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.

scholarly journals Endoscopic Endonasal Resection of a Suprasellar Pituitary Adenoma Mimicking Tuberculum Sellae Meningioma in a Patient with an Intrasellar Persistent Trigeminal Artery

2018 ◽  
Vol 79 (S 03) ◽  
pp. S285-S286
Author(s):  
Alaa Montaser ◽  
Alexandre Todeschini ◽  
Juan Revuelta Barbero ◽  
Mostafa Shahein ◽  
E. Chiocca ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Persistent Trigeminal Artery ◽  
Trigeminal Artery ◽  
Endoscopic Endonasal ◽  
Skull Base Reconstruction ◽  
Tuberculum Sellae Meningioma ◽  
Tuberculum Sellae

AbstractA 50-year-old female with an incidentally diagnosed suprasellar lesion was initially managed conservatively due to the presence of an intrasellar persistent trigeminal artery going through the dorsum sellae and fundamentally forming the blood supply of the entire posterior circulation. Serial follow-up brain magnetic resonance imaging (MRI) revealed progressive enlargement of the suprasellar lesion over 4 years period. Surgery was indicated after the initial tumor growth; however, the patient refused surgery for fear of complications related to the persistent trigeminal artery. Two-and-a-half years later, she presented with deterioration of vision. Formal visual field testing revealed a right temporal field defect. Brain MRI demonstrated significantly enlarged suprasellar lesion, most consistent with tuberculum sellae meningioma, exerting mass effect on the optic apparatus.The patient underwent endoscopic endonasal resection of the lesion through a transplanum/transtuberculum approach. Intraoperatively, absence of hypertrophic McConnel arteries, hyperostosis, and the fact that the dura was soft and not under tension was against the diagnosis of tuberculum sellae meningioma. Additionally, the tumor consistency was similar to a pituitary adenoma. A complete resection was accomplished and multilayer skull base reconstruction was performed with no complications. On postoperative day 1 (POD 1), she was operated upon for the evacuation of small suprasellar hematoma associated with vision deterioration. Histopathological examination confirmed the diagnosis of atypical pituitary adenoma with K i-67 labeling index of 4 to 5%. The patient ultimately recovered well with improved vision, and was discharged on POD 4 with no new neurological deficits. At 4 years follow-up, her vision was normalized and brain MRI showed no residual or recurrent lesion.The link to the video can be found at: https://youtu.be/QZmzctjAEbw.

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

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.

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

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Peng Yu ◽  
Tutu Xu ◽  
Xinyu Wu ◽  
Zhitong Liu ◽  
Yong Wang ◽  
...  
Keyword(s):  
Anterior Cerebral Artery ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Tuberculum Sellae Meningioma ◽  
Csf Leakage ◽  
Invasive Method ◽  
Tuberculum Sellae

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.

ENDOSCOPIC ENDONASAL RESECTION OF A SYNCHRONOUS PITUITARY ADENOMA AND A TUBERCULUM SELLAE MENINGIOMA

2007 ◽  
Vol 60 ◽  
pp. E401 ◽  
Author(s):  
Daniel M. Prevedello ◽  
Ajith Thomas ◽  
Paul Gardner ◽  
Carl H. Snyderman ◽  
Ricardo L. Carrau ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Endoscopic Endonasal ◽  
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.

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