Trans-sphenoidal Supradiaphragmatic Intradural Approach for Tuberculum Sellae Meningiomas

Abstract

Purpose: Traditionally, the transcranial approach has been used to remove tuberculum sellae (TS) meningiomas. However, the trans-sphenoidal route has recently been adopted for removal of parasellar tumors. The authors describe use of the trans-sphenoidal supradiaphragmatic intradural approach (TSIA) for removal of presellar and/or suprasellar TS meningiomas. Methods: Six women, aged from 37 to 69 years (average, 59.5 yrs), presented with headaches and visual disturbances. All cases underwent the TSIA via the transnasal trans-septal routes. After removal of tumors, the surgical dural and bony defects were repaired with autologous abdominal fat and silicone plate substitutes. Results: The extents of tumor removal were gross total in 3 patients and subtotal in 3. There was 1 postoperative cerebrospinal fluid leak and 1 aggravation of the visual function. The mean follow-up period was 49.3 months (from 92 to 14 mos). Conclusions: The major advantage of this technique is that it is easily applicable through a minor modification of the standard trans-sphenoidal approach. Although we used this TSIA in a limited number of cases, it can be concluded that TSIA makes it possible to remove TS meningiomas safely in selected cases. However, the transcranial approach is preferred whenever the surgeon aims for complete removal of the tumor.