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Endoscopic Endonasal Approach Limitations and Evolutions for Tuberculum Sellae Meningiomas: Data from Single-Center
Melih Caklili1, Atakan Emengen, Eren Yilmaz
1Taksim Education and Research Hospital, Department of Neurosurgery, Istanbul, Turkey.
Aim:
To determine the limits, to show the effect of tumor consistency on resection rates and to present the sinonasal morbidity rate in patients with tuberculum sellae meningiomas who underwent endoscopic endonasal approach.
Material And Methods:
We reviewed the medical data, radiological images, and surgical videos of the patients with pathologically confirmed meningiomas originating from the tuberculum sellae and they were operated via endoscopic endonasal approach between August 1997 and December 2020. We used our endoscopic classification based on infrachiasmatic corridor. In this classification, tumors were divided into those within the infrachiasmatic corridor and proximity of the optic nerve, internal carotid artery, and anterior artery complex and those outside the infrachiasmatic corridor.
Results:
Gross total resection was achieved in 45/60 (75%) patients. We found that tumor consistency was statistically significant on resection rates. Simultaneously, tumor median diameters on the anteroposterior (≤21.15 mm), transverse (≤19.75 mm), and superoinferior (≤15 mm) axes were statistically significant on resection rates.
Conclusion:
In summary, the most important factor in selecting the surgical technique is the tumor size. Infrachiasmatic corridor boundaries are the limitations of endoscopic approach. These limitations can change based on surgeon's experience. Also, tumor consistency is a factor that affecting degree of tumor resection rates.
Insights
Tumor size and consistency significantly impact resection rates for tuberculum sellae meningiomas treated with the endoscopic endonasal approach. The infrachiasmatic corridor defines the limits of this minimally invasive technique.
Area of Science:
- Neurosurgery
- Endoscopic Skull Base Surgery
- Oncology
Background:
- Tuberculum sellae meningiomas present unique surgical challenges.
- The endoscopic endonasal approach (EEA) offers a minimally invasive alternative for resection.
- Understanding the limitations and factors influencing EEA success is crucial.
Approach:
- Retrospective review of 60 patients with tuberculum sellae meningiomas treated via EEA.
- Utilized an endoscopic classification based on the infrachiasmatic corridor.
- Analyzed tumor consistency and size (anteroposterior, transverse, superoinferior axes) in relation to resection rates.
Key Points:
- Gross total resection was achieved in 75% of patients.
- Tumor consistency was a significant factor affecting resection rates.
- Tumor size, specifically median diameters across all axes, was also statistically significant for resection success.
Conclusions:
- Tumor size is the primary determinant for selecting surgical technique in tuberculum sellae meningiomas.
- The infrachiasmatic corridor delineates the boundaries for EEA, influenced by surgeon experience.
- Tumor consistency directly impacts the degree of resection achievable with EEA.
