The expanded endoscopic endonasal approach for treatment of tuberculum sellae meningiomas in a series of 40 consecutive cases

AbstractCompared with traditional craniotomy, the expanded endoscopic endonasal approach (EEEA) may have some advantages for tuberculum sellae meningioma (TSM) treatment. We described our experience of the therapeutic effect of endoscopic TSM treatment. From August 2015 to December 2019, 40 patients with a TSM were treated by the EEEA in our institution. EEEA outcome in TSM treatment was analyzed. Among 39 patients with visual impairment, 38 (97.4%) improved their visual function to some extent after the EEEA, and one case had no significant change in visual acuity. Among all patients, 38 (95.0%) achieved gross total resection (GTR) and 2 (5.0%) achieved near-total resection (NTR). Cerebrospinal fluid (CSF) leakage occurred in three patients (7.5%) and meningitis (post-CSF leakage) in two patients (5.0%). Eight patients (20.0%) suffered postoperative hyposmia, three of whom developed long-term hyposmia. One patient (2.5%) suffered from bleeding of the branch of the anterior cerebral artery intraoperatively leading to postoperative acute cerebral infarction. The EEEA is a safe and reliable minimally invasive method for TSM removal. Compared with traditional craniotomy, the EEEA may have better visual outcomes and a higher prevalence of GTR, but carries the risk of CSF leakage.

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How I do it: endoscopic endonasal resection of tuberculum sellae meningioma

Acta Neurochirurgica ◽

10.1007/s00701-021-04784-5 ◽

2021 ◽

Author(s):

Markus Wiedmann ◽

Aslan Lashkarivand ◽

Jon Berg-Johnsen ◽

Daniel Dahlberg

Keyword(s):

Team Approach ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Ongoing Debate ◽

Endoscopic Endonasal ◽

Microsurgical Technique ◽

Tuberculum Sellae Meningioma ◽

Tuberculum Sellae ◽

Dedicated Team ◽

Neurovascular Structures

Abstract Background Tuberculum sellae meningiomas (TSMs) adherent to neurovascular structures are particularly challenging lesions requiring delicate and precise microneurosurgery. There is an ongoing debate about the optimal surgical approach. Method We describe technical nuances and challenges in TSM resection using the endoscopic endonasal approach (EEA) in two cases of fibrous tumors with adherence to neurovascular structures. The cases are illustrated with a video (case 1) and figures (cases 1 and 2). Conclusion A dedicated team approach and precise microsurgical technique facilitate safe resection of complex TSMs through the EEA.

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Endoscopic Assisted Supraorbital Keyhole Approach or Endoscopic Endonasal Approach in Cases of Tuberculum Sellae Meningioma: Which Surgical Route Should Be Favored?

World Neurosurgery ◽

10.1016/j.wneu.2017.05.023 ◽

2017 ◽

Vol 104 ◽

pp. 601-611 ◽

Cited By ~ 18

Author(s):

Stefan Linsler ◽

Gerrit Fischer ◽

Volodymyr Skliarenko ◽

Axel Stadie ◽

Joachim Oertel

Keyword(s):

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Tuberculum Sellae Meningioma ◽

Tuberculum Sellae ◽

Keyhole Approach

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Endoscopic Endonasal Approach for Resection of Tuberculum Sellae Meningioma

Journal of Craniofacial Surgery ◽

10.1097/scs.0000000000006413 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Cheng Zhang ◽

Jianling Ding ◽

Ye Liu ◽

Maimaitiyiming Tuoheti ◽

Xiaopeng Yang ◽

...

Keyword(s):

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Tuberculum Sellae Meningioma ◽

Tuberculum Sellae

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Olfactory groove and tuberculum sellae meningioma resection by endoscopic endonasal approach versus transcranial approach: A systematic review and meta-analysis of comparative studies

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2018.08.029 ◽

2018 ◽

Vol 174 ◽

pp. 13-20 ◽

Cited By ~ 3

Author(s):

Victor M. Lu ◽

Anshit Goyal ◽

Richard A. Rovin

Keyword(s):

Systematic Review ◽

Comparative Studies ◽

Meta Analysis ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Tuberculum Sellae Meningioma ◽

Olfactory Groove ◽

Transcranial Approach ◽

Tuberculum Sellae

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Endoscopic Endonasal Approach for Craniopharyngiomas with Intraventricular Extension: Long-Term Outcomes and Meta-analysis

10.1055/s-0040-1702331 ◽

2020 ◽

Author(s):

Hanna Algattas ◽

Pradeep Setty ◽

Ezequiel Goldschmidt ◽

Eric W. Wang ◽

Elizabeth Tyler-Kabara ◽

...

Keyword(s):

Meta Analysis ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Long Term Outcomes ◽

Endoscopic Endonasal

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Endoscopic Endonasal Approach for Craniopharyngiomas with Intraventricular Extension: Case Series, Long-Term Outcomes, and Review

World Neurosurgery ◽

10.1016/j.wneu.2020.08.184 ◽

2020 ◽

Vol 144 ◽

pp. e447-e459

Author(s):

Hanna Algattas ◽

Pradeep Setty ◽

Ezequiel Goldschmidt ◽

Eric W. Wang ◽

Elizabeth C. Tyler-Kabara ◽

...

Keyword(s):

Case Series ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Long Term Outcomes ◽

Endoscopic Endonasal

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Endoscopic Endonasal Approach for Tuberculum Sellae Meningiomas

Neurosurgery ◽

10.1227/neu.0b013e318217219b ◽

2011 ◽

Vol 69 (1) ◽

pp. E260-E261 ◽

Cited By ~ 7

Author(s):

Juan C Fernandez-Miranda ◽

Paul A Gardner ◽

Carl H Snyderman

Keyword(s):

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Tuberculum Sellae

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Extended endoscopic endonasal approach for selected pituitary adenomas: early experience

Journal of Neurosurgery ◽

10.3171/2010.9.jns10262 ◽

2011 ◽

Vol 114 (2) ◽

pp. 345-353 ◽

Cited By ~ 44

Author(s):

Salvatore Di Maio ◽

Luigi M. Cavallo ◽

Felice Esposito ◽

Vita Stagno ◽

Olga Valeria Corriero ◽

...

Keyword(s):

Pituitary Adenomas ◽

Transsphenoidal Surgery ◽

Extent Of Resection ◽

Transsphenoidal Approach ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Endoscopic Endonasal ◽

Csf Leakage ◽

Endoscopic Endonasal Transsphenoidal Surgery ◽

Extended Endoscopic Approach

Object Whereas most pituitary adenomas are removable via the transsphenoidal approach, certain cases, such as dumbbell-shaped or suprasellar adenomas and recurrent and/or fibrous tumors, remain difficult to treat. The authors present their experience with the extended endoscopic endonasal approach to the suprasellar area in managing this subset of tumors, which are classically treated through a transcranial route. Methods From June 1997 to December 2008, 615 patients underwent endoscopic endonasal transsphenoidal surgery for pituitary adenomas in the Department of Neurosurgery of the Università degli Studi di Napoli Federico II. Of this group, 20 patients with pituitary adenomas needed an extended endoscopic endonasal transtuberculum/transplanum approach for tumor removal. Two surgical corridors were used during the transsphenoidal approach: 1) the conventional endosellar extraarachnoidal corridor and 2) a suprasellar transarachnoidal corridor. Results The extent of resection was gross total in 12 (60%) of the 20 patients, near total in 4 (20%), subtotal in 3 (15%), and partial in 1 (5%). Postoperative CSF leakage occurred in 1 patient. One patient experienced worsening of temporal hemianopsia. Conclusions The authors' initial results with the extended endoscopic approach to the suprasellar area for selected pituitary adenomas are promising and may justify a widening of the current classical indications for transsphenoidal surgery.

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Machine learning–based prediction of outcomes of the endoscopic endonasal approach in Cushing disease: is the future coming?

Neurosurgical FOCUS ◽

10.3171/2020.3.focus2060 ◽

2020 ◽

Vol 48 (6) ◽

pp. E5

Author(s):

Matteo Zoli ◽

Victor E. Staartjes ◽

Federica Guaraldi ◽

Filippo Friso ◽

Arianna Rustici ◽

...

Keyword(s):

Machine Learning ◽

Area Under The Curve ◽

Complex Data ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Cushing Disease ◽

Endoscopic Endonasal ◽

Internal Validation

OBJECTIVEMachine learning (ML) is an innovative method to analyze large and complex data sets. The aim of this study was to evaluate the use of ML to identify predictors of early postsurgical and long-term outcomes in patients treated for Cushing disease (CD).METHODSAll consecutive patients in our center who underwent surgery for CD through the endoscopic endonasal approach were retrospectively reviewed. Study endpoints were gross-tumor removal (GTR), postsurgical remission, and long-term control of disease. Several demographic, radiological, and histological factors were assessed as potential predictors. For ML-based modeling, data were randomly divided into 2 sets with an 80% to 20% ratio for bootstrapped training and testing, respectively. Several algorithms were tested and tuned for the area under the curve (AUC).RESULTSThe study included 151 patients. GTR was achieved in 137 patients (91%), and postsurgical hypersecretion remission was achieved in 133 patients (88%). At last follow-up, 116 patients (77%) were still in remission after surgery and in 21 patients (14%), CD was controlled with complementary treatment (overall, of 131 cases, 87% were under control at follow-up). At internal validation, the endpoints were predicted with AUCs of 0.81–1.00, accuracy of 81%–100%, and Brier scores of 0.035–0.151. Tumor size and invasiveness and histological confirmation of adrenocorticotropic hormone (ACTH)–secreting cells were the main predictors for the 3 endpoints of interest.CONCLUSIONSML algorithms were used to train and internally validate robust models for all the endpoints, giving accurate outcome predictions in CD cases. This analytical method seems promising for potentially improving future patient care and counseling; however, careful clinical interpretation of the results remains necessary before any clinical adoption of ML. Moreover, further studies and increased sample sizes are definitely required before the widespread adoption of ML to the study of CD.

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The efficacy of an endoscopic endonasal approach in the repair of cerebrospinal fluid fistula: a clinical analysis

International Journal of Scientific Reports ◽

10.18203/issn.2454-2156.intjscirep20191431 ◽

2019 ◽

Vol 5 (4) ◽

pp. 90

Author(s):

Fulya Ozer ◽

Can Alper Cagici ◽

Cem Ozer ◽

Cuneyt Yilmazer

Keyword(s):

Cerebrospinal Fluid ◽

Endoscopic Approach ◽

Graft Material ◽

Endoscopic Endonasal Approach ◽

Endonasal Approach ◽

Cerebrospinal Fluid Fistula ◽

Endoscopic Repair ◽

Endoscopic Endonasal ◽

Csf Leakage ◽

Fluid Fistula

Background: Cerebrospinal fluid (CSF) fistula is an abnormal CSF leakage due to bone and/or dural defect of the skull base and usually operated with endonasal endoscopic approach. The aim of this study was to determine the efficacy of an endonasal endoscopic approach in the repair of CSF leakage and to find the reasons of the recurrence of endoscopic procedure.Methods: The medical records of 24 patients that presented with the diagnosis of cerebrospinal fluid fistula and who had undergone endonasal endoscopic repair surgery were reviewed retrospectively. Results: 13 patients (54.2%) were found to have spontaneous CSF fistulas without any history of trauma, while 11 patients (45.8%) had posttraumatic CSF fistulas. The mean body mass index (BMI) of patients was 31. 3 kg/m² (20.1-49.6). Nasal septal cartilage was used as a graft material in 19 patients (79%) while only fascia was used in 5 patients (21%). The evaluation of long-term results revealed recurrence in 4 patients (16.6%). Two of these patients required a second surgical repair.Conclusions: An endoscopic endonasal approach is a safe method with less morbidity and a reliable outcome in the repair of CSF fistulas. The most important causative factors in the recurrence of endoscopic repair of CSF leak might be to have high BMI and not to use multilayered graft material for closure of fistula.

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