scholarly journals Tuberculum Sellae Meningiomas: Outcome of Twenty-eight Cases after Surgery

2020 ◽  
Vol 10 (1) ◽  
pp. 39-44
Author(s):  
Md Atikur Rahman ◽  
Nwoshin Jahan ◽  
Mohammad Shahnawaz Bari ◽  
Pijush Kanti Mitra ◽  
Ahsan Mohammad Hafiz ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Tumour Size ◽  
Pterional Approach ◽  
Total Resection ◽  
Anterior Clinoid Process ◽  
Postoperative Visual Acuity ◽  
Tuberculum Sellae ◽  
Planum Sphenoidale ◽  
Negative Predictor

Objective: To present this series of surgically treated tuberculum sellae meningiomas with particular regard to visual compromises Methods: A retrospective analysis was done on 28 patients (21 females) with meningiomas originating from the tuberculum sellae who underwent surgery between 2010 and 2019. The standard surgical approach of pterional craniotomy. Twelve meningiomas extended posteriorly onto the diaphragma sellae, 13 anteriorly to the planum sphenoidale, and 3 to the anterior clinoid process. 21 tumours involved the optic canal, one bilaterally. Follow up ranged from 6 to 12 months. Results: Total microscopic resection was achieved in 28 patients. Median tumour size was 3.2 cm. Postoperatively, visual acuity improved in 19 patients and deteriorated 3. Preoperative and postoperative visual acuity worsened with increasing duration of preoperative symptoms and with increasing age. Extension into the intraconal space was a negative predictor. Recurrence occurred in one cases. One patients died from causes unrelated to the tumour. Conclusions: In the majority of patients with tuberculum sellae meningiomas, total resection may be achieved through a pterional approach with minimal complications. Bang. J Neurosurgery 2020; 10(1): 39-44

scholarly journals The extended pterional approach allows excellent results for removal of anterior cranial fossa meningiomas

2016 ◽  
Vol 74 (5) ◽  
pp. 382-387 ◽  
Author(s):  
Jose Carlos Lynch ◽  
Mariangela Barbi Gonçalves ◽  
Celestino Esteves Pereira ◽  
Wladimir Melo ◽  
Gianni Ferraz Temponi
Keyword(s):  
Anterior Cranial Fossa ◽  
Surgical Mortality ◽  
Imaging Studies ◽  
Total Removal ◽  
Pterional Approach ◽  
Total Resection ◽  
Operative Strategy ◽  
Cranial Fossa ◽  
Tuberculum Sellae

ABSTRACT Objective To describe a unique operative strategy, instead the classical pterional approach, and to analyses it safety and effectiveness for removal of anterior cranial fossa meningiomas. Method We identify 38 patients with tuberculum sellae and olphactory groove meningiomas operated between 1986 and 2013. Medical charts, operative reports, imaging studies and clinical follow-up evaluations were reviewed and analyzed retrospectively. The pterional craniotomy is extended toward the frontal bone providing access through the subfrontal route, besides the usual anterolateral view provided by the classical pterional approach. Results Surgical mortality occurred in one patient (2.6%). Gross total resection was achieved in 27 patients (86.8%). Median time of follow-up was 69.4 months. Conclusion The extended pterional approach allows excellent results. Total removal of meningiomas of the anterior cranial fossa was obtained in 86.8 % of patients, with low morbidity and mortality.

Sphenoorbital meningioma: surgical technique and outcome

2011 ◽  
Vol 114 (5) ◽  
pp. 1241-1249 ◽  
Author(s):  
Soichi Oya ◽  
Burak Sade ◽  
Joung H. Lee
Keyword(s):  
Surgical Technique ◽  
Visual Outcome ◽  
Sphenoid Bone ◽  
Wide Resection ◽  
Tumor Control ◽  
Subtotal Resection ◽  
Total Resection ◽  
Anterior Clinoid Process ◽  
Orbital Wall

Object The aim of this study was to describe the surgical technique used for removal of sphenoorbital meningiomas in the authors' practice and to review the operative outcome. Methods Review of the senior author's practice between 1994 and 2009 revealed 39 patients (mean age 48 years) eligible for this study. Clinical presentation, surgical technique, postoperative outcome, and follow-up data are presented. Surgical technique is detailed, with an emphasis on aggressive removal consisting of drilling of the hypertrophied sphenoid bone, orbital wall, and anterior clinoid process, followed by tumor removal and a wide resection of the involved dura. A simple dural closure without reconstruction of the orbital roof or the lateral wall of the orbit is also described. Results Gross-total resection was achieved in 15 cases (38.5%), near-total resection with small residual in the cavernous sinus or periorbita in 20 cases (51.3%), and subtotal resection in 4 cases (10.3%). Postoperative complications included trigeminal hypesthesia in 9 patients, oculomotor palsy in 3 patients, and seizure in 2 patients. Seven patients had recurrence within the mean follow-up period of 40.7 months. Preoperative visual deficits were present in 21 patients (53.8%). Of these, 14 (66.7%) experienced visual recovery to normal levels postoperatively. Statistical analyses revealed preoperative severe visual deficit and sphenoid bone hypertrophy as an independent risk factor and an independent favorable factor, respectively, for a favorable visual outcome. Proptosis was resolved (≤ 2 mm) in 73.5% of the authors' patients. No patient had postoperative enophthalmos. Conclusions In the authors' practice, surgery for sphenoorbital meningiomas consists of resection of the orbital/sphenoid intraosseous, intraorbital, and intradural tumor components. The authors believe that aggressive removal of the orbital/sphenoid intraosseous tumor is critical for a favorable visual outcome and tumor control. Furthermore, satisfactory cosmetic results can be achieved with simple reconstruction techniques as described.

Factors Influencing Visual Outcome after Penetrating Keratoplasty Combined with Intraocular Lens Implantation

2003 ◽  
Vol 13 (2) ◽  
pp. 134-138 ◽  
Author(s):  
J.B. Jonas ◽  
R.M. Rank ◽  
W.M. Budde ◽  
G. Sauder
Keyword(s):  
Visual Acuity ◽  
Intraocular Lens ◽  
Penetrating Keratoplasty ◽  
Visual Outcome ◽  
Intraocular Lens Implantation ◽  
Postoperative Visual Acuity ◽  
Factors Influencing ◽  
Lens Implantation ◽  
Preoperative Visual Acuity

Purpose To establish which factors influence visual outcome after penetrating keratoplasty combined with intraocular lens implantation. Methods This retrospective noncomparative clinical interventional case series study included 135 consecutive patients (mean age 70.2 ± 13.6 years) who underwent central penetrating allogenic keratoplasty combined with intraocular lens (IOL) implantation, all operated by the same surgeon. There were 79 triple procedures, 33 keratoplasties combined with an exchange of IOL, and 23 penetrating keratoplasties combined with a secondary implantation of a posterior chamber lens. Mean follow-up was 28.3 ± 18.7 months (range 3.3–112 months). Reasons for keratoplasty were herpetic or traumatic corneal scars or defects (46), Fuchs corneal endothelial dystrophy (22), pseudophakic or aphakic bullous keratopathy (49), corneal endothelial decompensation due to other reasons (15), and keratoconus (3). Main outcome measures were postoperative visual acuity and gain in visual acuity. Results Mean postoperative visual acuity and mean gain in visual acuity were 0.33 ± 0.21 (median 0.30) and 0.25 ± 0.20 (median 0.20), respectively. Compared with the preoperative measurements, mean visual acuity increased in 129 patients (129/135, 95.6%). Factors influencing postoperative visual outcome and gain in visual acuity were preoperative visual acuity (p<0.005), reason for keratoplasty (p<0.005), and diameter of the graft (p = 0.046). Postoperative visual outcome was independent of age, sex, right or left eye, presence of diabetes mellitus, preoperative refractive error, length of follow-up, duration of surgery, and preoperative intraocular pressure. Conclusions The most important factors influencing visual outcome after central penetrating allogenic keratoplasty combined with IOL surgery are preoperative visual acuity, graft size, and reason for keratoplasty. Other factors such as age, sex, diabetes mellitus, and preoperative refractive error do not substantially influence postoperative visual outcome.

Surgical anatomy of the juxta—dural ring area

1998 ◽  
Vol 89 (2) ◽  
pp. 250-254 ◽  
Author(s):  
Susumu Oikawa ◽  
Kazuhiko Kyoshima ◽  
Shigeaki Kobayashi
Keyword(s):  
Surgical Anatomy ◽  
Lateral View ◽  
Horizontal Line ◽  
Anterior Clinoid Process ◽  
Lateral Projection ◽  
Content Type ◽  
Medial Side ◽  
Tuberculum Sellae ◽  
Planum Sphenoidale ◽  
Fine Print

Object. The authors report on the surgical anatomy of the juxta—dural ring area of the internal carotid artery to add to the information available about this important structure. Methods. Twenty sides of cadaver specimens were used in this study. The plane of the dural ring was found to incline in the posteromedial direction. Medial inclination was measured at 21.8° on average against the horizontal line in the anteroposterior view on radiographic studies. Posterior inclination was measured at 20.3° against the planum sphenoidale in the lateral projection, and the medial edge of the dural ring was located 0.4 mm above the tuberculum sellae in the same projection. The lateral edge of the dural ring was located 1.4 mm below the superior border of the anterior clinoid process. The carotid cave was situated at the medial or posteromedial aspect of the dural ring; however, two of the 20 specimens showed no cave formation. The carotid cave contained the subarachnoid space in 13 sides, the arachnoid membrane only in three sides, and the extraarachnoid space in two sides. The authors propose that the marker of the medial side of the dural ring, which is more proximal than the lateral, is the tuberculum sellae in the lateral view on radiographic studies. In the medial aspect of the dural ring the intradural space can be situated below the level of the tuberculum sellae because of the existence of the carotid cave. Conclusions. An aneurysm arising from the medial side of the juxta—dural ring area even below the tuberculum sellae is a potential cause of subarachnoid hemorrhage.

scholarly journals Surgical Techniques and the Choice of Operative Approach for Cranioorbital Lesions

2019 ◽  
Vol 81 (06) ◽  
pp. 686-693
Author(s):  
Haiyong He ◽  
Meiqin Cai ◽  
Manting Li ◽  
Lei Wei ◽  
Lun Luo ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Optic Nerve ◽  
Minimally Invasive ◽  
Surgical Techniques ◽  
Surgical Approaches ◽  
Modified Rankin Scale ◽  
Pterional Approach ◽  
Total Resection ◽  
Significant Difference

Abstract Objectives Cranioorbital lesions present a great challenge for neurosurgeons and ophthalmologists. There is no consensus on the choice of surgical approach. The aims of this study were to investigate 49 cases of cranioorbital lesions and evaluate surgical approaches and outcomes. Patients and Methods A retrospective study was done on 49 patients (51 operations) from 2009 to 2018. Information about the lesion was used to decide whether the supraorbital eyebrow approach (SEA) or pterional approach (PA) was performed. Results Twenty-eight patients had surgical resection using SEA, 21 patients received PA, each group included one case of recurrence, who underwent reoperation via the same approach. SEA provided better cosmetic satisfaction, and a shorter incision than PA (p < 0.05). There was no significant difference in total resection rates, visual outcomes, recovery of ptosis, and other new surgical-related complications between SEA group and PA group (p > 0.05). Forty-nine cases of proptosis (94.1%, 49/51) were improved. Thirty-three patients (33/37, 89.2%) who underwent follow-up for longer than 12 weeks had a modified Rankin Scale (mRS) score ≤ 3. Conclusion Surgery is the preferred treatment for cranioorbital lesions, but total resection is difficult. SEA may be a more minimally invasive option for some more limited lesions superior to optic nerve. PA may be more reasonable for the lesion with obvious hyperostosis and more extensive lesions.

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

scholarly journals Extended Pterional Approach for Medial Sphenoid Wing Meningioma: A Series of 47 Patients

2019 ◽  
Vol 81 (02) ◽  
pp. 107-113
Author(s):  
Jose Carlos Lynch ◽  
Celestino Esteves Pereira ◽  
Mariangela Gonçalves ◽  
Nelci Zanon
Keyword(s):  
Gross Total Resection ◽  
Surgical Mortality ◽  
Median Length ◽  
Pterional Approach ◽  
Total Resection ◽  
Operative Strategy ◽  
Imaging Results ◽  
Sphenoid Wing Meningioma

Abstract Background To describe our operative strategy and analyze its safety and effectiveness for the removal of medial sphenoid wing meningiomas (MSWMs) through the extended pterional approach. Method We identified 47 patients with MSWMs who were operated using this approach between 1986 and 2016. Medical charts, operative reports, imaging results, and clinical follow-up evaluations were reviewed and retrospectively analyzed. Results No surgical mortality was observed in this sample. Gross total resection was achieved in 30 (63.8%) patients. Intradural clinoidectomy was performed in 16 (34%) patients. The median length of follow-up was 8.5 years (range, 1–30 years). Conclusion The extended pterional approach associated with microsurgery techniques provided excellent results for the removal of MSWMs.

scholarly journals Vitreous Hemorrhage in Pediatric Age Group

2014 ◽  
Vol 2014 ◽  
pp. 1-12 ◽  
Author(s):  
Dora H. AlHarkan ◽  
Eman S. Kahtani ◽  
Priscilla W. Gikandi ◽  
Ahmed M. Abu El-Asrar
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Vitreous Hemorrhage ◽  
Visual Outcome ◽  
Age Group ◽  
Pediatric Age ◽  
Pediatric Age Group ◽  
Good Visual Outcome ◽  
Negative Predictor

Purpose.To identify and study causes of vitreous hemorrhage (VH) in pediatric age group and to investigate factors predicting visual and anatomical outcomes.Procedure.A retrospective review of patients aged 16 years or less with the diagnosis of vitreous hemorrhage from January 2005 until December 2010.Results.A total number of 230 patients (240 eyes) were identified. Traumatic vitreous hemorrhage accounted for 82.5%. In cases of accidental trauma, final visual acuity of 20/200 was significantly associated with visual acuity of ≥20/200 at presentation and the absence of retinal detachment at last follow-up. Patients with nontraumatic vitreous hemorrhage were significantly younger with higher rates of enucleation/evisceration/exenteration and retinal detachment at last follow-up compared to traumatic cases.Conclusion.Trauma is the most common cause of VH in pediatric age group. In this group, initial visual acuity was the most important predictor for visual outcome, and the presence of retinal detachment is a negative predictor for final good visual outcome. The outcome is significantly worse in nontraumatic cases compared to traumatic cases.

scholarly journals Visual Acuity Outcomes after Phacoemulsification in Eyes with Good Visual Acuity before Cataract Surgery

2021 ◽  
Author(s):  
Nikolaos Dervenis ◽  
Anna Praidou ◽  
Panagiotis Dervenis ◽  
Dimitrios Chiras ◽  
Brian Little
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Exclusion Criteria ◽  
Related Factors ◽  
Postoperative Visual Acuity ◽  
Good Visual Acuity ◽  
Snellen Visual Acuity ◽  
Vitreous Loss ◽  
Surgery Outcomes

Abstract Objective: To analyze cataract surgery outcomes and related factors in eyes presenting with good visual acuity. Subject and Methods: Retrospective longitudinal of patients undergoing phacoemulsification between the years 2014-2018 in Moorfields Eye Hospital and satellite units. Pre- and postoperative visual acuity (unaided, with glasses, with pinhole) were analyzed. Inclusion criteria were age≥40 years and pinhole visual acuity ≥6/9 preoperatively. Exclusion criteria were no postoperative visual acuity data. VA change variable was also defined according to postoperative visual acuity being above or below the Snellen 6/9 threshold. Results: 2720 eyes were included in the analysis. The unaided LogMAR visual acuity improved from 0.54 to 0.20 (p<0.001), the LogMAR visual acuity with glasses improved from 0.35 to 0.05(p<0.001) and the LogMAR pinhole visual acuity improved from 0.17 to 0.13(p<0.001). 8.1% of patients had Snellen visual acuity <6/9 postoperatively. Mean follow up period was 23,6±9.9 days. In multivariate logistic regression, factors associated with visual acuity <6/9 postoperatively were: age [OR=0.96, 95% CI (0.95, 0.98), p<0.001], vitreous loss [OR=0.21, 95% CI (0.08, 0.56), p=0.002] and iris trauma [OR=0.28, 95% CI (0.10, 0.82) p=0.02]. No significant adverse events occurred. Conclusions: Visual acuity improved significantly overall in this group of patients, although at least 8.1% of them did not reach their pinhole preoperative visual acuity. Worse visual acuity outcomes were associated with increasing age, vitreous loss and iris trauma. The 6/9 vision threshold may not be able to accurately differentiate those who may benefit from cataract surgery and those who may not.

scholarly journals Factors correlated with visual outcomes at two and four years after vitreous surgery for proliferative diabetic retinopathy

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244281
Author(s):  
Katsuhiro Nishi ◽  
Koichi Nishitsuka ◽  
Teiko Yamamoto ◽  
Hidetoshi Yamashita
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Vitreous Hemorrhage ◽  
Severe Case ◽  
Vitreous Surgery ◽  
Data Set ◽  
Postoperative Visual Acuity ◽  
Treatment Provision

Proliferative diabetic retinopathy (PDR) is the most severe case of diabetic retinopathy that can cause visual impairment. This study aimed to reveal the factors correlated with better postoperative visual acuity after a long follow-up in patients who underwent vitrectomy for PDR. We retrospectively analyzed the data set including systemic findings, ocular findings, and surgical factors from registered patients who could be completely followed up for 2 or 4 years after vitrectomy. We ultimately enrolled 128 eyes from 100 patients who underwent vitrectomy for PDR between January 2008 and September 2012 and were followed up for >2 years. Among them, 91 eyes from 70 patients could be followed up for 4 years. Factors related to the postoperative visual acuity of ≥20/40 and ≥20/30 after 2 and 4 years were investigated by logistic regression analysis. Better postoperative visual acuity correlated with the following factors: no rubeosis iridis ([≥20/40 at 2 years; odds ratio {OR}, 0.068; 95% confidence interval {CI}, 0.012–0.39; P = 0.003], [≥20/30 at 2 years; OR, 0.07; 95% CI, 0.01–0.40; P = 0.03], [≥20/30 at 4 years; OR, 0.078; 95% CI, 0.006–0.96; P = 0.04]), no fibrovascular membrane [(≥20/40 at 2 years; OR, 0.22; 95% CI, 0.061–0.81; P = 0.02), (≥20/40 at 4 years; OR, 0.26; 95% CI, 0.07–0.94; P = 0.04), (≥20/30 at 4 years; OR, 0.14; 95% CI, 0.04–0.52; P = 0.004)], existing vitreous hemorrhage (≥20/30 at 2 years; OR, 9.55; 95% CI, 1.03–95.27; P = 0.04), and no reoperation ([≥20/40 at 4 years; OR, 0.15; 95% CI, 0.03–0.78; P = 0.02], [≥20/30 at 4 years; OR, 0.06; 95% CI, 0.07–0.54; P = 0.01]). Treatment provision before disease severity and treatment without complications were associated with good postoperative visual acuity.

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