Tuberculum sellae meningiomas (TSMs) tend to compress the optic apparatus and an ideal surgical route, whether transcranial or endonasal, is still debated. Another issue is if the minimally invasive supraorbital (SO) approach offers the same results compared with the more invasive craniotomies. Aiming to guide approach selection, preoperative grading systems have been described.All cases of TSMs treated from 2013 to 2018 by extended endoscopic endonasal approach (EEA) or SO approach have been reviewed and classified according to three preoperative grading systems: McDermott scale, Optic Nerve Laterality Score, and Yaşargil criteria.A total of 15 patients with TSMs were treated with the EEA (n = 6) or the SO (n = 9) approach. Globally, gross total resection was obtained in 87% (n = 13) of cases and was higher with the SO (100%, n = 9) compared with the EEA (67%, n = 4). Visual function improved in all but one patient (n = 14). Compared with the EEA group, patients treated by the SO approach had larger tumors (32.3 mm vs. 24.5 mm), a higher rate of optic canal invasion (4/9 vs. 0/6), and arterial encasement (6/9 vs. 1/5). Patients with McDermott total points of 1 to 2 (7/15) were treated mainly by the EEA; all patients with McDermott total score of ≥3 (8/15) were treated by the SO approach. All patients with optic canal invasion (4/15) and lateral extension of the tumor (ONL score = 1-3) were treated by the SO approach.The SO and EEA are two minimally invasive approaches safe and effective for treating TSMs. For tumors with lateral extension (optic nerve laterality [ONL] score = 1-3), larger diameter (>30-35 mm), vascular encasement, or optic canal involvement (McDermott total point = 2-3), the SO craniotomy is preferred. For small and median tumors with no optic canal invasion or vascular encasement (McDermott total point = 1-2), the EEA represents a valid option.

Background/Objectives: Achieving gross total resection is crucial in the surgical management of pituitary neuroendocrine tumors (PitNETs). However, PitNETs with anterosuperior extension remain challenging to completely remove using the conventional transsellar approach (TSA) due to limited access to the anterior suprasellar region. This study evaluated the efficacy and safety of a modified TSA (mTSA) that involves additional removal of the tuberculum sellae and planum sphenoidale (PS) bones without expanding the dural incision. Methods: We retrospectively reviewed 104 patients with nonfunctioning PitNETs who underwent endoscopic transsphenoidal surgery between 2017 and 2022. Seventy-seven patients were treated with the conventional TSA and 27 with the mTSA. Tumor configuration and accessible area were measured on pre- and postoperative MR imaging and CT. The ratio of the accessible to total tumor area was calculated on mid-sagittal images. Surgical outcomes and postoperative complications were compared between groups. Results: Gross total resection was achieved in all patients. Tumors treated with mTSA were larger (median height, 32 mm vs. 25 mm; p < 0.001) and showed greater anterosuperior extension. The mTSA increased the median accessible tumor area from 70% to 88%, with a median PS removal distance of 4.4 mm. Postoperative complications were minimal: cerebrospinal fluid leakage (3%), meningitis (3%), transient ocular movement disturbance (2%), and transient visual worsening (1%). No hemorrhage or anosmia occurred. Conclusions: The mTSA safely expands the surgical corridor to the anterior suprasellar region, enhancing accessibility and enabling complete resection without dural incision. This approach balances surgical radicality and safety in PitNETs with anterosuperior extension.

The endoscopic endonasal approach has emerged as an effective and minimally invasive technique for the management of tuberculum sellae meningiomas. A 53-year-old woman with progressive visual deterioration due to a tuberculum sellae meningioma extending into the optic canal underwent endoscopic endonasal resection with optic canal decompression. Gross-total removal was achieved using a "French-door" dural opening and angled dissection, resulting in Simpson grade II resection with the preservation of neurovascular structures. Optic canal opening enabled safe tumor removal and significant visual improvement. Reconstruction employed sutured fascia lata grafts and a sphenoid sinus mucosal flap resulted in no postoperative cerebrospinal fluid leakage.The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25151

Tuberculum sellae meningiomas often compress the optic apparatus and encase the ACA-ACom complex, making approach selection challenging. This video demonstrates endoscopic endonasal resection of a large, recurrent, tuberculum sellae meningioma with severe adherence to the ACA-ACom complex. A transplanum-transtuberculum corridor provided direct access to the dural base, enabling early tumor devascularization and meticulous dissection of microvasculature to the optic nerves, pituitary stalk, and hypothalamus. Unroofing the optic canal facilitated early optic nerve decompression, reducing the risk of neural injury during tumor manipulation. Multilayer skull base reconstruction achieved watertight closure. Gross-total resection was achieved without ischemic sequelae, and postoperative visual function improved significantly.The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25148

Introduction: Tuberculum sellae meningiomas pose significant surgical challenges due to their proximity to critical neurovascular structures. Pterional craniotomy has been the conventional method for approaching anterior skull base lesions, while the supraorbital eyebrow approach has emerged as an alternative in selected cases.Case Presentation: We report the case of a 50-year-old woman with progressive left temporal hemianopia due to a tuberculum sellae meningioma. The tumor was resected via left supraorbital approach, achieving gross total resection. Estimated intraoperative blood loss 50 mL, and total operative time 185 minutes. Histopathological examination confirmed WHO Grade I meningioma. Postoperative recovery was uneventful. Contrast-enhanced brain MRI at 3-month follow-up showed no residual or recurrent tumor. Discussion: Surgical management of tuberculum sellae meningiomas is particularly challenging because of their proximity to critical structures. Conventional approaches provide wide exposure but require extensive soft tissue and bone manipulation. The supraorbital eyebrow approach offers a minimally invasive keyhole route. In our case, it allowed safe gross total resection, preservation of neurovascular function, and rapid postoperative recovery.Conclusion: This case highlights the feasibility, safety, and effectiveness of the supraorbital eyebrow approach for resecting anterior skull base meningiomas. Keywords: Anterior skull base surgery; Eyebrow craniotomy; Keyhole approach; Minimally invasive; Supraorbital approach; Tuberculum sellae meningioma

This study aimed to evaluate the effects of orbitotomy on tuberculum sellae meningioma surgery using the supraorbital approach through a quantitative assessment of brain retraction and stratified effect by tumor size. An in-silico study was conducted using three-dimensional (3D) head models generated from the imaging data of 35 patients (70 hemispheres) without brain deformation, created with a surgical simulation software (GRID, Kompath Inc., Tokyo, Japan). A skull base tumor model was created by inserting virtual hemispherical tumors of varying diameters (20, 30, 40, and 50 mm) into the tuberculum sellae within the 3D model. Supraorbital craniotomy was performed on the skull base tumor model, and the distance of frontal lobe retraction required to access the tumor apex was measured with and without orbitotomy. Imaging data from 35 patients (70 hemispheres) revealed that orbitotomy statistically reduced frontal lobe retraction by 0.8 mm for 20 mm tumors, 1.55 mm for 30 mm tumors, 2.8 mm for 40 mm tumors, and 3.31 mm for 50 mm tumors (p < 0.01 for all findings). A comparison of the effects of orbitotomy according to tumor size showed the highest impact on tumors larger than 40 mm. This study quantified changes in brain retraction associated with adding orbitotomy for tumors of various sizes. These findings provide specific estimates for each tumor size, serving as a guideline for determining the indications for orbitotomy and contributing to optimizing skull base surgical approaches.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-28722-y.

Diaphragma sellae meningiomas are rare suprasellar tumors often misidentified as tuberculum sellae meningiomas. Their association with the optic nerve, chiasm, pituitary stalk, internal carotid, and superior hypophyseal arteries presents unique surgical challenges. These tumors are classified into three types based on dural attachment with precise subtype identification. We present a Type A diaphragma sella meningioma, located anterior to the pituitary stalk, managed via a pterional craniotomy with extradural anterior clinoidectomy and optic unroofing. Posterior attachment with ICA adhesion and multiple SHA involvement favored a transcranial route, with clinoidectomy and optic unroofing widening the optico-carotid triangle for safe resection.

ABSTRACTObjective:To assess how pre-operative Edema Index (EI) affects surgical outcomes, complications, and hospital stay in patients with supratentorial meningiomas and its role as a predictor for surgical planning and prognosis.Methodology:A retrospective observational study was conducted at the Department of Neurosurgery Unit-II, Punjab Institute of Neurosciences, Lahore, over 14 months (January 2024–February 2025). 31 patients with supratentorial meningiomas were included through non-probability consecutive sampling.Results:Mean age was 41.39 years (range: 18–64 yrs), with male-to-female ratio of 1:1.82. 58.1% (18) were located in the convexity, followed by Parasagittal 12.9% (4), olfactory groove 6.5%(2) , parafalcine 6.5%(2), sphenoid wing 6.5%(2), tuberculum sellae 6.5%(2) and temporal 3.2%(1) regions. Based on size. 3.2% (1) of the tumors were small (<2cm), 35.5% (11) were medium (2-4cm), 38.7% (12) were large (4.1-6 cm) and 22.6% (7) were giant (>6cm). EI was <1 in 38.7% (12), 1–2 in 12.9% (4), and >2 in 32.3% (10); 16.1% (5) had no edema. Higher edema (EI >2) was more common in males (54.5%) than females (20%). Expansion duraplasty was required in 58.1% (18), bone removal in 9.7% (3) and bleeding occured in 6.5% (2). Grade I-II resections were achieved in 90% of patients with EI>2. Neurological deficits occurred in 6 (19.4%). 22.6%(7) had hospital stay exceeding 10 days.Conclusion:Pre-operative EI and tumor location significantly influences surgical complexity, extent of resection, complications, and hospital stay. Incorporating EI into preoperative evaluation can improve surgical planning and outcomes.

Abstract BACKGROUND AND OBJECTIVES Although most diseases affecting the sella and suprasellar region are benign, critical neurovascular structures contribute to early symptoms and potential for postoperative morbidity. We assessed the role of intraoperative ultrasound (IOUS) in surgical decision making and detecting inadvertent residual during resection. MATERIAL AND METHODS This is a retrospective study of 108 patients with sellar and suprasellar pathologies who underwent 110 endoscopic endonasal surgeries. The clinical details, magnetic resonance images (MRI), IOUS images, surgical videos, and operative notes were collected from patient records. RESULTS The mean age of the cohort was 57 years, 53.6% were males. Non-secreting pituitary adenomas were the predominant entity (43.6%); secreting adenomas (31.8%), Rathke’s cleft cyst (11.8%), craniopharyngiomas (5.3%), abscess (2.7%), tuberculum sellae meningiomas (1.8%) and others (hypophysitis, teratoma and collision tumor). Tumors involving the sella were 86.5%, 12.7% were suprasellar and 0.9% involved the cavernous sinus. Three cases that were suspected to be cystic adenomas on preoperative MRI underwent IOUS-guided cyst aspiration, which demonstrated mucinous content suggesting Rathke’s cleft cyst, and hence, marsupialization was deemed adequate. Another 3 cases suspected to be papillary craniopharyngiomas (PCP) on preoperative MRI demonstrated calcific shadows on IOUS, suggestive of adamantinomatous craniopharyngioma, precluding a conservative resection, which could suffice for PCP in the era of BRAF inhibitors. An extent of resection of more than 90% was obtained in 85.5% patients.. The mean residual volume was 3.68 cc. Intraoperative USG done just before closure identified residue in 17 (15.4%) patients, with a positive predictive value of 82.4% and a negative predictive value of 82.8%. The sensitivity of IOUS in detecting residual was 46.7% whereas specificity was 96.2%. The most common sites where residual as missed were lateral compartment of cavernous sinus followed by posterior and superior compartment CONCLUSION IOUS helps in surgical decision-making intraoperatively to achieve maximum safe resection.

This case report describes an exceedingly rare complication of endoscopic endonasal approach (EEA) surgery. We reported a delayed remote combined supratentorial intracerebral and subdural haemorrhage following the resection of a tuberculum sella meningioma. This report aims to analyse the pathophysiology and discuss the management of this critical complication, which is seldom documented in the literature. We present the case of a 54-year-old female with a WHO Grade I tuberculum sella meningioma. She underwent a complete (Simpson Grade I) resection via an endoscopic endonasal transsphenoidal approach. Her initial postoperative recovery was unremarkable for four days. On the fifth postoperative day, the patient experienced an acute decline in consciousness. An emergency non-contrast head computed tomography (CT) scan revealed a remote left parietal intracerebral haemorrhage (ICH) of approximately 20cc, associated with an acute left frontoparietal subdural haematoma (SDH), causing a significant midline shift. Despite the severity of the radiological findings, the patient was managed successfully with non-operative medical therapy. She made a full clinical recovery, and a three-month follow-up magnetic resonance imaging (MRI) confirmed complete resolution of the haematomas with no evidence of residual tumour or underlying vascular malformation. The clinical timeline and radiological pattern strongly suggest a venous aetiology. The most plausible mechanism is a cascade initiated by an occult cerebrospinal fluid (CSF) leak, leading to intracranial hypotension, cerebral ptosis, and the subsequent rupture of a cortical bridging vein. This case underscores the need for a high index of suspicion for remote intracranial haemorrhage (RIH) in any patient with delayed neurological deterioration after transsphenoidal surgery. Furthermore, it demonstrates that this life-threatening complication can often be managed successfully with conservative therapy.

Background: Anterior basal meningioma extends from the crista galli to the tuberculum sellae. They can be surgically approached through pterional, anterior bi-frontal trans-basal, eyebrow, trans-nasal, and notably through the fronto-lateral approach (FLA). Here, we highlight the feasibility and efficacy of this approach.Methods: A prospective observational study was conducted on 45 patients with anterior basal meningiomas using fronto-lateral, pterional, eyebrow, and bifrontal trans-basal approaches. Key surgical parameters assessed included brain retraction, cisternal opening, cerebrospinal fluid (CSF) aspiration, optic canal de-roofing, nerve decompression, duration, blood loss, bony work, and postoperative complications such as CSF leakage, muscle atrophy, and nerve palsy.Results: The patients were followed for an average of 2.8 years. Olfactory groove meningiomas accounted for 35.5% and tuberculum sellae for 46.6%, with headache and visual loss being common symptoms. Gross total resection was achieved in 95% of cases. The FLA was associated with the shortest operative time (P = 0.00001), high surgical unilaterality, minimal retraction, early CSF aspiration, less blood loss, reduced bony work, and better nerve preservation.Conclusion: The fronto-lateral (lateral supra-orbital) approach is the most in line with the principles of simplicity and safety. The use of papaverinated saline combined with early optic canal de-roofing has been associated with significant visual improvement in cases presenting with visual deterioration.

Effective reconstruction of skull base defects after endonasal endoscopic surgery is essential to prevent complications such as cerebrospinal fluid leakage and infection. Traditional methods may not always provide optimal outcomes for certain defects. This study evaluates the feasibility of using the Amplatzer Septal Occluder (ASO) as an adjunctive tool for skull base reconstruction in a cadaveric model. Three fresh cadavers were used to simulate endonasal endoscopic approaches for resecting skull base pathologies. Defects measuring 8 × 8 mm and 10 × 10 mm were created in the sella turcica, tuberculum sellae, planum sphenoidale, and olfactory groove. The ASO was deployed using a standard delivery system, with the distal disc positioned intracranially and the proximal disc in the nasal cavity. High-resolution endoscopic imaging and scopic views were obtained to assess the anatomic fit and functional integrity of the reconstruction. The ASO provided stable coverage for all defect sites without compressing critical neurovascular structures. The device conformed well to the irregular contours of the skull base. Functional testing using barium liquid demonstrated minimal to no leakage into the nasal cavity, suggesting the potential for a watertight seal. Imaging highlighted the ASO's feasibility as a structural component in multilayer reconstruction strategies. The ASO demonstrates significant promise as a supplementary tool for skull base reconstruction in endonasal endoscopic surgery. Its incorporation into a multilayer closure strategy could improve defect stability and reduce postoperative complications. Future studies are necessary to explore device customization, bioresorbable materials, and injectable bioactive substances to evaluate outcomes before clinical implementation in humans.

ABSTRACTBackgroundExtended endoscopic endonasal transsphenoidal approaches (ExEETSA) commonly result in high‐flow cerebrospinal fluid (CSF) leaks that demand robust reconstruction strategies. Although nasoseptal flap (NSF) is a standard reconstructive technique, high‐flow grade 3 CSF leaks require additional rigid reconstruction. This study evaluated the long‐term outcomes of collagen matrix‐hydroxyapatite (HXA)‐NSF for rigid skull base reconstruction without lumbar drain.MethodsA retrospective cohort study was conducted on 100 patients undergoing ExEETSA involved intraoperative high‐flow grade 3 CSF leak that were managed using a collagen matrix for dural repair followed by HXA and NSF reconstruction without lumbar drainage between January 2016 and December 2023. The primary outcomes assessed were postoperative CSF leakage, meningitis, and HXA‐related complications.ResultsThe median skull base defect diameter was 22.9 mm. Tuberculum sellae meningioma represented the predominant pathology (39.0%), with the transplanum/transtuberculum region being the most commonly affected area (77.0%). Postoperative CSF leakage occurred in 4% of cases. HXA exposure accompanied by partial NSF necrosis was observed in eight patients (8.0%). Of these, complete re‐mucosalization of the exposed HXA surface was achieved in five patients (62.5%), with a mean healing time of 23.6 months. There were no cases of meningitis or local infection requiring reoperation.ConclusionThe combination of collagen matrix, HXA, and NSF without lumbar drainage represents a safe and effective reconstruction strategy for managing intraoperative high‐flow Grade 3 CSF leaks in ExEETSA. This reconstructive technique yielded favorable outcomes, characterized by a low incidence of postoperative CSF leakage, manageable complications, and sustained long‐term effectiveness.Level of Evidence: IV.

The bibliometric approach investigates publications quantitatively and analyzes them with statistics. The aim of this study was to use bibliometric techniques to conduct a thorough survey of the literature on the optic canal in order to identify trends and uncommon subjects pertaining to the canal. The publications related to the optic canal were obtained using the Web of Science database. The literature review yielded 1030 publications in all. The bibliometric techniques were employed to analyze the identified publications (VOSviewer Version 1.6.20). The 1970s marked the beginning of research on the optic canal. The United States is the most productive country (198 articles). The majority of the publications were determined to be published in World Neurosurgery and the Journal of Neurosurgery. 94.01% of the publications were written in English, making up the majority. Optic nerve, meningioma, skull base, orbit, anatomy, sphenoid sinus, tuberculum sellae meningioma, optic canal decompression, ophthalmic artery, and optic neuropathy were found to be the most frequently used terms in the articles pertaining to optic canal. Findings demonstrated the researchers’ interest in the optic canal and offered quantifiable information regarding the canal’s position within science. Recent years have seen a rise in the number of studies conducted on this topic. This research represents, to the best of our knowledge, the first bibliometric analysis since 1970 that offers a thorough examination of scholarly publications with a focus on the optic canal.

The expanded endoscopic endonasal approach (EEA) has emerged as a viable alternative technique for the removal of tuberculum sellae meningioma (TSM) and planum sphenoidale meningioma (PSM), offering early tumor devascularization, wide optic canal decompression, while avoiding brain manipulation. The authors present 13-year experience with retrospective analysis evaluating the impact of tumor characteristics on the outcomes of TSM and PSM resections using the expanded EEA. Patients who underwent expanded EEA for TSMs or PSMs from 2010 to 2022 were analyzed. Patient's demographics, preoperative evaluations, tumor features, previous treatments, surgical outcomes, complications, follow-up, and recurrence rates were reviewed. Meningiomas were classified using the Sekhar-Mortazavi classification. The study included 52 patients (32 with TSMs and 20 with PSMs). Visual impairment was the most common presenting symptom, occurring in 41 patients (78.8%). Gross-total resection (GTR) was achieved in 42 patients (80.7%), reaching 92% for Sekhar-Mortazavi class I tumors. GTR rates decreased with larger tumor size, optic pathway involvement, and vascular encasement. Fibrous and fibroelastic tumors had lower resection rates. The postoperative cerebrospinal fluid leak rate decreased from 23.3% (2010-2017) to 9% (2018-2022), and 34 patients (79%) experienced visual improvement after surgery. The expanded EEA is a safe and effective technique for the resection of TSM and PSM, facilitating GTR and improving visual outcomes.

Abstract The expanded endonasal approach (EEA) is historically associated with high rates of postoperative cerebrospinal fluid (CSF) leak. Therefore, many surgeons advocate for routine lumbar drain (LD) placement despite mixed evidence of their efficacy. We report outcomes for anterior and central skull base reconstructions after EEA without LDs.A retrospective review was conducted evaluating consecutive patients undergoing EEAs for resection of central and anterior skull base pathology from 2015 to 2024 at two academic institutions.Incidence of postoperative CSF leak.Eighty-five patients underwent a total of 89 EEAs. Patients were predominantly female (62.9%) with an average age of 45.1 years (range 11 months–84 years). Tumors included primarily craniopharyngiomas (49.4%) and meningiomas (46.1%). No LDs were placed perioperatively, and there was an 100% intraoperative high-flow CSF leak rate. Skull base reconstruction was performed using pedicled nasoseptal flaps (NSFs) in all cases, tensor fascia lata grafts in 82 cases, and fat grafts in 78 cases. The postoperative CSF leak rate was 7.9%. Suprasellar tumors were associated with lower rates of postoperative CSF leak compared with tuberculum sella and planum sphenoidale pathology (p = 0.030), whereas meningiomas trended toward higher CSF leak rates compared with craniopharyngiomas (p = 0.059).We report a low rate of postoperative CSF leak without LD placement after EEA. Our results suggest that successful skull base reconstructions may be performed with multilayered closures using vascularized NSFs without the need for routine CSF diversion.

To analyze the relationship of the height of the pituitary gland (HPG) with the heights of the dorsum sellae (HDS) and tuberculum sellae (HTS) on pediatric magnetic resonance imaging (MRI) views. MRI slices of 180 healthy children (100 males and 80 females) aged 1-18 years were included in the study. Average HPG, HTS and HDS values were determined as 6.66 ± 1.58mm, 10.97 ± 1.99mm, 13.62 ± 2.67mm, respectively. No statistically significant difference was determined between the measurements in term of sex. All parameters correlated with pediatric ages. HPG increased up to the prepubescent period, and decreased after this period (p < 0.001). HDS and HTS increased with an irregular pattern (p < 0.001). There were six children (3.33%) with HPG > 10mm. There was no child with HPG/HDS > 1 or HPG/HTS > 1. This work provided three substantial additions to the literature as follows: (a) all pediatric HPGs were distinctly smaller than HDSs and HTSs, (b) some children (3.33%) at puberty (age range: 10-14 years), regardless of sex, might have a HPG > 10mm, even though there was no pathology at the pituitary gland, and (c) to our knowledge, this retrospective MRI examination evaluated the relation of HPG with variant sella morphology in normal children for the first time in the literature.

The purpose of this study was to investigate the clinical characteristics of parasellar meningioma patients treated with endoscopic endonasal surgery (EES) to determine the characteristics of the rare group of intrasellar (IS) meningiomas.Thirty-six patients (5 males and 31 females; age range, 28-89 years) with parasellar meningioma underwent EES from 2011 to 2022 at our institution. The patients were divided into groups according to the tumor site. We retrospectively compared clinical data of IS meningioma patients with other parasellar meningioma patients before and after surgery.There were 5 IS, 26 tuberculum sellae, 2 anterior clinoid process, 2 cavernous sinus, and 1 sphenoid-cavernous-petroclival (SCP) meningioma cases. Imaging revealed compression of the pituitary lobe or pituitary stalk in 22 patients, 5 of whom had IS meningiomas or SCP meningiomas occupying the intrasellar region. All the IS meningiomas were occupying the sella turcica; 4/5 had different preoperative diagnoses, and 4/5 induced hypopituitarism. Cavernous sinus invasion was observed in three cases of IS meningiomas, with total resection achieved in one case. In patients with other parasellar meningiomas, preoperative hypopituitarism was observed only in SCP meningiomas. There was no significant difference in the incidence of postoperative diabetes insipidus and hyponatremia between IS meningiomas and other parasellar meningiomas.EES may enable the successful removal of IS meningiomas, but total resection may be difficult in the presence of cavernous sinus invasion. Preoperative hypopituitarism occurs in patients with tumors occupying the sella turcica.

Introduction. The compressive effect on the chiasm is characteristic of skull base tumors of the middle and anterior cranial fossae, among which pituitary adenoma, tuberculum sellae meningioma and supradiaphragmatic craniopharyngioma are most common. The goal of treatment of skull base tumors is to decompress the anterior visual pathway and to improve or restore visual function; however, in some patients, visual deficits persist despite successful surgical intervention. For the prevention of irreversible vision loss and blindness, early diagnosis of tumors and determination of risk factors for the development of irreversible vision loss in skull base tumors play an important role. Prediction of the ophthalmic outcome after removal of skull base tumors remains a difficult and important issue. Aim. To analyze risk factors for the development of irreversible vision loss in tumors of the sellar region. Materials and methods. The results of diagnosis and treatment of 300 patients (600 eyes) with skull base tumors, who were treated at the National Academy of Medical Sciences of Ukraine Romodanov Neurosurgery Institute from 2017 to 2023. Depending on the ophthalmological result after the removal of the skull base tumors and decompression of the chiasm, the patients were divided into 2 subgroups: I – recovery of visual functions (100 patients, 33.3%, 200 eyes), II – without recovery of visual functions (200 patients, 66.7 %, 400 eyes). Neurological, ophthalmological and neurovisualization was used for an observation. Results. In our study, an analysis of risk factors for the development of irreversible vision loss in patients with skull base tumors was conducted. The analysis showed that the following factors: age, gender, histological type of tumor, the presence of strongly asymmetric chiasmal syndrome had no prognostic negative influence on the outcome of compressive optic neuropathy (p&gt;0.05). It was found that the duration of symptoms, the level of preoperative visual acuity and visual field, changes in the morphostructural parameters of the optic nerve and retina, and the size of the tumors have a significant negative prognostic value for the ophthalmological outcome (p&lt;0.05). Conclusions. The interaction of many factors, including the duration of symptoms, tumor volume, preoperative visual acuity level, visual field, morphostructural parameters of the optic nerve and retina, can have an effect on the functional visual outcome after the removal of the skull base tumors.

ObjectiveThere is a lack of available data regarding the incidence and characteristics of optic canal invasion (OCI) in large midline non-tuberculum sellae anterior skull base meningiomas (NTSAM), specifically those originating predominantly from the olfactory groove and planum sphenoidale. This study aims to describe the incidence and characteristics of OCI as well as clinical and visual outcomes following extensive tumor resection with optic canal exploration in intra-optic canal tumor removal. In addition, the predictive performance of OCI by preoperative magnetic resonance imaging (MRI) is investigated.Materials and methodsFrom 2016 to 2024, we retrospectively reviewed 24 patients with large midline NTSAM who underwent extensive tumor resection in our institution. The OCI was evaluated and compared between preoperative MRI and intraoperative findings. The OCI was classified as follows. Type 1 represented no invasion, type 2 represented secondary invasion, type 3 represented partial wall invasion (two subtypes), and type 4 represented invasion into the superior-medial-inferior walls of the optic canal. Visual functions were assessed before and after surgery.ResultsAmong 24 patients, a mean tumor size of 57.2 mm (range 39.0–79.0). The OCI was observed intraoperatively in 22 cases (91.7%), with 19 cases exhibiting bilateral OCI. Among the 48 optic canals in the 24 patients, 18 (37.5%) were type 4, 12 (25.0%) were type 3-inferomedial, 9 (18.8%) were type 3-superomedial, and 2 (4.2%) were type 2, where 7 (14.6%) optic canals were without OCI. A significant correlation was observed between intraoperative OCI and the tumors that exhibited involvement of the tuberculum sellae (TS) on MRI (p < 0.001). For patients with visual impairment, the vision in 27 of 38 (71.1%) eye sides showed improvement following the surgery. There was 1 (4.2%) case of tumor recurrence at the mean follow-up time of 27.3 months (range 4–73 months).ConclusionsA high incidence of OCI was observed in the large midline NTSAM. The identification of TS involvement on MRI can serve as a strong predictor of OCI. Therefore, optic canal exploration to remove the optic canal invasion during the surgical removal of these particular tumors should be contemplated to attain radical tumor resection to enhance the possibility of improving visual function and reduce the risk of recurrence.