Abstract
OBJECTIVE: Tubercu I um sel I ae men ingiomas are class i L-a I ly removed through several different surgical transcranial approaches, including the pterional transsylvian route. Recently, the indications for the transsphenoidal techniq lie, traditionally proposed only for the treatment of intrasellar lesions, have been exten,ecl to include lesions located in the supra- and parasellar areas and, among them, tul lerculum sellae meningiomas. We describe the surgical technique for the purely endo,,,copic endonasal variant of the extended transsphenoidal "low route" to tuberculum SE Ilae meningiomas.
PATIENTS AND METHODS: Over a 22-month period, Si i< patients (three men and three women; mean age, 56.1 yr; age range, 44-70 yr) under bent an extended encloscopic transsphenoidal approach for the treatment of tubercu um sellae meningiomas. Two I d 4 cm in size. The details of lesions were less than 2 cm and four were between 2 a the surgical technique have been described.
RESULTS: Gross total removal of the lesion, without thi! need for brain retraction and with minimal neurovascular manipulation, was achh1ved in five patients (83.3%), whereas in one patient, only subtotal removal was poss Ible (>90%) because the mass extended into the right optic canal. Four patients wit I preoperative visual function defects had complete recovery, whereas two patients exI I erienced a temporary worsening of vision. Both of these patients fully recovered with in a few days. One patient had a postope ative cerebrospinal fluid leak that required tl- Fee operations for cranial base defect repair. This patient showed rapid and unexpected,vorsening with respect to level of consciousness and anisocoria. An intraventricular hie,norrhage was discovered, and the patient died 6 days later. Another patient develo!)ed new permanent diabetes insipiclus that required hormonal replacement therapy.
CONCLUSION: In experienced hands and in carefully selected patients, the extended encloscopic transsphenoidal approach may constitute '2 viable alternative to transcranial approaches for tuberculum sellae meningioma. At 1 iresent, the major limits of the approach include the lack of a reliable technique for i he reconstruction of a cranial base defect and inadequate follow-up.