Endonasal Endoscopic Transsphenoidal Resection of Tuberculum Sella Meningioma with Anterior Cerebral Artery Encasement.

Hazem M Negm,Theodore H Schwartz,Sivashanmugam Dhandapani,Salomon Cohen,Vijay K Anand

doi:10.7759/cureus.311

Abstract

Anterior cerebral artery (ACA) encasement is often considered a contraindication for an endonasal endoscopic transsphenoidal approach. We report a patient with a tuberculum sella meningioma with ACA encasement, in whom a gross total excision was achieved through an endonasal endoscopic transsphenoidal transtuberculum, transplanum approach. The tumor was sharply dissected along the left ACA using meticulous bimanual sharp dissection after internal decompression. Moreover, the medial optic canals were opened and the optic nerves decompressed. A gasket seal closure with a nasoseptal flap was performed, and the patient was discharged on postoperative day four with improved vision. This case highlights the ability to remove planum and tuberculum meningiomas with vascular encasement through an endonasal endoscopic approach with the potential for safe vascular dissection. The absence of luminal narrowing can be used to assure the likelihood of a safe arachnoid plane.

Highlights

Tuberculum sellae and planum meningiomas have been traditionally removed through a transcranial approach, which has been proposed to provide a complete visualization of the dural tail and the ability to use a microdissection technique to release encapsulated vessels and to open the optic canals
Vascular encasement of the anterior cerebral artery (ACA) complex has been thought to be a contraindication to endonasal endoscopic approach (EEA) based on the presumed technical challenge and the more limited maneuverability provided by the EEA [2, 6]
We report a patient with a tuberculum sellae meningioma with encasement of the left ACA who underwent gross total excision of the tumor using the EEA and discuss the technical aspects of

Summary

Introduction

Tuberculum sellae and planum meningiomas have been traditionally removed through a transcranial approach, which has been proposed to provide a complete visualization of the dural tail and the ability to use a microdissection technique to release encapsulated vessels and to open the optic canals. We report a patient with a tuberculum sellae meningioma with encasement of the left ACA who underwent gross total excision of the tumor using the EEA and discuss the technical aspects of. The medical optic canals were opened bilaterally, and the tumor was removed to fully decompress the optic nerves (Figure 3H). MRI (Figure 4) showed a gross total excision of the tumor with bilateral ACAs floating in subarachnoid space, complete decompression of both optic canals, and the vascularized nasoseptal flap in-situ

Discussion

Conclusions

Disclosures