The endoscopic endonasal approach (EEA) and the transcranial approach (TCA) are good options for the treatment of tuberculum sellae (TS) meningiomas. The objective of this study was to identify the key anatomical features in TS meningiomas and compare the two surgical approaches.
The authors retrospectively reviewed clinical data in 178 patients with TS meningiomas treated at 3 institutions between January 2010 and July 2016. Patients with tumors encasing the internal carotid artery or anterior cerebral artery or involving the anterior clinoid process or cavernous sinus were excluded. Tumors were classified as high-lying or low-lying based on their location, and involvement of the optic canal was evaluated. The surgical outcomes of EEA and TCA were analyzed according to the relevant anatomical features.
During the study period, 84 patients underwent EEA and 94 patients underwent TCA. Based on preoperative MR images, 43 (24.2%) meningiomas were classified as high-lying tumors, 126 (70.8%) as low-lying, and 9 (5.0%) as nonspecific. Gross-total resection (GTR) was performed in 145 patients (81.5%); the GTR rate did not differ significantly between the EEA and TCA groups. Of 157 patients with preoperative visual disturbance, 140 had improved or stable vision postoperatively. However, 17 patients (9.6%) experienced some visual deterioration after surgery. The TCA group had a worse visual outcome than the EEA group in patients with preoperative optic canal involvement (77.6% vs 93.2%, p = 0.019), whereas there was no significant difference in visual outcome based on whether tumors were high-lying or low-lying.
The results of this study support EEA over TCA, at least with respect to visual improvement with acceptable complications, although TCA is still an effective approach for TS meningioma.
ABBREVIATIONSEEA = endoscopic endonasal approach; GTR = gross-total resection; KOSEN = Korean Society of Endoscopic Neurosurgery; MPR = multiplanar reconstruction; PS = planum sphenoidale; TCA = transcranial approach; TS = tuberculum sellae; VIS = visual impairment score.
AttiaMKandasamyJJakimovskiDBedrosianJAlimiMLeeDL: The importance and timing of optic canal exploration and decompression during endoscopic endonasal resection of tuberculum sella and planum sphenoidale meningiomas. Neurosurgery71 (1 Suppl Operative):58–672012
BanderEDSinghHOgilvieCBCusicRCPisapiaDJTsiourisAJ: Endoscopic endonasal versus transcranial approach to tuberculum sellae and planum sphenoidale meningiomas in a similar cohort of patients. J Neurosurg128:40–482018
de NotarisMSolariDCavalloLMD’EnzaAIEnseñatJBerenguerJ: The “suprasellar notch,” or the tuberculum sellae as seen from below: definition, features, and clinical implications from an endoscopic endonasal perspective. J Neurosurg116:622–6292012
FahlbuschRSchottW: Pterional surgery of meningiomas of the tuberculum sellae and planum sphenoidale: surgical results with special consideration of ophthalmological and endocrinological outcomes. J Neurosurg96:235–2432002
LinslerSFischerGSkliarenkoVStadieAOertelJ: Endoscopic assisted supraorbital keyhole approach or endoscopic endonasal approach in cases of tuberculum sellae meningioma: which surgical route should be favored?World Neurosurg104:601–6112017
MakarenkoSCarrerasEMAkagamiR: Craniotomy for perisellar meningiomas: comparison of simple (appropriate for endoscopic approach) versus complex anatomy and surgical outcomes. J Neurosurg126:1191–12002017
NozakiKKikutaKTakagiYMineharuYTakahashiJAHashimotoN: Effect of early optic canal unroofing on the outcome of visual functions in surgery for meningiomas of the tuberculum sellae and planum sphenoidale. Neurosurgery62:839–8462008
ZevgaridisDMedeleRJMüllerAHischaACSteigerHJ: Meningiomas of the sellar region presenting with visual impairment: impact of various prognostic factors on surgical outcome in 62 patients. Acta Neurochir (Wien)143:471–4762001