Doo-Sik Kong1, Chang-Ki Hong2, Sang Duk Hong3, Do-Hyun Nam1, Jung-Il Lee1, Ho Jun Seol1, Jiwoong Oh2, Dong Gyu Kim4, Yong Hwy Kim4. 1. Departments of1Neurosurgery and. 2. 2Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University; and. 3. 3Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University. 4. 4Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Abstract
OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: Shin Heon Lee; Chang-Min Ha; Sang Duk Hong; Jung Won Choi; Ho Jun Seol; Do-Hyun Nam; Jung-Il Lee; Doo-Sik Kong Journal: Front Oncol Date: 2022-05-04 Impact factor: 5.738
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
Authors: Jai Deep Thakur; Regin Jay Mallari; Alex Corlin; Samantha Yawitz; Amalia Eisenberg; John Rhee; Walavan Sivakumar; Howard Krauss; Neil Martin; Chester Griffiths; Garni Barkhoudarian; Daniel F Kelly Journal: PLoS One Date: 2022-07-28 Impact factor: 3.752