How I do it: endoscopic endonasal resection of tuberculum sellae meningioma.

Tuberculum sellae meningiomas (TSMs) adherent to neurovascular structures are particularly challenging lesions requiring delicate and precise microneurosurgery. There is an ongoing debate about the optimal surgical approach. We describe technical nuances and challenges in TSM resection using the endoscopic endonasal approach (EEA) in two cases of fibrous tumors with adherence to neurovascular structures. The cases are illustrated with a video (case 1) and figures (cases 1 and 2). A dedicated team approach and precise microsurgical technique facilitate safe resection of complex TSMs through the EEA.

Wiedmann M ，Lashkarivand A ，Berg-Johnsen J ，Dahlberg D ... -  《-》

Outcomes After Transcranial and Endoscopic Endonasal Approach for Tuberculum Meningiomas-A Retrospective Comparison.

Degree of resection and visual outcome are the main concerns in the surgical resection of tuberculum sellae meningioma (TSM). In addition to the transcranial approach (TCA), the endoscopic endonasal approach (EEA) has been used increasingly. However, the controversy regarding the optimal surgical approach is not clearly resolved. We compared the surgical outcomes of each approach for TSMs from 44 patients receiving EEA and 40 patients receiving TCA in 2 institutions between 2004 and 2015. We analyzed the surgical outcomes and affecting factors for the relapse of tumor and visual outcome. Gross total resection rates and relapse-free survival were not different between the 2 groups; however, the locations of residual or recurred tumor definitely differed. All recurrences in the TCA group were in the sella turcica, whereas residual tumors in EEA group were mainly located at lateral or superior to the clinoid process. The complete or partial improvement rate of visual function in the EEA group was 97.7%, but 9 patients (23.7%) in the TCA group experienced visual deterioration after surgery. EEA and younger age (<55 years) were associated with favorable visual outcome. Cerebrospinal fluid leakage occurred in only one case in the EEA group. Surgical approaches do not affect the gross total resection rates, but the locations of residual tumor or recurrence differ according to surgical approaches. EEA is superior to TCA in visual outcome. At least in pure TSMs, the trend seems to be shifting in favor of EEA, considering the huge difference in visual outcome.

Song SW ，Kim YH ，Kim JW ，Park CK ，Kim JE ，Kim DG ，Koh YC ，Jung HW ... -  《-》

Endoscopic Endonasal Approach for Resection of Tuberculum Sellae Meningioma: A Promising Surgical Approach.

Zhang C ，Ding J ，Liu Y ，Tuoheti M ，Yang X ，Wang J ，Wu Y ... -  《-》

Expanded Endoscopic Endonasal Approach for Removal of a Tuberculum Sella Meningioma.

This 46-year-old female patient presented after a 6-month progressive right-sided visual loss, with a visual acuity of 20/60, a temporo/infranasal visual field deficit, and optic atrophy. The magnetic resonance imaging disclosed a tuberculum sella meningioma with minimal right medial canal invasion, however, no encasement of carotid arteries. Tuberculum sella meningiomas represent 5%-10% of intracranial meningiomas and are surgically challenging tumors that can severely hinder vision. The endoscopic approach allows for early coagulation of the tumor meningeal supply, and importantly, facilitates gross total removal without any manipulation of the optic nerve while preserving the superior hypophyseal arteries.1-9.

Kalyvas A ，Almeida JP ，Mohan N ，O'Halloran PJ ，Vescan A ，Gentili F ... -  《-》

Endoscopic endonasal versus transcranial approach to tuberculum sellae and planum sphenoidale meningiomas in a similar cohort of patients.

Bander ED ，Singh H ，Ogilvie CB ，Cusic RC ，Pisapia DJ ，Tsiouris AJ ，Anand VK ，Schwartz TH ... -  《-》