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John H. Chi and Michael W. McDermott

Tuberculum sellae meningiomas are a classic tumor of the anterior fossa that present in patients with gradual visual deterioration secondary to optic apparatus compression. If untreated, complete blindness can occur. Treatment involves tumor removal and decompression of the optic chiasm via several operative approaches. Gross-total resection (Simpson Grade I or II) is the goal of treatment and can usually be accomplished safely. Special excision-related considerations include appreciation of arachnoid planes separating the tumor from neural tissue, adequate drilling of osseous elements for optimal exposure, and intraoperative preservation of the vascular supply to the optic apparatus. The authors reviewed their experience at the University of California, San Francisco, in cases of tuberculum sellae meningiomas treated between 1992 and 2002. In most patients, improvement of vision can be achieved with minimal postoperative complications and morbidity.

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Sophie Curey, Stéphane Derrey, Pierre Hannequin, Didier Hannequin, Pierre Fréger, Marc Muraine, Hélène Castel and François Proust

T he tuberculum sellae, a transversal bony prominence between the middle clinoid processes, separates the chiasmatic sulcus from the anterior wall of the pituitary fossa. 28 Tuberculum sellae meningiomas arise from the dural midline over the tuberculum sellae, chiasmatic sulcus, and limbus sphenoidale, 2 , 13 , 16 , 18 , 23 , 30 , 35 and account for 10% of all intracranial meningiomas. The narrow anatomical relationship between this area and the optic tractus explains the early visual disturbances secondary to the displacement of the optic chiasm and

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Isao Chokyu, Takeo Goto, Kenichi Ishibashi, Takashi Nagata and Kenji Ohata

T uberculum sellae meningiomas represent 5%–10% of intracranial meningiomas. 1 , 8 Complete removal is the optimal goal to prevent recurrence. However, treating this tumor is still challenging because of the high risk of visual pathway involvement and internal carotid artery (ICA) encasement and cavernous sinus infiltration. Various surgical approaches have been advocated to resect tuberculum sellae meningiomas. The unilateral or bilateral subfrontal approach was often selected in earlier microsurgical cases. 2 , 24 , 25 The advantage of this approach is that

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Masahiro Ogino, Masashi Nakatsukasa, Toru Nakagawa and Ikuro Murase

never been reported. We report on an elderly patient who experienced SAH from a ruptured anterior communicating artery (ACoA) aneurysm completely encased in a meningioma in the tuberculum sellae. Case Report History This 70-year-old woman presented at the cardiology outpatient clinic in our hospital with sudden onset of a bifrontal pulsative headache and nausea. She experienced no disturbance of consciousness, cranial nerve abnormalities, motor paresis, or sensory impairment. Emergency computerized tomography (CT) scanning disclosed SAH and she was referred to our

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Anil Nanda, Sudheer Ambekar, Vijayakumar Javalkar and Mayur Sharma

M eningiomas arising from the anterior cranial fossa floor constitute approximately 40% of all intracranial meningiomas, and tuberculum sellae meningiomas (TSMs) constitute approximately 25% of these tumors. 11 They originate primarily from dura of the tuberculum sellae, chiasmatic sulcus, and limbus sphenoidale. Surgical excision of these tumors is a challenging endeavor due to the close association of the tumor with critical neurovascular structures such as the internal carotid artery (ICA), the anterior cerebral artery, anterior communicating artery

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Masahiko Kitano, Mamoru Taneda and Yuzo Nakao

sinus is achieved by extension of the upper part of the surgical field after a posterior ethmoidectomy. 7 , 28 Removal of the tuberculum sellae and the planum sphenoidale makes it possible to reach the suprasellar space. Suprasellar meningiomas include those that arise from the tuberculum sellae, the planum sphenoidale, and the diaphragma sellae. Meningiomas originating from the tuberculum sellae commonly extend into the optic canal, and visual loss in an affected eye is the initial and most common symptom. Residual tumor in the optic canal may be the site of

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Christian A. Bowers, Tamer Altay and William T. Couldwell

require sharp dissection rather than simple suctioning for their removal. 14 Various approaches to the tuberculum sellae region have been used for resection. 11 Traditionally, a variety of craniotomies (pterional, unilateral subfrontal, bilateral subfrontal, and so forth) have been used in an attempt to find the most direct route to this region with the fewest potential complications or anatomical limitations. 5 While transsphenoidal surgery for pituitary adenomas has been practiced successfully for more than 50 years, in the past 25 years there have been many

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Matteo de Notaris, Domenico Solari, Luigi M. Cavallo, Alfonso Iodice D'Enza, Joaquim Enseñat, Joan Berenguer, Enrique Ferrer, Alberto Prats-Galino and Paolo Cappabianca

middle clinoidal process, 34 , 35 could be figured out. The structure named the “tuberculum sellae”—derived from the classic Latin word “tuber,” which etymologically means “small swelling, pimple, protuberance”—appears to fit such a description when observed from above via a transcranial route, but it does not as seen from below through an endoscopic endonasal corridor. Indeed, the tuberculum sellae has never been anatomically defined and measured from an inferior perspective, where it cannot be properly considered a tuberculum. For these reasons, we designed this

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Evan D. Bander, Harminder Singh, Colin B. Ogilvie, Ryan C. Cusic, David J. Pisapia, Apostolos John Tsiouris, Vijay K. Anand and Theodore H. Schwartz

A nterior skull base meningiomas are benign, dural-based tumors that benefit from surgical removal. To minimize the risk of recurrence, the goals of surgery are complete removal of the tumor, dural tail, and invaded bone. 31 Subtotal resection (STR) followed by radiation therapy may also be reasonable depending on the age of the patient and the location of the tumor. Meningiomas originating from the tuberculum sellae (TS) and planum sphenoidale (PS) account for approximately 15% of WHO Grade I meningiomas and often present with visual disturbance due to

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Doo-Sik Kong, Chang-Ki Hong, Sang Duk Hong, Do-Hyun Nam, Jung-Il Lee, Ho Jun Seol, Jiwoong Oh, Dong Gyu Kim and Yong Hwy Kim

T he tuberculum sellae (TS) is a bony ridge that forms the anterior aspect of the sella. 8 Meningiomas arising from the TS and planum sphenoidale (PS) account for approximately 15% of WHO grade I meningiomas. 1 , 12 , 16 , 18 , 26 Initially, patients with these lesions often present with visual disturbances caused by compression of the optic apparatus. Therefore, the primary goal of treatment for TS meningiomas is visual restoration as well as gross-total resection (GTR). Advanced microsurgical techniques have contributed to reducing morbidity and improving