scholarly journals Supraorbital transciliary keyhole approach for removal of tuberculum sellae meningioma: 3D surgical video

2021 ◽  
Vol 12 ◽  
pp. 5
Author(s):  
J. Javier Cuellar-Hernandez ◽  
J. Ramon Olivas-Campos ◽  
Paulo M. Tabera-Tarello ◽  
Miracle Anokwute ◽  
Alan Valadez-Rodriguez
Keyword(s):  
Visual Field ◽  
Tumor Resection ◽  
Visual Fields ◽  
Optic Nerves ◽  
Tuberculum Sellae Meningioma ◽  
Primary Indication ◽  
Tuberculum Sellae ◽  
Surgical Corridor ◽  
Keyhole Approach ◽  
Supraorbital Craniotomy

Background: Tuberculum sellae meningiomas have an incidence from 5 to 10% of all intracranial meningiomas[2] and tend to be surgically difficult and challenging tumors given their proximity to important structures such as the internal carotid artery (ICA), anterior cerebral artery (ACA), and optic nerves.[3] Typically, their growth is posteriorly and superiorly oriented, thereby displacing the optic nerves and causing visual dysfunction, which is the primary indication for surgical treatment.[1] The main goals of the treatment are the preservation or restoration of visual abilities and a complete tumor resection.[1] Conventionally, surgical approaches to tuberculum meningiomas involve largely invasive extended bifrontal, interhemispheric, orbitozygomatic, pterional, and subfrontal eyebrow approaches. The supraorbital craniotomy, however, is a minimally invasive transcranial approach that offers a similar surgical corridor to conventional transcranial approaches, using a limited craniotomy and minimal brain retraction that can be used for tumoral and vascular pathologies,[4,5] offering added cosmetic outcomes.[1] We present the case of a patient undergoing a supraorbital transciliary craniotomy with a tuberculum sellae meningioma causing bitemporal hemianopsia. Case Description: A 70-year-old female with chronic headaches and progressive vision loss and visual field deficit for about 1 year. On ophthalmological evaluation, she was able to fixate and follow objects with each eye, light perception was only present in the right eye, and the vision in the left eye was 0.2 decimal units. Her visual fields demonstrated severe campimetric deficits. Her extraocular movements were intact and bilateral pupils were equal, round, and reactive to light. MRI of the brain demonstrated tuberculum sellae meningioma with bilateral optic canal invasion, displacing the chiasm, and extending ≥180° around the medial ICA wall and anterior ACA wall. The patient underwent supraorbital transciliary keyhole approach for total resection of the tumor. Postoperatively, visual acuity and visual field were significantly improved. Conclusion: Performing a supraorbital transciliary keyhole craniotomy for tuberculum sellae meningiomas requires an adequate and meticulous preoperative planning to determine the optimal surgical corridor to the lesion. The use of supraorbital craniotomy is safe with good cosmetic results and potentially lower morbidity allowing for adequate exposure, resection, and release of neurovascular structures.

scholarly journals Microsurgical Resection of Tuberculum Sellae Meningioma through Left Cranio-orbital Approach

2018 ◽  
Vol 79 (S 02) ◽  
pp. S223-S224
Author(s):  
Mirza Pojskić ◽  
Kenan Arnautović
Keyword(s):  
Video Clip ◽  
Tumor Resection ◽  
Anterior Communicating Artery ◽  
Tuberculum Sellae Meningioma ◽  
Temporal Lobes ◽  
Microsurgical Resection ◽  
Tuberculum Sellae ◽  
Vascular Structures ◽  
Left And Right ◽  
Surgical Corridor

AbstractIn this video clip, the authors present the resection of a tuberculum sellae meningioma with compression of the left optic nerve and a chiasm (Fig. 1) through a standard cranial orbital (CO) skull base approach.1 2 3 The key step in the tumor resection was microsurgical dissection of left and right A1 segments of the anterior cerebral artery and the anterior communicating artery and the separation of the tumor from these vascular structures. This was followed by careful separation of the meningioma from both optic nerves, the chiasm and the pituitary stalk. The final step was coagulation and resection of the tumor origin on the dura of the tuberculum sellae, devascularizing the tumor. Once this was achieved, the tumor was removed. Using this approach, an optimal surgical corridor to the sellar area was provided while minimizing the retraction of frontal and temporal lobes.The link to the video can be found at: https://youtu.be/O59Fj2dNXB0.

scholarly journals Optic Nerve Vascular Compression in a Patient with a Tuberculum Sellae Meningioma

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Cezar José Mizrahi ◽  
Samuel Moscovici ◽  
Shlomo Dotan ◽  
Sergey Spektor
Keyword(s):  
Optic Nerve ◽  
Visual Field ◽  
Cerebral Artery ◽  
Anterior Cerebral Artery ◽  
Vascular Compression ◽  
Case Description ◽  
Tuberculum Sellae Meningioma ◽  
Documented Case ◽  
Suprasellar Tumor ◽  
Tuberculum Sellae

Background. Optic nerve vascular compression in patients with suprasellar tumor is a known entity but is rarely described in the literature.Case Description. We present a unique, well-documented case of optic nerve strangulation by the A1 segment of the anterior cerebral artery in a patient with a tuberculum sellae meningioma. The patient presented with pronounced progressive visual deterioration. Following surgery, there was immediate resolution of her visual deficit.Conclusion. Vascular strangulation of the optic nerve should be considered when facing progressive and/or severe visual field deterioration in patients with tumors proximal to the optic apparatus.

scholarly journals A novel scale for describing visual outcomes in patients following resection of lesions affecting the optic apparatus: the Unified Visual Function Scale

2018 ◽  
Vol 129 (6) ◽  
pp. 1438-1445
Author(s):  
Serge Makarenko ◽  
Vincent Ye ◽  
Peter A. Gooderham ◽  
Ryojo Akagami
Keyword(s):  
Visual Acuity ◽  
Visual Field ◽  
Visual Function ◽  
Tumor Resection ◽  
Visual Fields ◽  
Case Series ◽  
Relevant Information ◽  
Treatment Groups ◽  
Visual Outcomes ◽  
User Friendly

OBJECTIVEHistorically, descriptions of visual acuity and visual field change following intracranial procedures have been very rudimentary. Clinicians and researchers have often used basic descriptions, such as “improved,” “worsened,” and “unchanged,” to describe outcomes following resections of tumors affecting the optic apparatus. These descriptors are vague, difficult to quantify, and challenging to apply in a clinical perspective. Several groups have attempted to combine visual acuity and visual fields into a single assessment score, but these are not user-friendly. The authors present a novel way to describe a patient’s visual function as a combination of visual acuity and visual field assessment that is simple to use and can be used by surgeons and researchers to gauge visual outcomes following tumor resection.METHODSVisual acuity and visual fields were combined into 3 categories designed around the definitions of legal blindness and fitness to drive in Canada. The authors then applied the scale (the Unified Visual Function Scale, or UVFS) to their previously published case series of perisellar meningiomas to document and test overall visual outcomes for patients undergoing tumor resection. The results were compared with previously documented visual loss scales in the literature.RESULTSUsing the UVFS the authors were able to capture the overall visual change; the scale was sensitive enough to define the overall visual improvement or worsening quantitatively, using categories that are clinically relevant and understandable.CONCLUSIONSThe UVFS is a robust way to assess a patient’s vision, combining visual fields and acuity. The implementation of pre- and postoperative assessment is sensitive enough to assess overall change while also providing clinically relevant information for surgeons, and allows for comparisons between treatment groups.

Endoscopic Endonasal and Supraorbital Removal of Tuberculum Sellae Meningiomas: Anatomic Guides and Operative Nuances for Keyhole Approach Selection

2021 ◽  
Author(s):  
Regin Jay Mallari ◽  
Jai Deep Thakur ◽  
John H Rhee ◽  
Amalia Eisenberg ◽  
Howard Krauss ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Optic Canal ◽  
Tumor Removal ◽  
Endoscopic Endonasal ◽  
Fluid Attenuated Inversion Recovery ◽  
Tuberculum Sellae ◽  
Magnetic Resonance Imaging Mri ◽  
Mri Changes ◽  
Keyhole Approach ◽  
Additional Tumor

Abstract BACKGROUND With growing worldwide endoscopy experience, endonasal and supraorbital removal of tuberculum sellae meningiomas (TSM) has increased. OBJECTIVE To describe anatomic factors for guiding approach selection and outcomes. METHODS Retrospective analysis of patients undergoing endonasal or supraorbital TSM resection: approach criteria, clinical outcomes, acute magnetic resonance imaging (MRI) fluid-attenuated inversion-recovery (FLAIR)/T2 changes. RESULTS From 2008 to 2020, 33 patients (mean age 55 ± 11 yr) were identified: 20 (61%) had endonasal and 13 (39%) supraorbital removal. Comparing endonasal and supraorbital approaches, mean tumor volume (3.7 ± 3.5 cm3 vs 7.7 ± 8.5 cm3, P = .07); percent tumor above planum (42% vs 65%, P = .02), and lateral tumor beyond supraclinoid internal carotid arteries (1.4 ± 2.0 mm vs 4.0 ± 3.2 mm, P = .006) were greater for supraorbital route. Sellar depth was greater for endonasal route tumors (12.2 ± 2.6 mm vs 9.3 ± 2.4 mm, P = .003). Endoscopy, used in 10/13(77%) supraorbital cases, was helpful in additional tumor removal in 4/10(40%). Gross total removal and mean volumetric tumor resection were 16/20(80%) and 97.5% by endonasal, and 5/13(39%) and 96% by supraorbital route. Vision improved in 12/17 (71%) endonasal, 6/8 (75%) supraorbital operations, and worsened in 1 (3%) supraorbital case. Endonasal approach with optic canal decompression increased over study period: 15/20 (75%) endonasal patients vs 1/13(8%) supraorbital (P < .001). Postoperative FLAIR/T2 MRI changes occurred in 2/12 supraorbital and 0/20 endonasal cases. CONCLUSION In our experience, both endonasal and supraorbital routes are safe and effective for TSM removal. Greater tumor extension below planum and medial optic canal invasion favor endonasal route, while larger size and lateral extension favor supraorbital route. Given high frequency of TSM growth into optic canals and better access for medial optic canal tumor removal, endonasal route may be preferred for most TSMs.

Validation of the superior interhemispheric approach for tuberculum sellae meningioma

2012 ◽  
Vol 117 (6) ◽  
pp. 1013-1021 ◽  
Author(s):  
Sophie Curey ◽  
Stéphane Derrey ◽  
Pierre Hannequin ◽  
Didier Hannequin ◽  
Pierre Fréger ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Early Postoperative Period ◽  
Csf Leak ◽  
Karnofsky Performance Scale ◽  
Tuberculum Sellae Meningioma ◽  
Interhemispheric Approach ◽  
Tuberculum Sellae ◽  
Surgical Corridor ◽  
The Impact

Object The objective of this study was to evaluate the ophthalmological outcome, nonvisual morbidity, and surgical complications after tuberculum sellae meningioma (TSM) removal using a superior interhemispheric approach. Methods In the last decade, 20 consecutive patients with TSM underwent operations using the superior interhemispheric approach. Visual acuity, visual field, and ocular fundus examination were assessed both preoperatively and 6-months postoperatively. Nonvisual morbidity was determined at an early postoperative period and at 6 months based on assessment of the Karnofsky Performance Scale score, leakage of CSF, endocrinological status, and olfactory function, which was assessed using a visual analog scale (VAS). The potential brain injury related to the approach was assessed by MRI at 6 months. Magnetic resonance imaging was then performed yearly to detect a recurrence. The mean follow up was 56.3 ± 34 months. Results The primary presenting symptom for diagnosis of TSM in 20 patients (female:male ratio of 6.6:1, mean age 59.1 ± 11.1 years) was visual disturbance in 12 patients (60%), headache in 4 (20%), cognitive alteration in 1 (5%), epilepsy in 2 (10%), and accidental in 1 (5%). In a total of 40 eyes, 17 eyes in 11 patients presented with preoperative deterioration of visual acuity. Postoperatively, the visual acuity improved in 13 eyes in 8 patients (72.8%), remained unchanged in 3 eyes in 2 patients (18.2%) and deteriorated in 1 patient (9%). The nonvisual morbidity included olfactory deterioration in 7 patients (35%), and panhypopituitarism in 1 patient (5%). No patients experienced a CSF leak. The impact of olfactory deterioration on the quality of life, as estimated by a VAS score (range 0–10), was a mean of 5.7 ± 2.2 (95% CI 4.1–7.3). On the follow-up MRI, no additional lesions or recurrences were observed on the medial aspect of the frontal lobe along the surgical corridor. Conclusions The superior interhemispheric approach appears to be effective in resolving the problem of visual deterioration due to a TSM, without inducing surgical injury on the brain surface along the surgical corridor. Olfactory deterioration remained the challenging predominant nonvisual morbidity using this approach.

scholarly journals Endoscopic Endonasal Resection of Tuberculum Sellae Meningioma with Utilization of Indocyanine Green

2018 ◽  
Vol 79 (S 03) ◽  
pp. S269-S270 ◽  
Author(s):  
Mostafa Shahein ◽  
Alaa Montaser ◽  
Alexandre Todeschini ◽  
Juan Revuelta Barbero ◽  
Bradley Otto ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Indocyanine Green ◽  
Incidental Finding ◽  
Visual Fields ◽  
Brain Magnetic Resonance Imaging ◽  
Pathology Report ◽  
Endoscopic Endonasal ◽  
Who Grade ◽  
Tuberculum Sellae Meningioma ◽  
Tuberculum Sellae

AbstractWe present the case of a 67-year-old female with an incidental finding of a left-sided tuberculum sellae meningioma on a brain magnetic resonance imaging (MRI) for an unrelated complaint. Formal visual field testing showed a small defect in the inferior nasal and temporal fields of the left eye, compatible with mass effect on the optic nerve by the tumor.An endoscopic endonasal transtuberculum approach with decompression of the left optic nerve was performed using a standard binostril four-hand technique, with the patient positioned supine with the head turned to the right side and tilted to the left, fixed in a three-pin head clamp, under imaging guidance. After exposure, we drilled the tuberculum sellae and the floor of the sella and after opening the dura, the tumor and optic nerve came into view. The tumor was completely removed and we confirmed the patency of all perforating vessels using indocyanine green. Reconstruction was done in a multilayered fashion, using collagen matrix and a nasoseptal flap.Patient had an uneventful postoperative stay and was discharged on postoperative day 3, neurologically stable with no new hormonal deficits. Pathology report confirmed a WHO Grade I meningioma with K i-67 of 1% and 3-month postoperative MRI confirmed a gross total resection and visual fields exam showed a complete recovery.The link to the video can be found at: https://youtu.be/zRmt2aIvX5c.

Expanded Endoscopic Endonasal Transtuberculum Approach for Tuberculum Sellae Meningioma: Operative Video With 360-Degree Fly-Through and Surgical Rehearsal in Virtual Reality: 2-Dimensional Operative Video

2020 ◽  
Vol 19 (2) ◽  
pp. E179-E180 ◽  
Author(s):  
Walter C Jean ◽  
Ameet Singh
Keyword(s):  
Virtual Reality ◽  
Haptic Feedback ◽  
Tumor Resection ◽  
Three Dimensional ◽  
Early Career ◽  
Tissue Response ◽  
Endoscopic Endonasal ◽  
Tuberculum Sellae Meningioma ◽  
Patient Consent ◽  
Tuberculum Sellae

Abstract This video demonstrates the technique of the “Expanded Endoscopic Endonasal Transtuberculum Approach” and the utility of preoperative planning and surgical rehearsal in virtual reality (VR).  VR can be utilized to improve endoscopic skull base surgery in various ways. The patient is a 57-yr-old woman with sudden right abducens palsy. Transcranial surgery has been the gold-standard treatment of the tuberculum sellae meningioma that was found, but for suitable tumors, the endoscopic endonasal approach is equally effective for tumor resection with better visual outcomes.1-4  The three-dimensional, 360°, multicolored VR rendering (Surgical Theater SRP7.4.0, Cleveland, Ohio) of her tuberculum sellae meningioma clearly demonstrated that there was no encasement of the anterior cerebral arteries, the tumor did not extend lateral to the carotid arteries, and the surgical corridor was wide enough for endoscopic endonasal resection. The surgical exposure was then rehearsed with the sphenoidectomy and drilling of the sella floor and tuberculum performed in VR space. The step-by-step process of the endoscopic endonasal transtuberculum resection is demonstrated in the operative video.  Surgical planning in VR can be helpful to the early-career endoscopic surgeon. The three-dimensional renderings are quick to set up (15 min), and the examination of the anatomy is useful for choosing the surgical approach. Despite the lack of haptic feedback and tissue response such as vascularity and firmness in the current software, rehearsing the drilling for exposure can improve the efficiency in surgery.  Patient consent was obtained prior to the creation of the video and is available on request.

Visual Field Accuracy and Eye Movement Direction: A Child's Eye View

1980 ◽  
Vol 50 (2) ◽  
pp. 631-636
Author(s):  
Evans Mandes
Keyword(s):  
Eye Movements ◽  
Visual Field ◽  
Eye Movement ◽  
Visual Fields ◽  
Movement Direction

Post-exposural eye movements were studied in 32 adults and 24 7-yr.-old children. Stimuli were binary figures exposed tachistoscopically in both visual fields simultaneously. The data showed significant correlations between direction of eye movement and locus of recognition for both children and adults. No significant differences were found in frequencies of eye movements of children and adults. The data are interpreted in terms of the facilitative effects of post-exposural eye movements upon perception for both groups.

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