Endoscopic Endonasal Removal of Primary/Recurrent Meningiomas in the Medial Optic Canal: Surgical Technique and Long-Term Visual Outcome

2019 ◽  
Vol 17 (5) ◽  
pp. 470-480 ◽  
Author(s):  
Kiyohiko Sakata ◽  
Nobuyuki Takeshige ◽  
Yui Nagata ◽  
Hidenobu Yoshitake ◽  
Satoru Komaki ◽  
...  
Keyword(s):  
Visual Loss ◽  
Visual Disturbance ◽  
Optic Canal ◽  
Maximum Diameter ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Tumor Removal ◽  
Endoscopic Endonasal ◽  
Average Maximum ◽  
Tuberculum Sellae

Abstract BACKGROUND Tuberculum sellae meningiomas frequently extend into the optic canals, which leads to a progressive longitudinal visual loss. Therefore, in addition to tumor removal, unroofing and exploration inside the optic canal are important procedures. OBJECTIVE To perform endoscopic endonasal tumor removal with optic canal decompression for small primary or recurrent meningiomas associated with a progressive visual loss at the inferior-medial optic canal, which corresponded to a blind corner in the ipsilateral pterional/subfrontal approach. METHODS We retrospectively reviewed 2 cases of primary meningiomas that arose in the inferior-medial optic canal and 4 recurrent cases from the remnant inside the medial optic canal that had previously undergone craniotomy for tuberculum sellae meningiomas, and were treated by the endoscopic endonasal approach. RESULTS All tumors were detectable and could be removed without manipulation of the affected optic nerve. The average maximum diameter of the tumor was 8.4 mm (range: 5-12 mm). Two patients who had a long history of progressive visual disturbance and papillary atrophy did not recover from severe visual disturbances postoperatively. However, others showed considerable improvement, maintaining postoperative visual function during follow-up. There were no postoperative complications. CONCLUSION Endoscopic endonasal approach has several advantages for meningiomas in the medial optic canal and associated with progressive visual disturbance. In surgery of tuberculum sellae meningiomas, optic canal decompression and exploration inside the optic canal are important procedures to avoid symptomatic recurrence, which may be facilitated by the endoscopic endonasal approach. Papillary atrophy and duration of visual deterioration are predictive factors for postoperative visual outcomes.

scholarly journals How I do it: endoscopic endonasal resection of tuberculum sellae meningioma

2021 ◽  
Author(s):  
Markus Wiedmann ◽  
Aslan Lashkarivand ◽  
Jon Berg-Johnsen ◽  
Daniel Dahlberg
Keyword(s):  
Team Approach ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Ongoing Debate ◽  
Endoscopic Endonasal ◽  
Microsurgical Technique ◽  
Tuberculum Sellae Meningioma ◽  
Tuberculum Sellae ◽  
Dedicated Team ◽  
Neurovascular Structures

Abstract Background Tuberculum sellae meningiomas (TSMs) adherent to neurovascular structures are particularly challenging lesions requiring delicate and precise microneurosurgery. There is an ongoing debate about the optimal surgical approach. Method We describe technical nuances and challenges in TSM resection using the endoscopic endonasal approach (EEA) in two cases of fibrous tumors with adherence to neurovascular structures. The cases are illustrated with a video (case 1) and figures (cases 1 and 2). Conclusion A dedicated team approach and precise microsurgical technique facilitate safe resection of complex TSMs through the EEA.

Endoscopic Endonasal Approach for Tuberculum Sellae Meningiomas

Neurosurgery ◽  
2011 ◽  
Vol 69 (1) ◽  
pp. E260-E261 ◽  
Author(s):  
Juan C Fernandez-Miranda ◽  
Paul A Gardner ◽  
Carl H Snyderman
Keyword(s):  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Tuberculum Sellae

Endoscopic Endonasal Approach to the Optic Canal: Anatomical Considerations and Surgical Relevance

2015 ◽  
Vol 76 (S 01) ◽  
Author(s):  
Kumar Abhinav ◽  
Yancy Acosta ◽  
Luis Bonilla ◽  
Wei Wang ◽  
Maria Koutourousiou ◽  
...  
Keyword(s):  
Optic Canal ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

scholarly journals The expanded endoscopic endonasal approach for treatment of tuberculum sellae meningiomas in a series of 40 consecutive cases

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Peng Yu ◽  
Tutu Xu ◽  
Xinyu Wu ◽  
Zhitong Liu ◽  
Yong Wang ◽  
...  
Keyword(s):  
Anterior Cerebral Artery ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Total Resection ◽  
Endoscopic Endonasal ◽  
Tuberculum Sellae Meningioma ◽  
Csf Leakage ◽  
Invasive Method ◽  
Tuberculum Sellae

AbstractCompared with traditional craniotomy, the expanded endoscopic endonasal approach (EEEA) may have some advantages for tuberculum sellae meningioma (TSM) treatment. We described our experience of the therapeutic effect of endoscopic TSM treatment. From August 2015 to December 2019, 40 patients with a TSM were treated by the EEEA in our institution. EEEA outcome in TSM treatment was analyzed. Among 39 patients with visual impairment, 38 (97.4%) improved their visual function to some extent after the EEEA, and one case had no significant change in visual acuity. Among all patients, 38 (95.0%) achieved gross total resection (GTR) and 2 (5.0%) achieved near-total resection (NTR). Cerebrospinal fluid (CSF) leakage occurred in three patients (7.5%) and meningitis (post-CSF leakage) in two patients (5.0%). Eight patients (20.0%) suffered postoperative hyposmia, three of whom developed long-term hyposmia. One patient (2.5%) suffered from bleeding of the branch of the anterior cerebral artery intraoperatively leading to postoperative acute cerebral infarction. The EEEA is a safe and reliable minimally invasive method for TSM removal. Compared with traditional craniotomy, the EEEA may have better visual outcomes and a higher prevalence of GTR, but carries the risk of CSF leakage.

scholarly journals Effectiveness of Optic Decompression by Endoscopic Endonasal Approach on Patients with Traumatic Fracture of Optic Canal

OALib ◽  
2017 ◽  
Vol 04 (06) ◽  
pp. 1-8
Author(s):  
Rongjiang Luo ◽  
Zhichao Yan ◽  
Wentong Xia ◽  
Xianping Zeng ◽  
Rui Xu ◽  
...  
Keyword(s):  
Optic Canal ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Traumatic Fracture

scholarly journals A Study of Pituitary Adenoma Surgery: Transphenoidal Microscopic Versus Endoscopic Endonasal Approach

2015 ◽  
Vol 31 (1) ◽  
pp. 21-29
Author(s):  
Haradhan Deb Nath ◽  
Kanak Kanti Barua ◽  
Kazi Hafiz Uddin ◽  
Monirul Islam ◽  
Omar Faruque ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Visual Disturbance ◽  
Minimal Invasive ◽  
Endoscopic Approach ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Normal Vision ◽  
Microscopic Approach ◽  
Endoscopic Endonasal ◽  
Better Than

Background: Transphenoidal endoscopic approach is minimal invasive surgery in case of pituitary adenoma. Objective : To see the outcome of transphenoidal endoscopic and microscopic approach in case of pituitary tumor. Results : This study showed among the 37 patients, 25 (67.6%) were done by transphenoidal microscopic approach and 12 (32.4%) patients were done by endonasal endoscopic approach. Among the 12 patients 8(66.7%) were male and 4(33.3%) were female. Among the 25, patients 15(60%) were male and 10(40%) were female. It was documented that in 12 patients, 10(83.3%) were macroadenoma and 2(16.7%) were microadenoma. It was evident that among the 25 patient 18(72%) were macroadenoma and 7(28%) were microadenoma. Among 12 patients, 11 (91.7%) had preoperative visual disturbance and 1(8.3%) had normal vision. It was observed that among 25 patients, 23(92%) patients had preoperative visual disturbance and 2 (8%) patients had normal vision. Tumor was totally removed in 9(75%) patients in endoscopic approach and 14(56%) in microscopic approach. Clinically 10(83.3%) patients were improved in endoscopically and 16(64%) patients were improved in microscopic group. Conclusion: It was concluded that endoscopic endonasal approach is better than transphenoidal microscopic approach. Bangladesh Journal of Neuroscience 2015; Vol. 31 (1): 21-29

Endoscopic Endonasal versus Transcranial Optic Canal Decompression: A Morphometric, Cadaveric Study

2021 ◽  
Author(s):  
Jun Kim ◽  
Aaron R Plitt ◽  
Awais Vance ◽  
Scott Connors ◽  
James Caruso ◽  
...  
Keyword(s):  
Anatomical Study ◽  
Contralateral Side ◽  
Lateral Approach ◽  
Ct Scans ◽  
Optic Canal ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal ◽  
Transcranial Approach ◽  
The Mean

Abstract Introduction Decompression of the optic nerve within the optic canal is indicated for compressive visual decline. The two most common approaches utilized for optic canal decompression are a medial approach with an endoscopic endonasal approach and a lateral approach with a craniotomy. Our study is a cadaveric anatomical study comparing the length and circumference of the orbit decompressed via an endoscopic endonasal approach versus a frontotemporal craniotomy. Methods Five cadaveric specimens were utilized. Predissection computed tomography (CT) scans were performed on each specimen. On each specimen, a standard frontotemporal craniotomy with anterior clinoidectomy and superolateral orbital decompression was performed on one side and an endoscopic endonasal approach with medial wall decompression was performed on the contralateral side. Post-dissection CT scans were performed. An independent radiologist provided measurements of the length (mm) and circumference (degrees) of optic canal decompression bilaterally. Results The mean length of optic canal decompression for open and endoscopic approach was 13 mm (range 12–15 mm) and 12.4 mm (range 10–16 mm), respectively. The mean circumference of decompression for open and endoscopic approaches was 252.8 degrees (range 205–280 degrees) and 124.6 degrees (range 100–163 degrees), respectively. Conclusion The endoscopic endonasal and the transcranial approaches provide a similar length of optic canal decompression, but the transcranial approach leads to greater circumferential decompression. The endoscopic endonasal approach has the benefit of being minimally invasive, though. Ultimately, the surgical approach decision should be based on the location of the pathology and the surgeon's comfort.

scholarly journals Selection of endoscopic or transcranial surgery for tuberculum sellae meningiomas according to specific anatomical features: a retrospective multicenter analysis (KOSEN-002)

2019 ◽  
Vol 130 (3) ◽  
pp. 838-847 ◽  
Author(s):  
Doo-Sik Kong ◽  
Chang-Ki Hong ◽  
Sang Duk Hong ◽  
Do-Hyun Nam ◽  
Jung-Il Lee ◽  
...  
Keyword(s):  
Visual Outcome ◽  
Visual Disturbance ◽  
Optic Canal ◽  
Surgical Approaches ◽  
Anterior Clinoid Process ◽  
Endoscopic Endonasal ◽  
Anatomical Features ◽  
Significant Difference ◽  
Stable Vision ◽  
Tuberculum Sellae

OBJECTIVEThe endoscopic endonasal approach (EEA) and the transcranial approach (TCA) are good options for the treatment of tuberculum sellae (TS) meningiomas. The objective of this study was to identify the key anatomical features in TS meningiomas and compare the two surgical approaches.METHODSThe authors retrospectively reviewed clinical data in 178 patients with TS meningiomas treated at 3 institutions between January 2010 and July 2016. Patients with tumors encasing the internal carotid artery or anterior cerebral artery or involving the anterior clinoid process or cavernous sinus were excluded. Tumors were classified as high-lying or low-lying based on their location, and involvement of the optic canal was evaluated. The surgical outcomes of EEA and TCA were analyzed according to the relevant anatomical features.RESULTSDuring the study period, 84 patients underwent EEA and 94 patients underwent TCA. Based on preoperative MR images, 43 (24.2%) meningiomas were classified as high-lying tumors, 126 (70.8%) as low-lying, and 9 (5.0%) as nonspecific. Gross-total resection (GTR) was performed in 145 patients (81.5%); the GTR rate did not differ significantly between the EEA and TCA groups. Of 157 patients with preoperative visual disturbance, 140 had improved or stable vision postoperatively. However, 17 patients (9.6%) experienced some visual deterioration after surgery. The TCA group had a worse visual outcome than the EEA group in patients with preoperative optic canal involvement (77.6% vs 93.2%, p = 0.019), whereas there was no significant difference in visual outcome based on whether tumors were high-lying or low-lying.CONCLUSIONSThe results of this study support EEA over TCA, at least with respect to visual improvement with acceptable complications, although TCA is still an effective approach for TS meningioma.

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