Neuroendoscopic endonasal transsphenoidal resection of tuberculum sellae meningiomas

Abstract

Objective To explore the effect and clinical value of neuroendoscopic endonasal transsphenoidal approach for resection of tuberculum sellae meningiomas. Methods A retrospective analysis was conducted on 15 patient of tuberculum sellae meningiomas who were admitted to Department of Neurosurgery, the First Affiliated Hospital of Shenzhen University from June 2014 to November 2017 and underwent neuroendoscopic endonasal transsphenoidal surgery. We analyzed their clinical data to summarize the clinical effect and operation experience based on literature review. In addition, we discussed the application value of neuroendoscopic endonasal approach in resection of tuberculum sellae meningiomas. All patients were followed up post surgery by assessment of enhanced MRI and visual fields at outpatient department. Results Postoperative brain MR showed that gross total resection was achieved in 14 cases and subtotal resection in 1 case without postoperative complications. Postoperative visual acuity returned to normal in 12 patients, no obvious improvement was reported in 2 cases and visual deterioration occurred in 1. The follow-up period in 15 patients lasted for 1-41 months, with an average of 13.3±11.2 months. During the follow-up, mild enhancement in the saddle area was reported in only 1 case (41 months post operation). One case undergoing subtotal resection had reduced tumor size after radiotherapy. The visual fields of all patients remained the same post operation. Conclusion Neuroendoscopic endonasal transsphenoidal approach seems relatively safe and effective for resection of tuberculum sellae meningiomas, which could help enhance the rate of gross total resection and reduce the complication rate. Key words: Natural orifice endoscopic surgery; Meningioma; Neurosurgical procedures; Treatment outcome; Extended transsphenotidal