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.

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.

Effect of the variability in implantation depth of intracorneal ring segments using the femtosecond laser technology in corneal ectasia

2019 ◽  
Vol 30 (4) ◽  
pp. 668-675
Author(s):  
Cristina Peris-Martínez ◽  
Cristina Dualde-Beltrán ◽  
Ester Fernández-López ◽  
Maria José Roig-Revert ◽  
Mikhail Hernández-Díaz ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Clinical Outcomes ◽  
Relative Depth ◽  
Laser Technology ◽  
Corneal Ectasia ◽  
Implantation Depth ◽  
Prospective Longitudinal ◽  
The Impact

Purpose: To analyze the impact of the depth of implantation of intracorneal ring segments on morphological, biomechanical, and clinical outcomes in ectatic corneas. Methods: This prospective longitudinal study enrolled 40 eyes of 29 patients (age 20–51 years) with corneal ectasia that underwent intracorneal ring segments implantation (KeraRing, Mediphacos). Changes in visual acuity, refraction, corneal tomography, and corneal biomechanics (Ocular Response Analyzer, Reichert) were evaluated during a 6 month follow-up. Likewise, changes in ring segment implantation depth measured by optical coherence tomography (Visante OCT, Carl Zeiss Meditec) were also evaluated. Results: Mean relative depth of implantation was 71.6 ± 5.8%, 71.5 ± 6.5%, and 71.9 ± 6.3% at 1, 3, and 6 months after surgery, respectively (p = 0.827). The difference between the real relative depth of implantation and the theoretical attempted value of 70% was not statistically significant (p = 0.072). Differences in spherical equivalent during the follow-up changed significantly depending on the level of relative depth of implantation (p = 0.036), with an increase of 0.114 D per each 1% increase in relative depth of implantation. Likewise, a decrease of –0.194 D in the steepest keratometric reading was found per each decrease of 1% in relative depth of implantation (p = 0.026). Changes in corneal thickness (p = 0.092) and biomechanics (p = 0.080) were not related to relative depth of implantation. Conclusion: The effect on visual acuity and refraction of intracorneal ring segments when implanted in corneal ectasia is less clinically relevant when the implantation is done at a very deep plane. The variability of the depth of intracorneal ring segments implantation when using femtosecond laser technology is minimal and with no clinically significant effect on clinical outcomes.

Efficacy of surgical treatment of traumatic cataract with simultaneous intraocular lens implantation in children

2013 ◽  
Vol 4 (1) ◽  
pp. 37-40
Author(s):  
Diloram Asrarovna Zakirkhodzhayeva
Keyword(s):  
Visual Acuity ◽  
Surgical Treatment ◽  
Early Postoperative Period ◽  
Eye Injury ◽  
Traumatic Cataract ◽  
Iol Implantation ◽  
Intraocular Injection ◽  
Lens Implantation ◽  
One Year

Background: eye injury is often accompanied by lens damage. Aim: To evaluate the efficacy of surgical treatment of traumatic cataract with simultaneous IOL implantation in children. Material and methods: The results of surgical treatment of traumatic cataract with simultaneous IOL implantation in 62 children were analyzed: in 48 boys (77.4%) and 14 girls (22.6%) with a mean age 8.1 years. Results: visual acuity after surgery gradually increased from 0.09 to 0.22 by the end of the first month, 0.43 in 6 months and 0.47 in one year of follow-up. In 85.5% of the operated children visual acuity in the late post-op period was accounted 0.3–1.0, and in 82.2% of cases binocular vision was recovered. In the early postoperative period following complications were observed: exudative iridocyclitis — 16.1%; deposits of fibrin in the pupil — 8%; pigment deposits on surface of the IOL — 19%; secondary cataract — 12%; IOL or its haptics dislocation — 3% cases. Conclusions: Early IOL implantation during traumatic cataract surgery in children is suitable. Use of viscoelastics allows minimizing the severity of postoperative inflammation and reducing a risk of complications. Intraocular injection of Gemasa during surgery is effective to resolve hyphema, intraocular hemorrhages and fibrinoid exudate.

scholarly journals Effect of Cap-Lenticule Diameter Difference on the Visual Outcome and Higher-Order Aberrations in SMILE: 0.4 mm versus 1.0 mm

2017 ◽  
Vol 2017 ◽  
pp. 1-7
Author(s):  
Banu Torun Acar ◽  
Suphi Acar
Keyword(s):  
Visual Acuity ◽  
Visual Outcome ◽  
Higher Order ◽  
Early Postoperative Period ◽  
Higher Order Aberrations ◽  
Corrected Distance Visual Acuity ◽  
Lenticule Extraction ◽  
Group 2 ◽  
Group 1

Purpose. To evaluate the effect of cap-lenticule diameter difference (CLDD) on the visual outcome and higher-order aberrations (HOAs) of small-incision lenticule extraction (SMILE). Methods. A total of 132 patients who had bilateral SMILE for myopia or myopic astigmatism were included. The CLDD was 0.4 mm in 54 patients (group 1) and 1.0 mm in 78 patients (group 2). The refractive parameters, uncorrected (UDVA) and corrected distance visual acuity (CDVA), and HOAs were determined preoperatively and during six months follow-up. Results. Group 1 had better CDVA (in logMAR) compared to group 2 at day 1 (−0.07 ± 0.07 versus 0.04 ± 0.07, resp.; p<0.001) and week 1 (−0.07 ± 0.07 versus –0.04 ± 0.07, resp.; p=0.001). The visual acuity improved more in group 1 than in group 2. The UDVA (in logMAR) was 0.07 ± 0.07 and 0.29 ± 0.09 at day 1 (p<0.001) and −0.08 ± 0.07 and −0.06 ± 0.06 at six months (p=0.038) in group 1 and group 2, respectively. Group 1 was associated with significantly less induction of HOAs (0.24 ± 0.08 μm and 0.32 ± 0.26 μm, resp.; p=0.002). Conclusions. In SMILE, 0.4 mm CLDD is associated with better visual outcome and less induction of HOAs than 1.0 mm. Narrow CLDD should be considered in SMILE to increase the visual acuity particularly in the early postoperative period.

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 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

Endoscopic endonasal and transorbital approaches to petrous apex lesions

2021 ◽  
pp. 1-10
Author(s):  
Won Jae Lee ◽  
Sang Duk Hong ◽  
Kyung In Woo ◽  
Ho Jun Seol ◽  
Jung Won Choi ◽  
...  
Keyword(s):  
Demographic Data ◽  
Csf Leak ◽  
Petrous Apex ◽  
Mr Images ◽  
Lateral Direction ◽  
Endoscopic Endonasal ◽  
Complete Obliteration ◽  
Superior Portion ◽  
Surgical Corridor

OBJECTIVE The petrous apex (PA) is one of the most challenging areas in skull base surgery because it is surrounded by numerous critical neurovascular structures. The authors analyzed the clinical outcomes of patients who underwent endoscopic endonasal approach (EEA) and transorbital approach (TOA) procedures for lesions involving PA to determine the perspectives and proper applications of these two approaches. METHODS The authors included patients younger than 80 years with lesions involving PA who were treated between May 2015 and December 2019 and had regular follow-up MR images available for analysis. Patients with meningioma involving petroclival regions were excluded. The authors classified PA into three regions: superior to the petrous segment of the internal carotid artery (p-ICA) (zone 1); posterior to p-ICA (zone 2); and inferior to p-ICA (zone 3). Demographic data, preoperative clinical and radiological findings, surgical outcomes, and morbidities were reviewed. RESULTS A total of 19 patients with lesions involving PA were included. Ten patients had malignant tumor (chondrosarcoma, chordoma, and osteosarcoma), and 6 had benign tumor (schwannoma, Cushing’s disease, teratoma, etc.). Three patients had PA cephalocele (PAC). Thirteen patients underwent EEA, and 5 underwent TOA. Simultaneous combined EEA and TOA was performed on 1 patient. Thirteen of 16 patients (81.3%) had gross- or near-total resection. Tumors within PA were completely resected from 13 of 16 patients using a view limited to only the PA. Complete obliteration of PAC was achieved in all patients. Postoperative complications included 2 cases of CSF leak, 1 case of injury to ICA, 1 fatality due to sudden herniation of the brainstem, and 1 case of postoperative diplopia. CONCLUSIONS EEA is a versatile surgical approach for lesions involving all three zones of PA. Clival tumor spreading to PA in a medial-to-lateral direction is a good indication for EEA. TOA provided a direct surgical corridor to the superior portion of PA (zone 1). Patients with disease with cystic nature are good candidates for TOA. TOA may be a reasonable alternative surgical treatment for select pathologies involving PA.

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.

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.

Sign in / Sign up

Export Citation Format

Share Document