Endoscopic surgical resection of tuberculum sellae meningiomas based on decision-making algorithms proposed in the literature

Abstract

Recent publications and studies propose using decision-making algorithms in choosing the optimal approach for each individual case of tuberculum sellae meningioma (TSM). Minimally invasive endoscopic approaches offer the possibility of early devascularization, reduced brain and nerve retraction and speedy patient recovery. We used the decision-making algorithm proposed in the literature to choose between the extended endoscopic endonasal approach (EEA) or the classic transcranial approaches for resection of tuberculum sella/planum sphenoidale meningiomas, based on anatomical landmarks and lateral extension. We describe rates of gross-total resection, visual outcomes, as well as complications in four cases of TSMs, where EEA was used based on the proposed algorithm. Over a period of 15 months, we used the algorithm in nine patients with tuberculum sella/planum sphenoidale meningiomas, in four of whom we used the extended EEA. The mean follow-up duration was 3 months. Gross-total resection was achieved in three out of the four cases, the fourth being a second operation a long period of time after the classical transcranial approach had been used. Visual improvement was achieved in three out of the four cases. One patient had stable vision. There were no cerebrospinal fluid leaks or any kind of neurological postoperative deterioration, although a patient developed pulmonary embolism, but recovered successfully and was discharged. The algorithm proposed in the literature that was explored here is simple, minimally invasive and can produce excellent outcomes in the surgical resection of TSMs in carefully selected cases.