Article
Technical nuances in the management of tuberculum sellae meningiomas: a contemporary perspective and role of ICG videoangiography
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Authors
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Francesco Tomasello
- Clinica Neurochirurgica, Dipartimento di Neuroscienze, Università degli Studi di Messina, Italy
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Filippo Flavio Angileri
- Clinica Neurochirurgica, Dipartimento di Neuroscienze, Università degli Studi di Messina, Italy
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Salvatore Cardali
- Clinica Neurochirurgica, Dipartimento di Neuroscienze, Università degli Studi di Messina, Italy
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Stefano Priola and Alfredo Conti.
- Clinica Neurochirurgica, Dipartimento di Neuroscienze, Università degli Studi di Messina, Italy
| Published: | June 2, 2015 |
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Outline
Text
Objective: Tuberculum sellae meningiomas arise from the tuberculum sellae, planum sphenoidale, and chiasmatic sulcus, and comprise 5 to 10% of all intracranial meningiomas. They represent a surgical challenge due to their proximity to neurovascular structures as optic nerves and chiasm,anterior circulation and hypothalamus. Many transcranial microsurgical approaches have been described and are routinely used for the resection of tuberculum sellae meningiomas. The extended endoscopic endonasal transsphenoidal approach is an alternative route, but its clear indication and long-term outcome have yet to be determined.
We present our experience with the microsurgical treatment via a pterional approach on 28 patients presenting with tuberculum sellae meningiomas, focusing on technical strategies used to minimize injury to the optic apparatus and vascular structures.
Method: Twenty-eight patients with tuberculum sellae meningioma were microsurgically treated by the senior author (FT) at the Neurosurgical Department of University of Messina. All patients underwent pre- and post-operative neuroradiological and neuro-ophthalmological evaluations and, more recently, ICG Videoangiography of the optic nerves before and after removal of tumors.
A retrospective study was conducted analyzing the charts of the patients, including surgical records, discharge letters, histological records, follow-up records, and imaging studies.
Results: All patients were treated by a pterional microsurgical approach. A gross total removal has been achieved in 23 of 28 cases (82.1%). A good outcome has been reached in 23 of 28 cases (82.1%), while an improvement in visual outcome has been reached in 24 of 28 cases (84%). At follow-up (mean 93.5 months) a recurrence has been recorded in 3 of 28 cases (10.7%). There was no surgical mortality in this series.
Conclusions: Pterional approach should be still considered the standard approach for tuberculum sellae meningiomas. Alternative approaches as supraorbital and extended endoscopic endonasal transphenoidal approaches could be helpful in selected cases. Section of the falciform ligament (early) and unroofing of the optic canal, with neurovascular dissection along arachnoidal planes and meticulous respect of optic nerve microvasculature, as demonstrated by the ICG Videoangiography, may be essential in order to obtain a good visual outcome.
