Keyhole supraorbital eyebrow approach for fully endoscopic resection of tuberculum sellae meningioma

Abstract

Background: The fully endoscopic supraorbital trans-eyebrow keyhole approach is a technique utilized for the transcranial resection of tuberculum sellae meningioma (TSM). Surgery is the first choice for TSM treatment. This study aimed to summarize and analyze the safety, feasibility, limitations, and technical requirements of the fully endoscopic supraorbital trans-eyebrow keyhole approach for TSM resection.

Methods: Data of 19 TSM fully endoscopic supraorbital trans-eyebrow keyhole approach resections cases (six and 13 on the left and right eyebrows, respectively) were retrospectively analyzed at the Neurosurgery Department of the First Affiliated Hospital of Bengbu Medical College (Bengbu, China) from August 2015 to March 2022.

Results: All 19 patients were diagnosed with meningioma (World Health Organization grade I), and according to the scope of tumor resection (EOR), 18 patients (94.7%) had gross total resection (GTR), and one patient (5.3%) had near-total resection (NTR). Preoperative chief complaints were symptomatic visual dysfunction (n = 12), headache and dizziness (n = 6), and accidental discovery (n = 1). Postoperative visual function improved in 83.3% of cases (10/12), and headache and dizziness were relieved in 83.3% of cases (5/6 patients). Postoperative intracranial infection occurred in one case and was cured by external drainage of the lumbar cistern and anti-infective treatment. Two cases of frontal lobe injury were discharged after conservative treatment. There was no postoperative olfactory dysfunction, eyelid ptosis, cerebrospinal fluid leakage, or death. There were no reports of disease recurrence or death during the 3-month follow-up at an outpatient clinic or by telephone.

Conclusion: Fully endoscopic TSM resection through the keyhole approach is safe and feasible. It can be used to explore angles that cannot be seen under a microscope and show the true value of endoscopy technology. The endoscopic equipment and technical skills of the surgeon and surgical team are important in this technique.

Keywords: endoscope; endoscopic resection; keyhole supraorbital eyebrow approach; transcranial resection; tuberculum sellae meningioma.

Figure 1

Magnetic resonance imaging of the patients (A,C) Preoperative (B,D) postoperative.

Figure 2

Operating procedure. (A,B) Location of the surgical approach. (C) The DORO head brace was used to fix the head of the patient. (D) Upward retraction using two “fishhook-morphous” retractors. (E) Removal of the small free bone flap. (F) Supraorbital nerve. (G,H) Opening of the frontal sinus: before and after. (I) Release of cerebrospinal fluid.

Figure 3

Subdural endoscopic operation. (A–C) Location of the endoscope, instrument, and operators. (D) Resetting of the bone flap.

Figure 4

Intraoperative optic neural tube invasion (A) Under the optic nerve on the right side of the tumor and in the first space, push the optic nerve upward; (B) After total resection of the tumor (C) the main body of the tumor is located in the first space, and the right optic nerve is pushed upward and outward; (D) After total resection of the tumor.

Figure 5

The tumor completely surrounded bilateral anterior cerebral arteries.