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. 2022 Aug 31:9:979940.
doi: 10.3389/fsurg.2022.979940. eCollection 2022.

Surgical management of tuberculum sellae meningioma: Transcranial approach or endoscopic endonasal approach?

Kang Qian  1 , Chuansheng Nie  1 , Wende Zhu  1 , Hongyang Zhao  1 , Fangcheng Zhang  1 , Haijun Wang  1 , Xiaobing Jiang  1
Affiliations

Surgical management of tuberculum sellae meningioma: Transcranial approach or endoscopic endonasal approach?

Kang Qian et al. Front Surg. .

Abstract

Background: Tuberculum sellae meningioma (TSM), a common benign tumor in the sellae region, usually causes neurological deficits, such as vision impairment, by squeezing the peripheral neurovascular structures. Surgical management is recommended as the optimal strategy for TSM treatment and vision restoration. However, it remains challenging to resect TSM in the traditional transcranial approach (TCA). Recently, the endoscopic endonasal approach (EEA) has emerged as an effective option in skull base surgeries. Besides the effectivity, the advantages and limitations of EEA in TSM surgery remain controversial.

Object: We compared the surgical outcomes and complications between TCA and EEA surgeries to identify the principles in TSM surgical management.

Methods: Retrospective analysis was performed on the patients, who underwent TSM surgery in Wuhan Union Hospital between January 2017 and December 2021. The patients were assigned to TCA or EEA group according to the surgery they experienced. All patients were analyzed with the extent of tumor resection, vision outcome, postoperative complications, and follow-up results.

Results: A total of 112 patients were enrolled in this study, including 78 in TCA group and 34 in EEA group. The mean follow-up was 20.5 months (range 3-36 months). There were no statistically significant differences in patient demographic data, preoperative symptoms, and tumor characteristics between TCA and EEA groups. Both TCA and EEA surgeries are effective in TSM resection with relatively high gross total resection rates (85.9% in TCA vs. 91.2% in EEA, p > .05). Meanwhile, EEA surgery has a better outcome in vision restoration or stabilization than TCA surgery (74.6% in TCA vs. 93.1% in EEA, p < .05). Whereas EEA surgery causes more occurrences of cerebrospinal fluid (CSF) leakage than TCA surgery (0% in TCA vs. 11.8% in EEA, p < .05).

Conclusion: Both TCA and EEA surgeries are effective in TSM resection. EEA surgery has a better outcome in vision restoration or stabilization than TCA surgery, but induces higher risk of CSF leakage. As each approach has unique advantages and limitations, we must take all aspects into consideration, including approach feathers, tumor characteristics, and clinical requirements, to make the optimal choice in TSM surgical management.

Keywords: cerebrospinal fluid leakage; endoscopic endonasal approach; gross total resection; transcranial approach; tuberculum sellae meningioma.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Tuberculum sellae meningioma (WHO grade I). (A–D) Preoperative MRI shows an intrasellar and suprasellar tumor with internal carotid artery encasement (>180°) (asterisk). (E–H) Postoperative MRI demonstrates gross total resection of the tumor and skull base reconstruction. The optic nerve and pituitary (arrow) were decompressed. Visual acuity and visual field were restored rapidly and pituitary function was preserved after surgery.
Figure 2
Figure 2
Intraoperative photos of endoscopic endonasal surgery for tuberculum sellae meningioma. (A) Nasal mucosa constriction. (B) Remove the middle turbinate. (C) Vascularized nasoseptal flap separation. (D) Expose the anterior fossa dura. (E) Enlarge the skull base exposure. (F) Intratumor decompression. (G) Dissociate the tumor boundary. (H) Resect the main part of tumor. (I) Dissect the adherent tumor from the anterior cerebral artery complex. (J) Gross total resection of tumor. (K) Reconstruct the skull base by vascularized nasoseptal flap. (L) Probe the nasal 10 days after surgery. ICA, internal carotid artery; PG, pituitary gland; TS, tuberculum sellae; OC, optic canal; ON, optic nerve; ACA, anterior cerebral artery.
See this image and copyright information in PMC

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