Article
Surgical strategy for tuberculum sellae meningioma after introduction of extended transsphenoidal approach
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Authors
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K. Maruyama
- Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan
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R. Yamaguchi
- Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan
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A. Noguchi
- Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan
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A.Y. Shiokawa
- Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan
| Published: | June 4, 2012 |
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Outline
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Objective: Surgical approach for tuberculum sellae meningiomas includes interhemispheric approach (IA), pterional approach (PA), and extended transsphenoidal approach (ETA), which was recently introduced in our institute. The risk and benefit of each approach have to be clarified.
Methods: Out of 176 meningiomas removed in our institute in the past 17 year period, 21 tuberculum sellae meningiomas were treated with direct surgical approaches. Patient age ranged from 34 to 72 years (mean 56 years). Treatment results according to the surgical approaches were analyzed. After the introduction of ETA, surgical approach was decided by judiciously considering the merit and defect of ETA.
Results: Selected surgical approach was IH in 8 patients, PA in 11, and ETA in 2. IA was mainly selected for relatively large tumors because it provided wide working space. PA was mainly performed for laterally located tumors from the side of worse visual function in 6 patients and better function in 3. ETA was selected for relatively small tumors located between the bilateral internal carotid arteries. Water-tight suture of the dura to prevent leakage of cerebrospinal fluid needed special surgical skills because of a deep and limited working space, and extensive removal of dural attachment was difficult. However, ETA was beneficial because it enabled wide opening of the bilateral optic canals and direct visualization of the tumor interfaces below the optic nerves. The rate of visual function improvement was the highest in ETA, followed by IA>PA, whereas the rate of Simpson grade I or II removal was the highest in IA, followed by ETA>PA. The rate of complication other than visual function was the highest in ETA, followed by IA>PA.
Conclusions: ETA might be an effective approach for relatively small tuberculum sellae meningiomas between the bilateral internal carotid arteries if water-tight dural closure is secured. Larger tumors would be better removed via IA in midline location or via PA in off-midline location after careful consideration of the laterality of visual function.
