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

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.

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 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.

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.

Surgical management of tuberculum sellae meningioma: Role of selective extradural anterior clinoidectomy

2006 ◽  
Vol 20 (3) ◽  
pp. 129-138 ◽  
Author(s):  
Naoki Otani ◽  
Carl Muroi ◽  
Hirohito Yano ◽  
Nadia Khan ◽  
Athina Pangalu ◽  
...  
Keyword(s):  
Surgical Management ◽  
Tuberculum Sellae Meningioma ◽  
Anterior Clinoidectomy ◽  
Tuberculum Sellae

Suprasellar meningiomas: the effect of tumor location on postoperative visual outcome

1988 ◽  
Vol 69 (4) ◽  
pp. 523-528 ◽  
Author(s):  
Brian T. Andrews ◽  
Charles B. Wilson
Keyword(s):  
Visual Loss ◽  
Visual Outcome ◽  
Tumor Location ◽  
Postoperative Recovery ◽  
Optic Canal ◽  
Visual Disability ◽  
Content Type ◽  
Tuberculum Sellae ◽  
Diaphragma Sellae ◽  
Planum Sphenoidale

✓ The authors reviewed 38 cases of suprasellar meningioma to determine the correlation between tumor site and postoperative visual outcome. Progressive visual loss, the most frequent initial complaint (94.7%), occurred over a mean of 24½ months, was most often unilateral (18 patients) or bilateral but asymmetrical (14 patients), and was severe (20/200 vision or worse) in 23 patients; 24 patients had visual field abnormalities. Computerized tomography or magnetic resonance studies clearly delineated the lesions but did not appear to permit earlier diagnosis. Eleven patients had tumors limited to the tuberculum sellae; the tumor extended from the tuberculum sellae onto the planum sphenoidale in nine patients, into one optic canal in eight, onto the diaphragma sellae in seven, and onto the medial sphenoid wing in three. Patients with tumors affecting the optic canal had severe unilateral visual loss more often than those with tumors at other sites. Tumors limited to the tuberculum sellae were most often completely resected; postoperative recovery of vision was also most frequent in patients with tumors at this site. Tumors involving the diaphragma sellae or the medial sphenoid wing were least often completely removed and most likely to be associated with postoperative visual deterioration. Overall, 42% of patients had improved vision postoperatively, 30% remained unchanged, and 28% were worse. After a mean follow-up period of 38 months, 24 patients are doing well, four have significant visual disability, and three are blind or doing poorly. Two patients died of causes unrelated to their tumor. Three patients have had tumor recurrence.

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