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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
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Transnasal Endoscopic Surgery for Suprasellar Meningiomas.

Prasheelkumar P Gupta1, Salman T Shaikh1, Chandrashekhar E Deopujari1

  • 1Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India.

Neurology India
|June 25, 2021
PubMed
Summary

Endoscopic trans-nasal surgery offers effective suprasellar meningioma resection with improved visual outcomes and reduced cerebrospinal fluid (CSF) leak rates. Vascularized flaps enhance defect closure, making it a viable alternative to transcranial approaches.

Keywords:
Endonasalendoscopymeningiomaplanumsuprasellartuberculum

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Area of Science:

  • Neurosurgery
  • Endoscopic Skull Base Surgery

Background:

  • Endoscopic trans-nasal surgery has advanced significantly, improving outcomes for pituitary tumors.
  • Suprasellar meningiomas present unique challenges for endoscopic trans-nasal excision regarding instrument manipulation, tumor removal, and defect closure to prevent cerebrospinal fluid (CSF) leaks.

Purpose of the Study:

  • To evaluate the efficacy of trans-nasal endoscopic surgery for radical resection of suprasellar meningiomas.
  • To compare outcomes with traditional transcranial approaches.

Main Methods:

  • Retrospective review of 12 suprasellar meningioma cases treated over 14 years.
  • Analysis of surgical approaches including primary extended endoscopic trans-sphenoidal surgery, management of residual/recurrent tumors after transcranial surgery, and combined approaches.

Main Results:

  • All patients experienced visual improvement and headache resolution.
  • No CSF leaks requiring further repair were observed.
  • One transient case of Syndrome of Inappropriate Antidiuretic Hormone (SIADH) was managed successfully.

Conclusions:

  • Trans-nasal endoscopic surgery is effective for suprasellar meningiomas, yielding comparable tumor excision results to transcranial surgery.
  • Superior visual outcomes and significantly reduced CSF leak rates were achieved using vascularized flaps.
  • Individual case assessment is crucial, considering tumor extension and carotid artery involvement.