Martin M Mortazavi1, Harley Brito da Silva1, Manuel Ferreira1, Jason K Barber1, James S Pridgeon1, Laligam N Sekhar2. 1. Department of Neurological Surgery, University of Washington, Harborview Medical Center, Seattle, Washington, USA. 2. Department of Neurological Surgery, University of Washington, Harborview Medical Center, Seattle, Washington, USA; Department of Radiology, University of Washington, Harborview Medical Center, Seattle, Washington, USA. Electronic address: lsekhar@u.washington.edu.
Abstract
BACKGROUND: The resection of planum sphenoidale and tuberculum sellae meningiomas is challenging. A universally accepted classification system predicting surgical risk and outcome is still lacking. OBJECTIVES: We report a modern surgical technique specific for planum sphenoidale and tuberculum sellae meningiomas with associated outcome. A new classification system that can guide the surgical approach and may predict surgical risk is proposed. METHODS: We conducted a retrospective review of the patients who between 2005 and March 2015 underwent a craniotomy or endoscopic surgery for the resection of meningiomas involving the suprasellar region. Operative nuances of a modified frontotemporal craniotomy and orbital osteotomy technique for meningioma removal and reconstruction are described. RESULTS: Twenty-seven patients were found to have tumors arising mainly from the planum sphenoidale or the tuberculum sellae; 25 underwent frontotemporal craniotomy and tumor removal with orbital osteotomy and bilateral optic canal decompression, and 2 patients underwent endonasal transphenoidal resection. The most common presenting symptom was visual disturbance (77%). Vision improved in 90% of those who presented with visual decline, and there was no permanent visual deterioration. Cerebrospinal fluid leak occurred in one of the 25 cranial cases (4%) and in 1 of 2 transphenoidal cases (50%), and in both cases it resolved with treatment. There was no surgical mortality. CONCLUSION: An orbitotomy and early decompression of the involved optic canal are important for achieving gross total resection, maximizing visual improvement, and avoiding recurrence. The visual outcomes were excellent. A new classification system that can allow the comparison of different series and approaches and indicate cases that are more suitable for an endoscopic transsphenoidal approach is presented.
BACKGROUND: The resection of planum sphenoidale and tuberculum sellae meningiomas is challenging. A universally accepted classification system predicting surgical risk and outcome is still lacking. OBJECTIVES: We report a modern surgical technique specific for planum sphenoidale and tuberculum sellae meningiomas with associated outcome. A new classification system that can guide the surgical approach and may predict surgical risk is proposed. METHODS: We conducted a retrospective review of the patients who between 2005 and March 2015 underwent a craniotomy or endoscopic surgery for the resection of meningiomas involving the suprasellar region. Operative nuances of a modified frontotemporal craniotomy and orbital osteotomy technique for meningioma removal and reconstruction are described. RESULTS: Twenty-seven patients were found to have tumors arising mainly from the planum sphenoidale or the tuberculum sellae; 25 underwent frontotemporal craniotomy and tumor removal with orbital osteotomy and bilateral optic canal decompression, and 2 patients underwent endonasal transphenoidal resection. The most common presenting symptom was visual disturbance (77%). Vision improved in 90% of those who presented with visual decline, and there was no permanent visual deterioration. Cerebrospinal fluid leak occurred in one of the 25 cranial cases (4%) and in 1 of 2 transphenoidal cases (50%), and in both cases it resolved with treatment. There was no surgical mortality. CONCLUSION: An orbitotomy and early decompression of the involved optic canal are important for achieving gross total resection, maximizing visual improvement, and avoiding recurrence. The visual outcomes were excellent. A new classification system that can allow the comparison of different series and approaches and indicate cases that are more suitable for an endoscopic transsphenoidal approach is presented.
Authors: Brett E Youngerman; Matei A Banu; Mina M Gerges; Eseosa Odigie; Abtin Tabaee; Ashutosh Kacker; Vijay K Anand; Theodore H Schwartz Journal: J Neurosurg Date: 2020-07-24 Impact factor: 5.115
Authors: I S Muskens; S J H Diederen; J T Senders; A H Zamanipoor Najafabadi; W R van Furth; A M May; T R Smith; A L Bredenoord; M L D Broekman Journal: Acta Neurochir (Wien) Date: 2017-08-06 Impact factor: 2.216
Authors: Danyal Z Khan; Ivo S Muskens; Rania A Mekary; Amir H Zamanipoor Najafabadi; Adel E Helmy; Robert Reisch; Marike L D Broekman; Hani J Marcus Journal: Acta Neurochir (Wien) Date: 2020-09-05 Impact factor: 2.216