How I do it: contralateral supraorbital approach for tuberculum sellae meningioma

Contralateral supraorbital eyebrow approach for tuberculum sellae meningioma

BACKGROUND

The main challenge in tuberculum sellae meningioma (TSM) resection is the safe dissection of the optic nerves, which many a times are compressed and distorted by the tumor. While intuitive, an approach from the side of predominant tumor extension makes tumor dissection from the medial surface of the ipsilateral optic nerve rather blind. We describe here a contralateral supraorbital eyebrow approach (c-SEA) to address this "blind spot."

METHOD

c-SEA was performed using a 2 × 2 cm craniotomy. The patient improved after surgery and postoperative imaging confirmed the totality of the tumor resection.

CONCLUSION

c-SEA can be an excellent minimally invasive option for asymmetric TSM.

How I do it: optic canal unroofing in surgery for tuberculum sellae meningiomas with compression of the optic nerve

BACKGROUND

Tuberculum sellae meningiomas are challenging to treat when accompanied with altered vision due to compression of the optic nerve. These tumors mostly refer to be benign; therefore, gross total removal and excellent functional recovery are desired.

METHOD

We describe the microsurgical treatment of tuberculum sellae meningioma with altered vision function on the left eye. Intradural unroofing of the optic canal with gross total resection of the tumor led to immediate excellent recovery. Intraoperative video highlights key steps of our surgical approach.

CONCLUSION

Optic canal unroofing is in our opinion safe and mandatory when treating tuberculum sellae meningiomas with compression of optic nerve.

Resection of Tumors Located in the Anterior Skull Base and Sellar Region Through the Supraorbital Keyhole Approach via a Forehead Wrinkle Incision: Modifications and Deficiencies

OBJECTIVE

To investigate the clinical effect of the supraorbital keyhole approach (SKA) via a forehead wrinkle incision in the resection of tumors in the anterior skull base and sellar region.

METHODS

Sixty patients with tumors located in the anterior skull base and sellar region treated through the SKA in our hospital from 2017 to 2020. The skin incision and bone flap position were designed individually according to the size and growth of the tumor. The clinical data of the patients were retrospectively analyzed.

RESULTS

Based on the feasibility of this surgical approach, personalized skin incisions and bone flaps were designed for different lesions. Among the 60 patients, gross total resection was achieved in 53 cases (88.3%), for meningiomas 97.8% (46/47) and near-total resection in 7 cases (11.7%). In the survey of the patients' scale scores toward skin incision after operation, the "no pain"' level was 90.0% (54/60) and 91.7% (55/60) for the level of "very satisfactory"' of the aesthetic of the skin incision (as shown in Supplementary Digital Content, Table 2, http://links.lww.com/SCS/D742). Three patients whose satisfaction with the aesthetic of the incision excelled scale 3, suggesting that they were not completely satisfied with the wound healing. No permanent skin incision discomfort was noted during follow-up. There were no surgical deaths.

CONCLUSIONS

The SKA via forehead wrinkle incision is a flexible and feasible method for tumors near the midline of the anterior skull base and sellar region. However, this approach requires strict preoperative planning, which includes choosing appropriate tumors and applicable forehead wrinkles.