Tuberculum Sellae Meningioma Resection: Technical Nuances on the Frontopterional Approach

AbstractTuberculum sellae meningioma remains a surgical challenge. Deep location of tumor, vascular and nerve encasement, and pituitary stalk involvement are the main technical issues. The frontopterional approach represents a natural, simple, and elegant approach to this area enabling surgeon to have a direct control on all anatomical structures. A 42-year-old woman was referred with a delayed diagnosis of tuberculum sellae meningioma due to the presence of HLA-B27-associated uveitis. She presented with 1/10 visual acuity in the left eye and no right visual function. A left frontopterional craniotomy was performed. Visual function improved postoperatively. The video illustrates the cisternal anatomy via pterional approach.The link to the video can be found at: https://youtu.be/Hmbf5bt7A64.

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Pterional approach versus unilateral frontal approach on tuberculum sellae meningioma: Single centre experiences

Asian Journal of Neurosurgery ◽

10.4103/1793-5482.95691 ◽

2012 ◽

Vol 7 (1) ◽

pp. 21 ◽

Cited By ~ 6

Author(s):

Ignatius Mardjono ◽

Ahmad Faried ◽

Roland Sidabutar ◽

BenyAtmadja Wirjomartani ◽

MuhammadZafrullah Arifin

Keyword(s):

Single Centre ◽

Pterional Approach ◽

Tuberculum Sellae Meningioma ◽

Tuberculum Sellae

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

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0041-1727148 ◽

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.

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Use of the Neurological Pupil Index to Predict Postoperative Visual Function After Resection of a Tuberculum Sellae Meningioma: A Case Report

Cureus ◽

10.7759/cureus.5998 ◽

2019 ◽

Author(s):

Kunal P Raygor ◽

Philip V Theodosopoulos

Keyword(s):

Case Report ◽

Visual Function ◽

Tuberculum Sellae Meningioma ◽

Tuberculum Sellae ◽

Neurological Pupil Index

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Surgery of Tuberculum Sellae Meningioma: A Technical Purview on Pterional Approach

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1625945 ◽

2018 ◽

Vol 79 (S 03) ◽

pp. S265-S266 ◽

Cited By ~ 3

Author(s):

Anil Nanda ◽

Devi Patra ◽

Amey Savardekar ◽

Nasser Mohammed ◽

Vinayak Narayan ◽

...

Keyword(s):

Optic Nerve ◽

Surgical Techniques ◽

Endocrine Function ◽

Pituitary Stalk ◽

Anterior Communicating Artery ◽

Pterional Approach ◽

Tuberculum Sellae Meningioma ◽

Tumor Identification ◽

Transcranial Approach ◽

Tuberculum Sellae

Objective Amidst the raging debate between transnasal and transcranial approaches, the critical factor that dictates success lies in the meticulous dissection of the tumor from the optic apparatus, anterior communicating artery complex, and the pituitary stalk. In this surgical video, we describe the resection of a tuberculum sellae meningioma through the pterional approach highlighting dissection through the appropriate arachnoidal plane. Case Description The patient is a 75-year-old female who presented with optic nerve compression with bitemporal hemianopia and endocrine function abnormalities. A transcranial approach was done to effectively decompress the optic nerve. The video includes a detailed discussion on the surgical techniques including working between the different surgical corridors, working in the arachnoid plane to dissect the neurovascular structures away from the tumor, identification, and preservation of pituitary stalk. Postoperatively, the patient's visual field deficit improved with a remaining isolated right temporal field defect at 2 months follow-up. Her endocrine function improved after the surgery. Conclusion In the era of endoscopic surgery, transcranial approaches for suprasellar tumors like tuberculum sellae meningiomas still have a distinct surgical role. Our discussion extends to reiterate the strengths and weaknesses of the transcranial approach to this region as compared with the endoscopic approach. We believe decompression of optic nerves, separation of Acom complex from the tumor, and preservation of pituitary stalk are better achieved through a transcranial approach.The link to the video can be found at: https://youtu.be/kw5eP3oUd6Q.

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Clinical Outcomes of Tuberculum Sellae Meningiomas Focusing on Reversibility of Postoperative Visual Function

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0034-1384158 ◽

2014 ◽

Vol 75 (S 02) ◽

Author(s):

H. Seol ◽

D. Nam ◽

D. Kong ◽

J. Lee ◽

K. Park

Keyword(s):

Clinical Outcomes ◽

Visual Function ◽

Tuberculum Sellae

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Younger age of onset and uveitis associated with HLA-B27 and delayed diagnosis in Thai patients with axial spondyloarthritis

Scientific Reports ◽

10.1038/s41598-021-93001-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Naphruet Limsakul ◽

Praveena Chiowchanwisawakit ◽

Parichart Permpikul ◽

Yubolrat Thanaketpaisarn

Keyword(s):

Regression Analysis ◽

Multiple Regression Analysis ◽

Axial Spondyloarthritis ◽

Age At Onset ◽

Delayed Diagnosis ◽

Musculoskeletal Symptom ◽

Hla B27 ◽

Delay In Diagnosis ◽

Factors Associated ◽

Younger Age

AbstractTo identify characteristics associated with HLA-B27, and to identify factors associated with delayed diagnosis in Thai patients with axial spondyloarthritis (axSpA). This cross-sectional study included Thai patients were diagnosed with axSpA by a rheumatologist at Siriraj Hospital. Clinical data were collected. Regression analyses were employed to identify factors associated with study outcomes. Of total 177 patients, 127 (72%) were positive HLA-B27. Uveitis [Odds ratio (OR) 4.0], age at onset of the first musculoskeletal symptom of ≤ 28 years [OR 3.5], female [OR 0.4], and psoriasis [OR 0.4] were significantly associated with HLA-B27 in multiple regression analysis. Those with positive HLA-B27 had less spinal flexibility. Elevated C-reactive protein (p = 0.012) was associated with shorter delay in diagnosis, while uveitis (p < 0.001) and younger age at onset of the first symptom (p = 0.002) were associated with longer delay in diagnosis in multiple regression analysis. Younger age at onset of the first musculoskeletal symptom and uveitis were associated with HLA-B27 and delayed diagnosis in axSpA patients. Young people with musculoskeletal symptom and uveitis should be referred to a rheumatologist to rule out or make a timely diagnosis of axSpA.

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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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