The contralateral subfrontal approach can simplify surgery and provide favorable visual outcome in tuberculum sellae meningiomas

Abstract

The ipsilateral approach for the tumor-dominant or amblyopic side in surgery of tuberculum sellae meningiomas (TSMs) frequently requires manipulation of the optic nerve and unroofing of the optic canal, which results in postoperative visual aggravation. We suggest a contralateral approach and discuss the benefits with respect to the postoperative visual outcome. Between 2005 and August 2011, 24 patients with TSMs underwent surgical resection via the contralateral approach. The contralateral approach accesses the tumor from the opposite side of the tumor-dominant or amblyopic side. Using this technique, the tumor was separated from the noncompromised optic nerve with only internal debulking. The tumor was dissected from the optic nerve without manipulation of the compromised optic nerve under the direct view of the inferomedial aspect of the optic nerve. The tumor that extended into the optic canal could be removed easily via dural unroofing of the medial wall of the optic canal. Seventeen patients (70.8 %) were improved, 6 (25 %) were unchanged, and 1 (4.2 %) worsened on visual acuity of the affected eye. Fifteen (62.5 %) were improved, 8 (33.3 %) were unchanged, and 1 patient (4.2 %) worsened on visual field defect of the affected eye. However, deterioration of visual acuity and visual field defect of the nonaffected eye was developed in one (4.2 %) and three patients (12.5 %), respectively. Surgical approach-related visual field defect was developed on two patients (8.3 %). The contralateral approach reduces manipulation of the involved optic nerve and directly visualizes the inferomedial aspect of the compromised optic nerve which could result in improvement of postoperative visual outcomes.