Clinical Outcome after Endoscopic Endonasal Resection of Tuberculum Sella Meningiomas. Issue 5 (10th October 2017)

• Record Type: Journal Article
• Authors: Elshazly, Khaled; Kshettry, Varun R; Farrell, Christopher J; Nyquist, Gurston; Rosen, Marc; Evans, James J
• Is Part Of: Operative neurosurgery. Volume 14:Issue 5(2018)
• Page Start: 494
• Page End: 502
• Publication Date: 2017-10-10
• Subjects: Meningioma -- Endonasal -- Endoscopic -- Transphenoidal -- Transnasal -- Endocrine -- Vision -- Outcome; Nervous system -- Surgery -- Periodicals; 617.480590
• DOI: 10.1093/ons/opx165
• Languages: English
• ISSNs: 2332-4252

Abstract

Abstract: BACKGROUND: In select cases, the endoscopic endonasal approach (EEA) has distinct advantages for resection of tuberculum sella meningiomas (TSM). OBJECTIVE: To report the extent of resection (EOR), complication rates, and outcomes in a large series of TSM treated by the EEA. METHODS: Twenty-five consecutive TSM cases treated by EEA from 2008 to 2016 were retrospectively reviewed. Patient history, imaging, volumetric EOR, complications, and outcomes are presented. RESULTS: Mean patient age was 53.9 yr, with female predominance (84%). Preoperatively, 84% of patients had vision impairment and 68% had optic canal tumor invasion. The tumor was abutting or partially encasing the anterior cerebral artery in 14 (56%) and 3 (12%) patients, respectively. The supraclinoid internal carotid artery (ICA) was partially or completely encased in 4 (16%) and 4 (16%) patients, respectively. Gross total resection (GTR) was achieved in 19/25 (76%) cases. Complete ICA encasement was the most common reason for subtotal resection. Among patients without complete ICA encasement, GTR was achieved in 19/20 (95%) patients. Optic canal invasion, tumor volume, intratumoral calcifications, and partial vascular encasement were not limiting factors for GTR. Eighty-eight percent of patients with preoperative visual impairment had improvement or normalization of vision. No patient experienced permanent visual deterioration or new permanent pituitary dysfunction. Cerebrospinal fluid leakage occurred in 2 (8%) cases. CONCLUSION: The EEA for resection of TSM provides high rates of GTR and visual improvement with a low rate of complications. Direct contact or partial encasement of the ICA and anterior cerebral artery does not limit the EOR.