scholarly journals Unilateral Subfrontal Approach for Giant Tuberculum Sellae Meningioma: Single Center Experience and Review of the Literature

2021 ◽  
Vol 11 ◽  
Author(s):  
Feng Xiao ◽  
Jie Shen ◽  
Luyuan Zhang ◽  
Jiqi Yang ◽  
Yuxiang Weng ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Frontal Sinus ◽  
Optic Canal ◽  
Cerebrospinal Fluid Leakage ◽  
Limb Weakness ◽  
Tuberculum Sellae Meningioma ◽  
Left Limb ◽  
Surgical Data ◽  
Tuberculum Sellae ◽  
Subfrontal Approach

BackgroundMicrosurgical Transcranial approach (mTCA) is the primary choice for the resection of giant Tuberculum Sellae Meningiomas (TSM). The objective of this study is to explore surgical details of unilateral subfrontal approach.MethodsTen patients with giant TSM treated by unilateral subfrontal approach were included from January 2018 to June 2021. Demographic characteristics, surgical data, post-procedure complications and outcomes of patients have been descriptive analyzed, combined with systematic literature review to explore the surgical details and the prognosis of unilateral subfrontal approach.ResultsTen patients include six male and four females, age range from 35 to 77 years, duration of visual impairment from 1 to 12 months, were all performed unilateral subfrontal approach. Nine patients achieved radical resection (Simpson grades I-II) through post-operative imaging confirmation, and Simpson IV resection was performed in the remaining one due to cavernous sinus invasion. The postoperative visual acuity was improved or maintained in 8 patients. Visual acuity decreased in 2 cases, including 1 case of optic nerve atrophy and the other case of optic canal not opening. Five cases with frontal sinus opened were repaired during the operation and there was no postoperative cerebrospinal fluid leakage or intracranial infection. One patient suffered from postoperative anosmia, one patient developed left limb weakness, but their symptoms have improved in the follow-up.ConclusionSummarize the experience of our center and previous literature, unilateral forehead bottom craniotomy is a feasible surgical approach for giant tuberculum sellae meningioma. Intraoperative application of EC glue and pedicled fascia flap to repair the frontal sinus can prevent complications associated with frontal sinus opening. Optic canal unroofing has huge advantage in visual improvement.

Characteristic of optic canal invasion in 31 consecutive cases with tuberculum sellae meningioma

2016 ◽  
Vol 39 (4) ◽  
pp. 691-697 ◽  
Author(s):  
Pree Nimmannitya ◽  
Takeo Goto ◽  
Yuzo Terakawa ◽  
Hidetoshi Sato ◽  
Toshiyuki Kawashima ◽  
...  
Keyword(s):  
Optic Canal ◽  
Tuberculum Sellae Meningioma ◽  
Tuberculum Sellae

scholarly journals Microsurgical Resection of Tuberculum Sellae Meningioma through Pterional Approach with Extradural Optic Canal Unroofing

2021 ◽  
Author(s):  
Satoshi Matsuo ◽  
Toshiyuki Amano ◽  
Sojiro Yamashita ◽  
Yuichiro Miyamatsu ◽  
Akira Nakamizo
Keyword(s):  
Video Clip ◽  
World Health ◽  
Optic Canal ◽  
Pterional Approach ◽  
Who Grade ◽  
Poor Prognostic Factor ◽  
Tuberculum Sellae Meningioma ◽  
Tuberculum Sellae ◽  
Optic Canal Unroofing ◽  
Neurovascular Structures

AbstractTuberculum sellae meningiomas pose significant challenges because they are surrounded by crucial neurovascular structures, such as the optic and oculomotor nerves, pituitary stalk, internal carotid artery and its branches, and the anterior cerebral arteries. Even if small, such meningiomas frequently extend to the optic canal that is considered a poor prognostic factor for vision. In this video clip, we illustrate the case of a 60-year-old female who had an approximately 3-cm tuberculum sellae meningioma with optic canal involvement. She underwent surgical resection of the tumor through a pterional approach. After extradural optic canal unroofing, detaching, devascularizing, and debulking the tumor, careful dissection of the meningioma from the surrounding tissues was performed. Next, the tumor extensions into both of the optic canals were removed. Finally, coagulation and resection of the tumor origin on the dura of the tuberculum sellae following Simpson's grade-I resection were performed. Histopathology revealed that the tumor was a World Health Organization (WHO) grade-I meningioma. The patient had an uneventful postoperative course and her visual acuity was preserved, with no visual field defect on postoperative visual examination. In this video, the basic surgical techniques in performing extradural optic canal unroofing, preserving the arachnoid plane, and stay in collect layer, which is the essential technique for dissecting meningiomas and for preserving neurovascular structures, are demonstrated.The link to the video can be found at: https://youtu.be/vD54Iji0C4Q.

Direct epidural electrical stimulation of the optic nerve: a new method for intraoperative assessment of function

2008 ◽  
Vol 109 (4) ◽  
pp. 647-653 ◽  
Author(s):  
Roman Bošnjak ◽  
Mitja Benedièiè
Keyword(s):  
Electrical Stimulation ◽  
Optic Nerve ◽  
Optic Canal ◽  
Tumor Removal ◽  
Tuberculum Sellae Meningioma ◽  
Close Relationship ◽  
Tuberculum Sellae ◽  
The Impact ◽  
Light Flashes ◽  
Stimulation Of

Intraoperative visual system monitoring of lesions with a close relationship to the optic apparatus by using light flashes reportedly is difficult to perform, and the results are too unreliable to interpret. The authors used direct epidural electrical stimulation of the optic nerve (ON) during surgery instead of light flashes. Four patients were included in this feasibility study. In 3 patients—1 each harboring a planum sphenoidale meningioma, a tuberculum sellae meningioma, and an intraorbital ON sheath meningioma—2 stimulating needle electrodes were placed on each side of the ON just anterior to the optic canal, before unroofing the optic canal and an extradural anterior clinoidectomy. In the fourth patient, who harbored a frontotemporal astrocytoma, stimulation was applied at the exit of the ON from the canal. The electrically induced visual evoked potentials (eVEPs) were recorded from the scalp before, during, and after tumor removal. A typical eVEP consisted of N20 and N40 waves. The amplitude of the N40 wave varied up to 25% prior to tumor removal. In the patient with a symptomatic tuberculum sellae meningioma, the decompressive effect of opening the optic canal and the impact of manipulation during piecemeal tumor removal were detected by the eVEPs. In the patient with an ON sheath meningioma and light sensation, only the N20 wave was observed. Epidural electrical stimulation of the ON is a safe means of providing a stable signal and real-time information on nerve conduction during surgery. It may be a useful adjunct in improving visual outcomes postoperatively. Further clinical studies are necessary.

scholarly journals Resection of an Optic Canal Meningioma through a Contralateral Subfrontal Approach with Endoscopic Assistance: A 2D Operative Video

2018 ◽  
Vol 79 (S 02) ◽  
pp. S229-S230
Author(s):  
Moujahed Labidi ◽  
Kentaro Watanabe ◽  
Anne-Laure Bernat ◽  
Shunya Hanakita ◽  
Sébastien Froelich
Keyword(s):  
Optic Nerve ◽  
Optic Canal ◽  
Direct Visualization ◽  
Medial Aspect ◽  
Total Resection ◽  
Medial Side ◽  
Endoscopic Assistance ◽  
Tuberculum Sellae ◽  
Surgical Field ◽  
Subfrontal Approach

Objective To review the use of the contralateral subfrontal approach for the resection of an optic canal meningioma. Design Operative video. Results A meningioma, located in the inferomedial side of the optic canal (Fig. 1), was found to cause significant visual deterioration. The subfrontal route was preferred to expose the tumor without mobilization of the optic nerve. Drilling of the anterior limb of the chiasmatic sulcus (limbus sphenoidale) provided adequate exposure of the medial aspect of the optic canal. Gross total resection (Simpson II) of the tumor was accomplished, and endoscopic assistance allowed identification and coagulation of an infiltrated dura mater in the chiasmatic sulcus and tuberculum sellae. Conclusion The subfrontal approach grants an optimal surgical trajectory to the contralateral chiasmatic sulcus and optic nerve. When the medial side of the optic canal is drilled, tumors extending into the optic canal can be safely resected, under direct visualization of the inferomedial side of the optic nerve. Breach into the sphenoid sinus can occur during drilling of the anterior limb of the chiasmatic sulcus. Endoscopic assistance can provide a better view on blind areas of the surgical field, including the depth of the optic canal (Fig. 2).The link to the video can be found at: https://youtu.be/fS2udUCPH1g.

scholarly journals Characteristic of Optic Canal Invasion in 31 Consecutive Cases with Tuberculum Sellae Meningioma

2018 ◽  
Vol 79 (S 01) ◽  
pp. S1-S188
Author(s):  
Kenji Ohata ◽  
Pree Nimmannitya ◽  
Kousuke Nakajo ◽  
Hiroki Morisako ◽  
Takeo Goto
Keyword(s):  
Optic Canal ◽  
Tuberculum Sellae Meningioma ◽  
Tuberculum Sellae

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 Tuberculum sellae meningiomas: surgical considerations

2010 ◽  
Vol 68 (3) ◽  
pp. 424-429 ◽  
Author(s):  
José Alberto Landeiro ◽  
Mariangela Barbi Gonçalves ◽  
Rodrigo Dias Guimarães ◽  
João Klescoski ◽  
Jorge Luiz Amorim Correa ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Optic Nerve ◽  
Visual Field ◽  
Surgical Approach ◽  
Visual Function ◽  
Visual Outcome ◽  
Optic Canal ◽  
Incomplete Resection ◽  
Total Resection ◽  
Tuberculum Sellae

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.

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.

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