over the internal carotid artery into the opticocarotid triangle, which is a difficult region to safely access with a purely endoscopic endonasal approach. We present a case of an endoscopic-assisted microsurgical resection of a tuberculum sellae meningioma using a modified one-piece extended transbasal approach in a patient with unilateral visual loss. The approach allows both interhemispheric and subfrontal routes to the suprasellar region. Early optic nerve decompression and division of the falciform ligament is critical to optimize visual outcomes. This video atlas demonstrates the operative technique and surgical nuances of the skull base approach, optic nerve decompression, tumor-arachnoid dissection, and safe handling of the neurovascular structures. A gross total resection was achieved and the patient had restoration of normal vision with normal pituitary function. In summary, the modified one-piece extended transbasal approach with endoscopic assistance is an important strategy in the armamentarium for surgical management of tuberculum sellae meningiomas.The link to the video can be found at: https://www.youtube.com/watch?v=jKNtRzMSFVE.

Endoscopic endonasal approach for a tuberculum sellae meningioma

2012 ◽  
Vol 32 (Suppl1) ◽  
pp. E8 ◽  
Author(s):  
Juan C. Fernandez-Miranda ◽  
Carlos D. Pinheiro-Neto ◽  
Paul A. Gardner ◽  
Carl H. Snyderman
Keyword(s):  
Optic Nerve ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Optic Canal ◽  
Csf Leak ◽  
Endoscopic Endonasal ◽  
Tuberculum Sellae Meningioma ◽  
Tuberculum Sellae

The authors present the technical and anatomical nuances needed to perform an endoscopic endonasal removal of a tuberculum sellae meningioma. The patient is a 47-year-old female with headaches and an incidental finding of a small tuberculum sellae meningioma with no vascular encasement, no optic canal invasion, but mild inferior to superior compression of the cisternal segment of the left optic nerve. Neuroophthalmology assessment revealed no visual defects. Treatment options included clinical observation with imaging follow-up studies, radiosurgery, and resection. The patient elected to undergo surgical removal and an endonasal endoscopic approach was the preferred surgical option. Preoperative radiological studies showed the presence of an osseous ring between the left middle and anterior clinoids, the so-called carotico-clinoidal ring. The surgical implications of this finding and its management are illustrated. The surgical anatomy of the suprasellar region is reviewed, including concepts such as the chiasmatic sulcus and limbus sphenoidale, medial and lateral optico-carotid recesses, and the paraclinoidal and supraclinoidal segments of the internal carotid artery. Emphasis is made in the importance of exposing the distal dural ring of the internal carotid artery and the precanalicular segment of the optic nerve for adequate intradural dissection. The endonasal route allows for early coagulation of the tumor meningeal supply and extensive resection of dural attachments, and importantly, provides an inferior to superior access to the infrachiasmatic region that facilitates complete tumor removal without any manipulation of the optic nerve. The lateral limit of dural removal is formed by the distal dural ring, which is gently coagulated after the tumor is resected. A 45° scope is used to inspect for any residual tumor, in particular at the entrance of the optic nerve into the optic canal and at the most anterior margin of the exposure (limbus sphenoidale). The steps for reconstruction are detailed and include intradural placement of dural substitute and extradural placement of the nasoseptal flap. The nuances for proper harvesting, positioning, and reinforcement of the flap are described. No lumbar drain was used. The patient had an uneventful recovery with no CSF leak or any other complications. Imaging follow-up at 6 months showed complete removal of the tumor. The patient had no sinonasal or neurological symptoms, and olfaction was fully preserved. The video can be found here: http://youtu.be/kkuV-yyEHMg.

scholarly journals Microsurgical Resection of Tuberculum Sellae Meningioma via Pterional Craniotomy with Extradural Anterior Clinoidectomy and Optic Unroofing

2018 ◽  
Vol 79 (S 02) ◽  
pp. S218-S218 ◽  
Author(s):  
Ihsan Dogan ◽  
Melih Ucer ◽  
Mustafa Başkaya
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Visual Field Examination ◽  
Who Grade ◽  
Tuberculum Sellae Meningioma ◽  
Pterional Craniotomy ◽  
Anterior Clinoidectomy ◽  
Microsurgical Resection ◽  
Tuberculum Sellae

AbstractMicrosurgical treatment of suprasellar tumors, in particular tuberculum sellae meningiomas, poses significant challenge. These tumors are surrounded by vital neurovascular structures, such as optic apparatus, pituitary stalk, internal carotid artery and its branches, and anterior cerebral arteries. In large and complex cases, early identification and decompression of these structures may facilitate safer dissection and resection. Therefore, extradural anterior clinoidectomy with optic unroofing facilitates the internal carotid artery exposure and optic nerve decompression. In this video, we describe a 37-year-old female patient who presented with new onset of severe headaches. On visual examination, she was found to have bitemporal visual defects. MRI scan of the head showed a large, approximately 3 cm suprasellar tumor consistent with tuberculum sellae meningioma. She underwent surgical resection via pterional craniotomy with extradural anterior clinoidectomy and optic unroofing. Microsurgical gross total resection was achieved and histopathology was WHO grade II meningioma. She had an uneventful postoperative course and visual field examination improved significantly. In this video, surgical technique in performing extradural anterior clinoidectomy and optic unroofing and steps of microsurgical resection are demonstrated.The link to the video can be found at: https://youtu.be/oPZ8NTyvxJc.

scholarly journals Accessing the Medial Surface of the Paraclinoid Internal Carotid Artery via the Contralateral Interoptic Trajectory: An Anatomical Study

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Xiaochun Zhao ◽  
Ali Tayebi-Meybodi ◽  
Mohamed Labib ◽  
Evgenii Belykh ◽  
Leandro Borba Moreira ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Sagittal Plane ◽  
Vertical Line ◽  
Coronal Plane ◽  
Falciform Ligament ◽  
Medial Surface ◽  
Accessible Area

Abstract INTRODUCTION Aneurysms arising on the medial surface of the paraclinoid segment of the internal carotid artery (ICA) are surgically challenging. Using the space between bilateral optic nerves, the contralateral interoptic (CIO) trajectory can partially expose the medial paraclinoid ICA. In this study, we quantitatively measured the accessible area of the medial ICA through the CIO trajectory and offered a potential patient selection algorism based on the preoperative angiogram. METHODS The CIO trajectory was performed on 10 sides of cadaveric heads, through which the paraclinoid ICA was identified. The falciform ligament medial to the contralateral optic nerve was incised to avoid injuring the contralateral optic nerve. The contralateral optic nerve was gently elevated and the medial surface of the paraclinoid ICA was inspected via different angles to obtain the maximal exposure. The accessible area was painted with a dye, the distance from the distal dural ring (DDR) to the proximal and distal boarders of this accessible area was measured. The superior and inferior borders were measured using the clockface method relative to a vertical line on the coronal plane. RESULTS The average distances from DDR to the proximal and distal end of the accessible area are [Mean ± SD] 2.7 ± 1.65 and 8.8 ± 2.35 mm, respectively. On the coronal plane, the average angles of the superior and inferior end of the accessible area relative to a vertical line are 24.3 ± 16.50° and 129.3 ± 15.40°, respectively. CONCLUSION Through a CIO trajectory, the paraclinoid ICA can be exposed 2.7 8.8 mm distal to the DDR on the sagittal plane and 24.3 16.5° medially on the coronal plane. Aneurysms with necks falling within this range can be accessed via a CIO trajectory, which can offer a reference of preoperative parameters for patients' selection.

Retinal and Optic Nerve Ischemia due to an Internal Carotid Artery Dissection: The “Cup of Wine” Sign

2020 ◽  
Vol 83 (3) ◽  
pp. 325-326
Author(s):  
Jordi Sarto ◽  
Gerard Mayà-Casalprim ◽  
Álvaro Carbayo ◽  
Daniel Santana ◽  
Xabier Urra
Keyword(s):  
Optic Nerve ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Carotid Artery Dissection ◽  
Artery Dissection ◽  
Internal Carotid Artery Dissection

Compressive optic nerve atrophy resulting from a distorted internal carotid artery

2000 ◽  
Vol 22 (4) ◽  
pp. 322-324 ◽  
Author(s):  
Tatsuya Ishikawa ◽  
Tatsuhiko Ito ◽  
Eiichi Shoji ◽  
Kazuhisa Inukai
Keyword(s):  
Optic Nerve ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Optic Nerve Atrophy

Parameters for Contralateral Approach to Ophthalmic Segment Aneurysms of the Internal Carotid Artery

Neurosurgery ◽  
2000 ◽  
Vol 47 (5) ◽  
pp. 1130-1137 ◽  
Author(s):  
Yukinari Kakizawa ◽  
Yuichiro Tanaka ◽  
Yasser Orz ◽  
Tomomi Iwashita ◽  
Kazuhiro Hongo ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Bone Resection ◽  
Pterional Approach ◽  
Aneurysm Neck ◽  
Contralateral Approach ◽  
Ophthalmic Segment Aneurysms ◽  
Contralateral Pterional Approach

Abstract OBJECTIVE This study was undertaken to define more accurately the feasibility and indications of the contralateral pterional approach to ophthalmic segment aneurysms of the internal carotid artery (ICA). METHODS Between 1995 and 1999, 46 patients with ophthalmic segment aneurysms of the ICA were surgically treated in our institution. Eleven of the 46 aneurysms were operated using the contralateral pterional approach. All aneurysms were successfully clipped without complications; three patients required bone resection around the aneurysm neck. We studied the 11 patients who were treated with the contralateral approach by defining six parameters to assess the feasibility of the approach and to predict the necessity for bone resection: 1) Parameter A, the distance between the anterior aspect of the optic chiasm and the limbus sphenoidale; 2) Parameter B, the distance between the bilateral optic nerves at the entrance to the optic canal; 3) Parameter C, the interrelation of the optic nerve and the ICA, expressed as a/b in which a is the length from the midline to the optic nerve and b is the length from the midline to the ICA; 4) Parameter D, the size of the aneurysm neck; 5) Parameter E, the direction of the aneurysm from the ICA wall on the anteroposterior angiogram; and 6) Parameter F, the distance from the medial side of the estimated distal dural ring to the proximal aneurysm neck on the lateral angiogram. RESULTS Parameters A to F were 8.8 mm (range, 5.4–11.1 mm), 14.5 mm (range, 10.4–22.2 mm), 0.9 mm (range, 0.6–1.3 mm), and 3.0 mm (range, 2.3–4.7 mm), 5 to 160 degrees, and 1.3 mm (range, 0.3–2.4 mm), respectively. All patients had excellent operative outcomes without visual dysfunction. Three patients required drilling of the bone around the optic canal on the craniotomy side; bone drilling was not required when Parameter E was between 30 and 160 degrees and Parameter F was more than 1 mm. CONCLUSION Parameters A to D are important for assessing the feasibility of the contralateral approach to ICA-ophthalmic segment aneurysms, and Parameters E and F are most useful for calculating the difficulty of this approach.

A Surgical Technique for the Removal of Clinoidal Meningiomas

2006 ◽  
Vol 59 (suppl_1) ◽  
pp. ONS-108-ONS-114 ◽  
Author(s):  
Joung H. Lee ◽  
Burak Sade ◽  
Bong J. Park
Keyword(s):  
Optic Nerve ◽  
Surgical Technique ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Oculomotor Nerve ◽  
Tumor Removal ◽  
The Past ◽  
Aggressive Tumor ◽  
Neurovascular Structures

Abstract CLINOIDAL MENINGIOMAS, ALSO referred to as medial or inner sphenoid wing meningiomas, are often difficult and challenging to remove completely and safely, especially when they become large enough to encircle, compress, or displace the adjacent critical neurovascular structures such as the optic nerve, the internal carotid artery and its branches, and the oculomotor nerve. In this article, the authors describe the detailed surgical technique used in their practice in addition to subtle nuances learned from their experience of operating on more than 40 patients with clinoidal meningiomas over the past several years. The primary goals of surgery are to achieve aggressive tumor removal with avoidance of intraoperative morbidity and, in addition, for those with preoperative compromised vision, to provide improvement in their visual function after surgery.

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