scholarly journals Anterior Interhemispheric Approach for Tuberculum Sellae Meningioma

2011 ◽  
Vol 68 (suppl_1) ◽  
pp. ons84-ons89 ◽  
Author(s):  
Shunsuke Terasaka ◽  
Katsuyuki Asaoka ◽  
Hiroyuki Kobayashi ◽  
Shigeru Yamaguchi
Keyword(s):  
Visual Outcome ◽  
Visual Field Defects ◽  
Preoperative Period ◽  
Tuberculum Sellae Meningioma ◽  
Interhemispheric Approach ◽  
Visual Status ◽  
Number Of Patients ◽  
Impairment Score ◽  
Anterior Interhemispheric Approach ◽  
Tuberculum Sellae

Abstract BACKGROUND: The tuberculum sellae meningioma (TSM) arises from the tuberculum sellae, chiasmatic sulcus, and limbus sphenoidale. OBJECTIVE: To retrospectively analyze patients with TSM who underwent surgery via an anterior interhemispheric approach, with special attention to visual outcomes. METHODS: Nine consecutive patients between April 2004 and December 2009 were examined. Visual impairment score (VIS) was used to analyze the visual status of the patients. A VIS is the sum of the scores in specific tables for visual acuity and visual field defects. Visual status was sequentially evaluated in the preoperative period and within 2 weeks of the operation. Any change in the VIS was considered an improvement or deterioration of visual function. All tumors were removed via an anterior interhemispheric approach. Following the wide dissection of the interhemispheric fissure, the tumor was first detached from its origin and debulked with the ultrasonic aspirator starting at the midline. The debulking continued until the arachnoid plane separating the nerve and tumor was visualized. RESULTS: Gross total resection (Simpson I + II) was achieved in all 9 patients. The average VIS was 56.1 in the preoperative period and 26.3 in the postoperative period. Among 9 patients, 8 patients had an improvement of the VIS after surgery. VIS was unchanged in 1 patient, and no patients experienced visual deterioration. Other nonvisual complications, such as rhinoliquorrhea, venous infarction, and permanent anosmia, occurred in 3 patients. CONCLUSION: Despite the small number of patients, a high resection rate and favorable visual outcome support the suitability of this approach for resection of TSM.

scholarly journals Microsurgical Management of Tuberculum Sellae Meningiomas by the supraorbital keyhole eyebrow approach: Surgical Outcome

2017 ◽  
Vol 14 (3) ◽  
pp. 26-32
Author(s):  
Robin Bhattarai ◽  
Liang CaoFeng ◽  
Guo Ying
Keyword(s):  
Visual Acuity ◽  
Visual Fields ◽  
Visual Outcome ◽  
Skin Incision ◽  
Impairment Score ◽  
Eyebrow Incision ◽  
Tuberculum Sellae ◽  
The Mean

The aim of this study was to evaluate (surgical) visual outcomes in patients treated via supraorbital keyhole eyebrow incision approach. Data from 14 patients with TSMs (Tuberculum Sellae Meningioma) who underwent microsurgical treatment by a supraorbital keyhole eyebrow skin incision between September 2006 and September 2013 were retrospectively collected and analyzed. Patients were analyzed on the basis of clinical, radiological, and surgical factors that appeared to affect the outcome. To quantify the extent of ophthalmological disturbances Visual impairment score was used to analyze visual acuity and visual fields, which range from 0 (best) to 100 (worst). Change in visual function was assessed as the main outcome. The mean age of the 10 women and 4 men enrolled in the study was 56.50years (range, 42~74 years). The presenting symptom was asymmetrical visual loss in 71.4% of the patients.And examination revealed decreased visual acuity (Snellen notation) in 100% and impaired visual fields (Goldmann perimetry) in 58.3 % (7/12 cases, central scotoma and temporal anopia n=1, classical bitemporal hemianopia n=4, incongruent homonymous hemianopia n=2 , 2 cases data N/A) of the patients. Simpson grades I resection via a supraorbital keyhole eyebrow skin incision approach, were achieved in 100% of the patients. Quality of life was assessed according to Karnofsky scale and was 86.67 (range: 70~100). The mean follow-up duration was 51.73 months (range: 27~91 months).No recurrent tumors were observed during this period. According to the findings of this study, this approach provides a pleasing cosmetic outcome and also decreases brain manipulation while minimizing the likelihood of procedure-related morbidity. A favorable visual outcome was observed in most of the patients in the late postoperative period. Nepal Journal of Neuroscience, Volume 14, Number 3, 2017, page : 26-32

Fronto-basal interhemispheric approach for tuberculum sellae meningiomas; long-term visual outcome

2009 ◽  
Vol 23 (4) ◽  
pp. 422-430 ◽  
Author(s):  
Ahmed Ganna ◽  
Amir R. Dehdashti ◽  
Konstantina Karabatsou ◽  
Fred Gentili
Keyword(s):  
Visual Outcome ◽  
Interhemispheric Approach ◽  
Tuberculum Sellae

scholarly journals Early Post-operative Visual Outcome in Patient with Pituitary Adenoma

2013 ◽  
Vol 28 (2) ◽  
pp. 108-115
Author(s):  
Md Rezaul Amin ◽  
Haradhon Deb Nath ◽  
M Afzal Hossain ◽  
Kanak Kanti Barua
Keyword(s):  
Pituitary Adenoma ◽  
Visual Field ◽  
Visual Function ◽  
Tumor Resection ◽  
Visual Outcome ◽  
Visual Field Defects ◽  
Bivariate Analysis ◽  
P Value ◽  
Duration Of Symptoms ◽  
Visual Status

Background: Pituitary adenoma, which accounts for 17.4% of all brain tumors, is the third most frequently diagnosed brain tumor, following intracranial glioma and meningioma. The visual disturbance in pituitary adenoma ranged from blurring of vision with or without headache to total loss of vision. In patients with visual field defects, bitemporal hemianopia was the commonest visual field defect. Early improvement of visual function is one of the major indication surgery. Objective: The purpose of this study was to comparison between the pre and post-operative visual parameters and to find out the value in assessment of the prognosis of early postoperative visual function and also to find out the factor which influence the early post-operative visual outcome. Methods: A prospective study was done from September 2010 to April 2012 in the department of neurosurgery, Bangabandhu Sheikh Mujib Medical University, 30 cases of pituitary adenoma had been included in this study of those who were presented with visual symptoms. Visual assessment was done before the operation and outcome was analyzed at discharged from hospital. Results: Within 60 eyes, 13 (43.3%) patients presented with blindness of one or both eyes. 10 (33.3%) presented with uniocular and 3 (10.0%) presented with binocular blindness. Duration of the symptoms ranged from 2 months to 48 months. Patients underwent either transcranial or transsphenoidal tumor decompression. At discharge out of 30 patients, 23 (76.7%) showed improvement, 2 (6.6%) patients were deteriorated post-operatively. P value was <0.001, in z ‘test’, Z=91.5, which was highly significant. Post-operative visual status was analyzed with age, sex, duration of symptoms, suprasellar extension, and methods of surgery and extent of tumor resection to find out that any other factor influenced the visual outcome. In bivariate analysis it was shown that only duration of the symptoms only other factor that influenced the visual outcome (statistically significant, p value 0.017). Conclusion: With this study it was statistically proved that pre-operative visual status is the main factor for improvement of early post-operative visual outcome in pituitary adenoma and duration of symptoms had also influence the early post-operative visual outcome. Duration less than 12 months had a favorable outcome. DOI: http://dx.doi.org/10.3329/bjn.v28i2.17182 Bangladesh Journal of Neuroscience 2012; Vol. 28 (2): 108-115

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.

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

Ultrasonic bone curettage for optic canal unroofing and anterior clinoidectomy

2006 ◽  
Vol 104 (4) ◽  
pp. 621-624 ◽  
Author(s):  
Han Soo Chang ◽  
Masahiro Joko ◽  
Joon Suk Song ◽  
Kiyoshi Ito ◽  
Tatsushi Inoue ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Visual Outcome ◽  
Optic Canal ◽  
Internal Auditory Meatus ◽  
Major Morbidity ◽  
Anterior Clinoidectomy ◽  
Optic Nerve Damage ◽  
Bone Removal ◽  
Visual Status ◽  
Optic Canal Unroofing

✓Extradural unroofing of the optic canal and subsequent mobilization of the optic nerve is a useful technique in the surgical treatment of parasellar tumors; however, the drilling procedure itself is associated with the risk of optic nerve damage. A safer technique would certainly be beneficial. The ultrasonic bone curette is a device developed in Japan for safer bone removal. Its use in intradural anterior clinoidectomy and opening of the internal auditory meatus has been reported before. In this article the authors describe their experience in using this device for extradural unroofing of the optic canal in patients with parasellar tumors. Between March 2002 and November 2004, the aforementioned technique was used in the treatment of eight patients with parasellar tumors. After undertaking a frontotemporal craniotomy and orbital osteotomy, an ultrasonic bone curette was used to unroof the optic canal via an epidural approach; in five cases anterior clinoidectomy was added subsequently. Using an ultrasonic bone curette, unroofing of the optic canal was completed safely and required much less expertise than that required for standard drilling. The mortality and major morbidity rates were 0%. The visual function outcome was satisfactory, with the overall visual status improving in all seven patients in whom this symptom was present preoperatively. The ultrasonic bone curette makes the unroofing of the optic canal safer and easier, possibly improving the visual outcome of patients undergoing surgery for parasellar tumors.

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