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Ahmed Mohyeldin, Jayakar V. Nayak and Juan C. Fernandez-Miranda

Transcript Here we present the case of a large, challenging tuberculum sella meningioma resected via an endoscopic endonasal approach. This is a case of a 24-year-old female who presented with progressive visual decline, and an MRI revealed a large meningioma compressing her optic chiasm. Preoperative visual field testing revealed minimal to no light perception in the left eye and severe compression of the optic chiasm, that revealed a right eye peripheral visual field loss (0:50). 0:53 A preoperative CT angiogram helped us create and simulate a three

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Georgios Klironomos and Amir R. Dehdashti

Tuberculum sella meningiomas can be approached through lateral approaches including pterional/orbitozygomatic craniotomies, frontobasal craniotomy, or through expanded endoscopic transsphenoidal approaches. The authors present the case of a 60-year-old male who presented with bitemporal hemianopia and significant right-side visual acuity compromise due to a large tuberculum sella meningioma. The tumor had an important extension to the posterior fossa. A right orbitozygomatic trans-sylvian approach was deemed most suitable to tackle the posterior extension of the tumor. Some operative nuances are detailed in the video including dissection of the tumor off the carotid artery, basilar bifurcation, and small thalamoperforators attached to the tumor. Postoperatively, the patient’s bilateral hemianopia improved significantly, but his right visual activity remained unchanged. The remaining part of the tumor in the sella and midclivus was addressed with a second-stage expanded endoscopic transclival approach.

The video can be found here: https://youtu.be/KbewhlT2FWs.

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Joao Paulo Almeida and Fred Gentili

TO THE EDITOR: We read with great interest the article by Magill et al. 5 ( Magill ST, Morshed RA, Lucas CHG, et al: Tuberculum sellae meningiomas: grading scale to assess surgical outcomes using the transcranial versus transsphenoidal approach. Neurosurg Focus 44(4): E9, April 2018 ). We would like to congratulate the authors for their efforts in addressing the issue of tuberculum sella meningiomas, which is of interest to all those dealing with this challenging entity. The decision-making process for the treatment of skull base meningiomas is complex and

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Beth A. Gibbons, William R. Miele, Jeffrey E. Florman, Carl B. Heilman and Michael A. Horgan

the sphenoid, maxillary, and ethmoid sinuses. In our series the most frequently affected sinus was the sphenoid sinus. The most common locations of meningiomas in this series were the planum sphenoidale and tuberculum sellae. This finding may represent a selection bias, as practitioners without expertise in skull base tumor resection often refer patients with planum sphenoidale and tuberculum sella meningiomas to our centers for evaluation and treatment. Patients will frequently present with symptoms of changes in facial contours, pain in the affected area

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F. Karl Gregorius, Robert S. Hepler and W. Eugene Stern

of the meninges in the region of the pituitary body, pressing on the chiasm. Ann Ophthalmol 6: 15–16, 1897 16. Weyand RD : Olfactory groove and tuberculum sella meningiomas. University of Minnesota, Masters , Thesis , 1951 Weyand RD: Olfactory groove and tuberculum sella meningiomas. University of Minnesota, Masters Thesis, 1951

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Kurtis I. Auguste and Michael W. McDermott

lt pst temporal radiation necrosis lt TO 44 no S. aureus yes 2 4 42, F recurrent lt frontal glioma lt frontal 98 yes P. acnes no 1 5 56, M recurrent GBM rt FT 33 yes S. epidermidis no 17 6 42, M recurrent rt frontal meningioma rt frontal 171 yes Corynebacterium sp. yes 22 7 55, F tuberculum sella meningioma extended bifrontal 55 yes S. aureus no 3 8 38, F falcotentorial meningioma occipital 29 yes Enterococcus sp. & S. epidermidis no 21 9 45, F

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Brian J. Dlouhy, Michael P. Chae and Charles Teo

12 Figueiredo EG , Deshmukh V , Nakaji P , Deshmukh P , Crusius MU , Crawford N , : An anatomical evaluation of the mini-supraorbital approach and comparison with standard craniotomies . Neurosurgery 59 : 4 Suppl 2 ONS212 – ONS220 , 2006 13 Fries G , Perneczky A : Endoscope-assisted brain surgery: part 2—analysis of 380 procedures . Neurosurgery 42 : 226 – 232 , 1998 14 Hayhurst C , Teo C : Tuberculum sella meningioma . Otolaryngol Clin North Am 44 : 953 – 963 , viii – ix , 2011 15 Hernesniemi J , Ishii K

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Ali Tayebi Meybodi, Leandro Borba Moreira, Michael T. Lawton, Jennifer M. Eschbacher, Evgenii G. Belykh, Michelle M. Felicella and Mark C. Preul

anatomical information. This relationship is important to consider while performing surgical exploration of the optic canal for various pathologies such as tuberculum sella meningiomas extending into the optic canal or paraclinoid aneurysms. Of note, the use of the term “interdural” for the intracanalicular course of the OphA should not be confused with the interdural (i.e., clinoidal) segment of the ICA between the proximal dural ring and the DDR. Several previous studies have described the OphA as piercing the ONDS and accompanying the optic nerve within the optic

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Huy Q. Truong, Edinson Najera, Robert Zanabria-Ortiz, Emrah Celtikci, Xicai Sun, Hamid Borghei-Razavi, Paul A. Gardner and Juan C. Fernandez-Miranda

. = descending; Inf. = infundibular; Opt. = optic; PS = pituitary stalk. Figure is available in color online only. Case 2: Posterior Displacement: Tuberculum Sella Meningioma A 43-year-old male was incidentally diagnosed with a sellar tumor during a workup following a minor head trauma. Further physical examination revealed a mild temporal hemianopia in the left eye. Magnetic resonance imaging showed a homogeneously enhancing, extraaxial lesion in the prechiasmatic cistern, compressing the left optic nerve. An endoscopic endonasal transsellar-transtuberculum approach was

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Walid I. Essayed, Prashin Unadkat, Ahmed Hosny, Sarah Frisken, Marcio S. Rassi, Srinivasan Mukundan Jr., James C. Weaver, Ossama Al-Mefty, Alexandra J. Golby and Ian F. Dunn

endoscopic transsphenoidal resection of tuberculum sella meningioma with anterior cerebral artery encasement . Cureus 7 : e311 , 2015 26430585 11 Eloy JA , Shukla PA , Choudhry OJ , Singh R , Liu JK : Challenges and surgical nuances in reconstruction of large planum sphenoidale tuberculum sellae defects after endoscopic endonasal resection of parasellar skull base tumors . Laryngoscope 123 : 1353 – 1360 , 2013 23483459 10.1002/lary.23766 12 Essayed WI , Singh H , Lapadula G , Almodovar-Mercado GJ , Anand VK , Schwartz TH