Article
Comparative analysis of the transciliary supraorbital approach for the resection of parasellar meningiomas and pituitary adenomas
Vergleichende Analyse des transciliaren supraorbitalen Zugangs für die Resektion parasellärer Meningeome und Hypophysenadenome
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Authors
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Kai-Michael Scheufler
- Klinikum Dortmund, Klinik für Neurochirurgie, Dortmund, Deutschland
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Daniela Diesing
- Klinikum Dortmund, Klinik für Neurochirurgie, Dortmund, Deutschland
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Jan Frederick Cornelius
- Heinrich-Heine-Universität, Universitätsklinikum Düsseldorf, Klinik für Neurochirurgie, Düsseldorf, Deutschland
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Franziska Staub-Bartelt
- Heinrich-Heine-Universität, Universitätsklinikum Düsseldorf, Klinik für Neurochirurgie, Düsseldorf, Deutschland
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Thomas Beez
- Heinrich-Heine-Universität, Universitätsklinikum Düsseldorf, Klinik für Neurochirurgie, Düsseldorf, Deutschland
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Sebastian Alexander Ahmadi
- Heinrich-Heine-Universität, Universitätsklinikum Düsseldorf, Klinik für Neurochirurgie, Düsseldorf, Deutschland
| Published: | May 8, 2019 |
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Outline
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Objective: To analyze the feasibility, safety, and technical nuances of the transciliary supraorbital approach in the resection of parasellar meningiomas (PSM) and pituitary adenomas (PA).
Methods: Retrospective study of clinical and anatomical characteristics, approach-related considerations, and clinical results. Hormonal status, vision and field of view (FOV), tumor volume, invasion of the cavernous sinus and spatial relationship to vessels, optic chiasm, pituitary stalk and third ventricle were analyzed. Statistical analysis was performed using SPSS 24 (IBM, Armonk, NY, USA).
Results: PSM (N=66, 41f, 25m) showed significant female predilection compared to PA (N=27, 11f, 16m; p<0.02). Mean tumor volume was comparable (PSM: 54.4 ±16.4ccm, PA: 44.5±18.6ccm). 77% of PSMs and 60% of PAs were treated using a right-sided approach. Vision and FOV deficits were significantly more common in cases of PSM vs. PA (p<0.01): 96% of PAs and 56% of PSMs presented with FOV deficits. Vision was affected in 70% and 32%, respectively. Postoperative deterioration of vision or FOV was seen in 4.5% of PSMs and 15% of PAs. 7.4% of patients with PSM and 3% with PA displayed oculomotor palsy postoperatively. Hormonal disturbances occurred significantly more frequently in patients with PA compared to PSM (44% vs. 6%, p<0.01). Extent of resection was equal for both entities (R0: 65%; R1: 20%; R2: 15%). PAs required transtubercular exploration of the sella significantly more often than PSMs (41% vs 11%). Supplemental endoscopy was used during dissection of the posterior circulation in 63% of PAs and 24% of PSMs (p<0.01). The pituitary stalk was sacrificed in 81% of PAs and 24% of PSMs, while drilling of the optic canal was required in 27% vs. 11%, respectively. There were no surgical site infections in this series.
Conclusion: The transciliary supraorbital approach is safe for resection of large PSMs and PAs, offering access to the tumor via the inter- and suprachiasmatic and opticocarotid windows. Perioperative (specifically access related) morbidity was low in our cohort. Endoscopic assistance was useful during resection of large PAs. R0 and R1 resection was achieved in 85% of patients in this series.
