Endoscopic Endonasal and Supraorbital Removal of Tuberculum Sellae Meningiomas: Anatomic Guides and Operative Nuances for Keyhole Approach Selection
| Autor: | Amalia Eisenberg, Regin Jay Mallari, John H. Rhee, Howard R. Krauss, Jai Deep Thakur, Walavan Sivakumar, Garni Barkhoudarian, Chester Griffiths, Daniel F. Kelly |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
medicine.medical_specialty Decompression medicine.medical_treatment Fluid-attenuated inversion recovery Meningioma Tuberculum Sellae Meningioma Meningeal Neoplasms Humans Medicine Sella Turcica Craniotomy Aged Retrospective Studies medicine.diagnostic_test Optic canal business.industry Endoscopy Middle Aged medicine.disease Surgery Treatment Outcome medicine.anatomical_structure Tuberculum sellae Neurology (clinical) business |
| Zdroj: | Operative Neurosurgery. 21:E71-E81 |
| ISSN: | 2332-4260 2332-4252 |
| Popis: | BACKGROUND With growing worldwide endoscopy experience, endonasal and supraorbital removal of tuberculum sellae meningiomas (TSM) has increased. OBJECTIVE To describe anatomic factors for guiding approach selection and outcomes. METHODS 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. RESULTS 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 |
| Databáze: | OpenAIRE |
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