Endoscopic Assisted Supraorbital Keyhole Approach or Endoscopic Endonasal Approach in Cases of Tuberculum Sellae Meningioma: Which Surgical Route Should Be Favored?

Keyhole approaches are under investigation for skull base tumor surgery. They are expected to have a low complication rate with the same successful resection rate compared with endoscopic endonasal procedures. In this study, we compare our current series of tuberculum sellae meningiomas resected via an endoscopic endonasal or microsurgical supraorbital keyhole approach. Between 2011 and 2016, 16 patients were treated using the supraorbital keyhole procedure and 6 patients received an endoscopic endonasal procedure. Both surgical techniques were analyzed and compared concerning complications, surgical radicality, endocrinologic, and ophthalmologic outcome and recurrences in patients' follow-up. The 2 different approaches yielded similar rates of gross total resection (endonasal 83% [5 of 6] vs. supraorbital 87% [14 of 16]), near total resection (17% [1 of 6] vs. 13% [2 of 16]), and visual recovery (endonasal 66% [2 of 3] vs. supraorbital 60% [3 of 5]). An extension lateral to the internal carotid artery was noted in 81% (13 of 16) of the supraorbital cases and in none of the endonasal cases. Tumor volume was 14.9 cm3 (±8.2 cm3) for supraorbital tumors versus 2.1 cm3 (±0.8 cm3) for the endonasal approach. Both approaches provide minimally invasive surgical routes accessing meningiomas of the sellar region. The ideal approach should be tailored to the individual patient considering the tumor anatomy, lateral extension, and the experience of the surgeon with both surgical approaches. We suggest using the supraorbital approach for larger meningiomas of sellar region with far lateral extension or broad vascular encasement.

Linsler S ，Fischer G ，Skliarenko V ，Stadie A ，Oertel J ... -  《-》

Endonasal versus supraorbital keyhole removal of craniopharyngiomas and tuberculum sellae meningiomas.

Fatemi N ，Dusick JR ，de Paiva Neto MA ，Malkasian D ，Kelly DF ... -  《-》

Decision-making algorithm for minimally invasive approaches to anterior skull base meningiomas.

Ottenhausen M ，Rumalla K ，Alalade AF ，Nair P ，La Corte E ，Younus I ，Forbes JA ，Ben Nsir A ，Banu MA ，Tsiouris AJ ，Schwartz TH ... -  《-》

Endoscopic Endonasal and Supraorbital Removal of Tuberculum Sellae Meningiomas: Anatomic Guides and Operative Nuances for Keyhole Approach Selection.

With growing worldwide endoscopy experience, endonasal and supraorbital removal of tuberculum sellae meningiomas (TSM) has increased. To describe anatomic factors for guiding approach selection and outcomes. Retrospective analysis of patients undergoing endonasal or supraorbital TSM resection: approach criteria, clinical outcomes, acute magnetic resonance imaging (MRI) fluid-attenuated inversion-recovery (FLAIR)/T2 changes. From 2008 to 2020, 33 patients (mean age 55 ± 11 yr) were identified: 20 (61%) had endonasal and 13 (39%) supraorbital removal. Comparing endonasal and supraorbital approaches, mean tumor volume (3.7 ± 3.5 cm3 vs 7.7 ± 8.5 cm3, P = .07); percent tumor above planum (42% vs 65%, P = .02), and lateral tumor beyond supraclinoid internal carotid arteries (1.4 ± 2.0 mm vs 4.0 ± 3.2 mm, P = .006) were greater for supraorbital route. Sellar depth was greater for endonasal route tumors (12.2 ± 2.6 mm vs 9.3 ± 2.4 mm, P = .003). Endoscopy, used in 10/13(77%) supraorbital cases, was helpful in additional tumor removal in 4/10(40%). Gross total removal and mean volumetric tumor resection were 16/20(80%) and 97.5% by endonasal, and 5/13(39%) and 96% by supraorbital route. Vision improved in 12/17 (71%) endonasal, 6/8 (75%) supraorbital operations, and worsened in 1 (3%) supraorbital case. Endonasal approach with optic canal decompression increased over study period: 15/20 (75%) endonasal patients vs 1/13(8%) supraorbital (P < .001). Postoperative FLAIR/T2 MRI changes occurred in 2/12 supraorbital and 0/20 endonasal cases. In our experience, both endonasal and supraorbital routes are safe and effective for TSM removal. Greater tumor extension below planum and medial optic canal invasion favor endonasal route, while larger size and lateral extension favor supraorbital route. Given high frequency of TSM growth into optic canals and better access for medial optic canal tumor removal, endonasal route may be preferred for most TSMs.

Mallari RJ ，Thakur JD ，Rhee JH ，Eisenberg A ，Krauss H ，Griffiths C ，Sivakumar W ，Barkhoudarian G ，Kelly DF ... -  《-》

Tuberculum sellae meningiomas: grading scale to assess surgical outcomes using the transcranial versus transsphenoidal approach.

Magill ST ，Morshed RA ，Lucas CG ，Aghi MK ，Theodosopoulos PV ，Berger MS ，de Divitiis O ，Solari D ，Cappabianca P ，Cavallo LM ，McDermott MW ... -  《-》