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Lin PW, You W, Guo AS, Lin ZR, Wang YZ. Efficiency and safety of optic canal unroofing in tuberculum sellae meningiomas: a meta-analysis and systematic review. Neurosurg Rev 2023; 46:240. [PMID: 37698750 PMCID: PMC10497650 DOI: 10.1007/s10143-023-02151-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/31/2023] [Accepted: 09/06/2023] [Indexed: 09/13/2023]
Abstract
Optic canal unroofing (OCU) has gradually become a routine technique for tuberculum sellae meningiomas (TSMs) resection. This meta-analysis aimed to evaluate the efficacy and safety of OCU. A systematic review and meta-analysis of the published literature on this topic from 2003 to 2023 were conducted in accordance with the PRISMA guidelines. Rigorous statistical analysis with a p-value was performed for related change in visual improvement, gross total resection (GTR), visual deterioration, and olfactory nerve damage. The study included 15 articles with 384 patients in whom OCU was performed by the transcranial approach (TCA) or the endoscopic endonasal approach (EEA). Of these, 341 patients had preoperative visual loss, and 266 patients had postoperative visual recovery. The overall rate of visual improvement was 0.803 (95% CI: 0.733-0.874, p < 0.01). The rate of visual improvement in the EEA and TCA groups was 0.884 (95% CI: 0.803-0.965, p < 0.01) and 0.788 (95% CI: 0.700-0.875, p < 0.01). Further analysis of classification shows that the rate of visual improvement in Type I: < 2 cm was 0.889(95% CI: 0.739-0.969), Type II:2-4 cm was 0.844(95% CI: 0.755-0.910), Type III: > 4 cm was 0.500(95% CI: 0.068-0.932) and the total was 0.853(95% CI: 0.779-0.927 p < 0.01) with low heterogeneity of I2 = 20.80%.Twelve studies separately reported GTR with OCU was 293; the rate of GTR was 0.911 (95% CI: 0.848-0.961, p < 0.01). And the rate of GTR in Type I: < 2 cm was 0.933(95% CI: 0.817-0.986), Type II:2-4 cm was 0.880(95% CI: 0.800-0.936), Type III: > 4 cm was 0.600(95% CI: 0.147-0.947). The total was 0.897(95% CI: 0.830-0.965 p < 0.01) with low heterogeneity of I2 = 34.57%. The related complications of OCU were visual deterioration and olfactory nerve damage. Visual decline was reported in nine studies, and the rate was 0.077 (95% CI: 0.041-0.113, p < 0.01). Six studies reported olfactory nerve damage, and the overall rate was 0.054 (95% CI: 0.019-0.090, p < 0.01). OCU could significantly recover preoperative impaired vision and make GTR easier to achieve, which was also a safe and effective technique in TSM.
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Affiliation(s)
- Peng-Wei Lin
- The School of Clinical Medicine, Fujian Medical University, Zhangzhou Affiliated Hospital of Fujian Medical University, Fuzhou, 350122, Fujian Province, China
| | - Wei You
- Department of Neurosurgery, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, Fujian Province, China
| | - Ai-Shun Guo
- Department of Neurosurgery, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, Fujian Province, China.
| | - Zhen-Rong Lin
- Department of Neurosurgery, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, Fujian Province, China
| | - Yu-Zhe Wang
- Department of Neurosurgery, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, Fujian Province, China
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Sasaki T, Morisako H, Ikegami M, Wardhana DW, Fernandez-Miranda JC, Goto T. Endoscopic Supraorbital Eyebrow Approach for Medium-Sized Tuberculum Sellae Meningiomas: A Cadaveric Stepwise Dissection, Technical Nuances, and Surgical Outcomes. World Neurosurg 2023; 176:e40-e48. [PMID: 36940807 DOI: 10.1016/j.wneu.2023.03.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Tuberculum sellae meningiomas (TSMs) have traditionally been removed using a transcranial approach. In recent years, endoscopic surgery for TSMs has been reported with an expansion of indications. OBJECTIVE We have performed a fully endoscopic supraorbital keyhole approach for small to medium-sized TSMs and performed radical tumor removal similar to conventional transcranial procedure. We report the details of this surgical procedure including cadaveric stepwise dissection and initial surgical results for small to medium-sized TSMs. METHODS We used an endoscopic supraorbital eyebrow approach for 6 patients with TSMs between September 2020 and September 2022. Mean tumor diameter was 16.0 mm (range, 10-20 mm). The surgical approach included an eyebrow skin incision ipsilateral to the lesion, a small frontal craniotomy, subfrontal exposure of the lesion, removal of the tuberculum sellae, unroofing of the optic canal, and resection of the tumor. The extent of resection, preoperative and postoperative visual function, complications, and operative time were evaluated. RESULTS Optic canal involvement was observed in all patients. Two patients (33%) showed visual dysfunction before surgery. Simpson grade 1 tumor resection was achieved in all cases. Visual function was improved in 2 cases, and remained unchanged in 4 cases. Postoperative pituitary function was preserved in all cases, with no decreases in olfaction. CONCLUSIONS The endoscopic supraorbital eyebrow approach for TSMs allowed resection of the lesion, including tumor extending to the optic canal, with a good surgical view. This technique is minimally invasive for patients and may represent a good surgical option for medium-sized TSMs.
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Affiliation(s)
- Tsuyoshi Sasaki
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
| | - Hiroki Morisako
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan; Department of Neurosurgery, Stanford University, Palo Alto, California, USA
| | - Masaki Ikegami
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Donny Wisnu Wardhana
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | | | - Takeo Goto
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Yan H, Yan C, Mao J, Jin W. Case report: A rare case of thyrotropin-secreting pituitary macroadenoma with diffuse calcification presenting with hyperthyroidism and literature review. Front Oncol 2023; 13:1121140. [PMID: 36874111 PMCID: PMC9978486 DOI: 10.3389/fonc.2023.1121140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/27/2023] [Indexed: 02/18/2023] Open
Abstract
Background Thyroid-stimulating hormone (TSH)-secreting pituitary adenomas (TSHomas) are rare and usually present with hyperthyroidism. Calcification in pituitary tumors is an infrequent finding. Herein, we report an extremely rare case of TSHoma with diffuse calcification. Case description A 43-year-old man was admitted to our department with a complaint of palpitations. An endocrinological examination revealed elevated serum levels of TSH, free triiodothyronine (FT3), and free thyroxin, whereas the physical examination revealed no obvious abnormality. Computerized tomography (CT) showed a sellar mass with diffuse calcification. Contrast-enhanced T1-weighted images revealed a less-enhancing tumor without obvious suprasellar or parasellar expansion. The tumor was completely removed via endoscopic transnasal-sphenoidal surgery. Microscopically, nests of cells were inconspicuous among the diffuse psammoma bodies. Expression of TSH was patchy, and only several TSH-positive cells were observed. Postoperatively, the serum levels of TSH, FT3, and FT4 decreased to their normal range. Follow-up MR images showed no evidence of residual tumor or regrowth after the resection. Conclusions Herein, we report a rare case of TSHoma with diffuse calcification that presented with hyperthyroidism. A correct and early diagnosis was made according to the European Thyroid Association guidelines. This tumor was completely removed via endoscopic transnasal-transsphenoidal surgery (eTSS), and thyroid function was normalized after the operation.
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Affiliation(s)
- Huiying Yan
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Chaolong Yan
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jiannan Mao
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Wei Jin
- Department of Neurosurgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Kachhara R, Nigam P, Nair S. Tuberculum Sella Meningioma: Surgical Management and Results with Emphasis on Visual Outcome. J Neurosci Rural Pract 2022; 13:431-440. [PMID: 35945998 PMCID: PMC9357473 DOI: 10.1055/s-0042-1745817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background
Tuberculum sella meningioma form a distinct surgical entity with significant morbidity for the patient due to early and profound visual involvement. Surgical treatment of tuberculum sella meningioma is challenging in view of the proximity of vital neuro-vasculature. These lesions may be approached via a high-route (trans-cranial) or a low-route (trans-sphenoidal).
Materials and Methods
The authors present a consecutive series of 36 patients, operated by the first author from 1996 onward, with an analysis of clinical presentation (emphasizing visual deterioration), imaging features, operative approaches, and outcome with postoperative visual status.
Results
There were 36 patients (72 eyes) in the series, 75% females and 25% males. The mean age of patients was 48.05 ± 10.02 years. In all, 88.89% had visual diminution, 50% had headache, 5.56% had behavioral changes, and 2.78% had seizures. The mean tumor size was 4.01 ± 1.01 cm. The frontotemporal approach was employed in 66.67% of patients, and all patients underwent a right-sided approach. There was no significant difference between improvement in the vision between the right eye and left eye, despite the fact that right-sided approach was employed in nearly cases.
Conclusion
While tuberculum sella meningioma have profound morbidity in terms of visual deterioration, timely surgical intervention may help patients gain serviceable vision postoperatively. We advocate the trans-cranial approach and find no difference in visual outcomes on employing right-sided approach, regardless of the side with worse vision.
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Affiliation(s)
- Rajneesh Kachhara
- Department of Neurosurgery, Institute of Neurosciences, Medanta Multi-Speciality Hospital, Indore, Madhya Pradesh, India
| | - Pulak Nigam
- Department of Neurosurgery, Institute of Neurosciences, Medanta Multi-Speciality Hospital, Indore, Madhya Pradesh, India
| | - Suresh Nair
- Department of Neurosurgery, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
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Youngerman BE, Banu MA, Gerges MM, Odigie E, Tabaee A, Kacker A, Anand VK, Schwartz TH. Endoscopic endonasal approach for suprasellar meningiomas: introduction of a new scoring system to predict extent of resection and assist in case selection with long-term outcome data. J Neurosurg 2021; 135:113-125. [PMID: 32707549 PMCID: PMC8111689 DOI: 10.3171/2020.4.jns20475] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/27/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The endoscopic endonasal approach (EEA) has gained increasing popularity for the resection of suprasellar meningiomas (SSMs). Appropriate case selection is critical in optimizing patient outcome. Long-term outcome data are lacking. The authors systematically identified preoperative factors associated with extent of resection (EOR) and determined the relationship between EOR and long-term recurrence after EEA for SSMs. METHODS In this retrospective cohort study, the authors identified preoperative clinical and imaging characteristics associated with EOR and built on the recently published University of California, San Francisco resectability score to propose a score more specific to the EEA. They then examined the relationship between gross-total resection (GTR; 100%), near-total resection (NTR; 95%-99%), and subtotal resection (STR; < 95%) and recurrence or progression with Kaplan-Meier survival analysis. RESULTS A total of 51 patients were identified. Radiographic GTR was achieved in 40 of 47 (85%) patients in whom it was the surgical goal. Significant independent risk factors for incomplete resection were prior surgery (OR 25.94, 95% CI < 2.00 to 336.49, p = 0.013); tumor lateral to the optic nerve (OR 13.41, 95% CI 1.82-98.99, p = 0.011); and complete internal carotid artery (ICA) encasement (OR 15.12, 95% CI 1.17-194.08, p = 0.037). Tumor size and optic canal invasion were not significant risk factors after adjustment for other variables. A resectability score based on the multivariable model successfully predicted the likelihood of GTR; a score of 0 had a positive predictive value of 97% for GTR, whereas a score of 2 had a negative predictive value of 87.5% for incomplete resection. After a mean follow-up of 40.6 ± 32.4 months (mean ± SD), recurrence was 2.7% after GTR (1 patient with atypical histology), 44.4% after NTR, and 80% after STR (p < 0.0001). Vision was stable or improved in 93.5% and improved in 67.4% of patients with a preoperative deficit. There were 5 (9.8%) postoperative CSF leaks, of which 4 were managed with lumbar drains and 1 required a reoperation. CONCLUSIONS The EEA is a safe and effective approach to SSMs, with favorable visual outcomes in well-selected cases. The combination of postoperative MRI-based EOR with direct endoscopic inspection can be used in lieu of Simpson grade to predict recurrence. GTR dramatically reduces recurrence and can be achieved regardless of tumor size, proximity or encasement of the anterior cerebral artery, or medial optic canal invasion. Risk factors for incomplete resection include prior surgery, tumor lateral to the optic nerve, and complete ICA encasement.
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Affiliation(s)
- Brett E. Youngerman
- Departments of Neurosurgery Weill Cornell Medicine, NewYork-Presbyterian Hospital
- Department of Neurosurgery, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, New York
| | - Matei A. Banu
- Department of Neurosurgery, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, New York
| | - Mina M. Gerges
- Departments of Neurosurgery Weill Cornell Medicine, NewYork-Presbyterian Hospital
- Department of Neurosurgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Eseosa Odigie
- Departments of Neurosurgery Weill Cornell Medicine, NewYork-Presbyterian Hospital
| | - Abtin Tabaee
- Otolaryngology Weill Cornell Medicine, NewYork-Presbyterian Hospital
| | - Ashutosh Kacker
- Otolaryngology Weill Cornell Medicine, NewYork-Presbyterian Hospital
| | - Vijay K. Anand
- Otolaryngology Weill Cornell Medicine, NewYork-Presbyterian Hospital
| | - Theodore H. Schwartz
- Departments of Neurosurgery Weill Cornell Medicine, NewYork-Presbyterian Hospital
- Otolaryngology Weill Cornell Medicine, NewYork-Presbyterian Hospital
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Ipsilateral vs controlateral approach in tuberculum sellae meningiomas surgery: a retrospective comparative study. Neurosurg Rev 2021; 44:3581-3591. [PMID: 33890190 DOI: 10.1007/s10143-021-01536-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/16/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
Most of tuberculum sellae meningiomas (TSM) show asymmetric growth. They are usually resected through ipsilateral approaches. The access of the inferior-medial side of the ipsilateral optic nerve might be challenging, which result in increased manipulation of the compromised optic nerve. The contralateral approach has been described to avoid these technical difficulties. Assessing the long-term visual and olfactory outcome, as well as recurrence rate in patients operated for TSM through ipsilateral or contralateral approaches. Single center retrospective cohort study about 94 patients operated on between March 2000 and April 2018. Seventy percent of the preoperative visual acuity loss totally resolved (44%) or showed varying degrees of improvement (26%) after surgery. Seventy-two percent of the preoperative visual field defects evolved favorably (44% recovery, 28% improvement). Eight patients showed aggravated visual disturbances (9%). A contralateral approach seemed to be predictive of visual field defects improvement after surgery (OR = 0.4), with borderline significant results (p = .08). There was a higher rate of postoperative olfactory nerve impairment after a contralateral approach (37% vs 17%, p = .03). Total removal of the tumor fragment entering the optic canal was accomplished in 96% in the contralateral vs 75% in the ipsilateral group (p = .04). The 2-, 5-, and 7-year tumor progression-free survival were 100% in the Simpson grade 2 group, and 85% (n = 17), 74% (n = 11), and 67% (n = 5) in the Simpson grade 4 group, respectively (p = .00). Resection of tuberculum sellae meningiomas through a contralateral approach seems to provide better visual outcome and tumor control at the cost of increased olfactory nerve disorders.
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Khan DZ, Muskens IS, Mekary RA, Zamanipoor Najafabadi AH, Helmy AE, Reisch R, Broekman MLD, Marcus HJ. The endoscope-assisted supraorbital "keyhole" approach for anterior skull base meningiomas: an updated meta-analysis. Acta Neurochir (Wien) 2021; 163:661-676. [PMID: 32889640 PMCID: PMC7474310 DOI: 10.1007/s00701-020-04544-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/16/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The gold-standard treatment for symptomatic anterior skull base meningiomas is surgical resection. The endoscope-assisted supraorbital "keyhole" approach (eSKA) is a promising technique for surgical resection of olfactory groove (OGM) and tuberculum sellae meningioma (TSM) but has yet to be compared with the microscopic transcranial (mTCA) and the expanded endoscopic endonasal approach (EEA) in the context of existing literature. METHODS An updated study-level meta-analysis on surgical outcomes and complications of OGM and TSM operated with the eSKA, mTCA, and EEA was conducted using random-effect models. RESULTS A total of 2285 articles were screened, yielding 96 studies (2191 TSM and 1510 OGM patients). In terms of effectiveness, gross total resection incidence was highest in mTCA (89.6% TSM, 91.1% OGM), followed by eSKA (85.2% TSM, 84.9% OGM) and EEA (83.9% TSM, 82.8% OGM). Additionally, the EEA group had the highest incidence of visual improvement (81.9% TSM, 54.6% OGM), followed by eSKA (65.9% TSM, 52.9% OGM) and mTCA (63.9% TSM, 45.7% OGM). However, in terms of safety, the EEA possessed the highest cerebrospinal fluid leak incidence (9.2% TSM, 14.5% OGM), compared with eSKA (2.1% TSM, 1.6% OGM) and mTCA (1.6% TSM, 6.5% OGM). Finally, mortality and intraoperative arterial injury were 1% or lower across all subgroups. CONCLUSIONS In the context of diverse study populations, the eSKA appeared not to be associated with increased adverse outcomes when compared with mTCA and EEA and offered comparable effectiveness. Case-selection is paramount in establishing a role for the eSKA in anterior skull base tumours.
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Affiliation(s)
- Danyal Z Khan
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
| | - Ivo S Muskens
- Department of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, The Hague, The Netherlands
| | - Rania A Mekary
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
- Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS University, Boston, MA, USA
| | - Amir H Zamanipoor Najafabadi
- Department of Neurosurgery, University Neurosurgical Centre Holland, Leiden University Medical Centre, Haaglanden Medical Centre and Haga Teaching Hospital, Leiden, and The Hague, The Netherlands
| | - Adel E Helmy
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Robert Reisch
- ENDOMIN - Center for Endoscopic and Minimally Invasive Neurosurgery, Hirslanden Hospital, Zurich, Switzerland
| | - Marike L D Broekman
- Department of Neurosurgery, Haaglanden Medical Center and Leiden University Medical Center, The Hague, The Netherlands
- Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hani J Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, UK
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Sankhla S, Jayashankar N, Khan M, Khan G. Surgical Management of Tuberculum Sellae Meningioma: Our Experience and Review of the Literature. Neurol India 2021; 69:1592-1600. [DOI: 10.4103/0028-3886.333529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lefevre E, Terrier LM, Bekaert O, Simonneau A, Rogers A, Vignal-Clermont C, Boissonnet H, Robert G, Lot G, Chauvet D. Microsurgical Transcranial Approach of 112 Paraoptic Meningiomas: A Single-Center Case Series. Oper Neurosurg (Hagerstown) 2020; 19:651-658. [PMID: 32649763 DOI: 10.1093/ons/opaa207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 04/27/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Predictors of visual outcomes after optic nerve decompression are controversial. OBJECTIVE To identify the predictors of poor visual outcomes after surgery of meningiomas responsible of a compressive optic neuropathy. METHODS We focused on paraoptic meningiomas (POMs), which gathered tuberculum sellae meningiomas (TSMs) and anterior clinoid meningiomas (ACMs) responsible for visual impairment or threatening visual function, that underwent surgery at our institution between January 2009 and December 2015 and analyzed the clinical and radiological findings of our patients. RESULTS Among 112 patients who underwent surgery for a POM, a preoperative visual deficit was present in 108 patients (96.4%). Six months after surgery, 79 patients (70.5%) had a visual improvement, 15 patients (13.4%) had an unchanged vision, and 18 patients (16.1%) had deteriorated vision. A preoperative visual deficit of 6 mo or more was a strong predictor of poor visual outcome after surgery (P = .034). Poor visual outcome after surgery was not significantly related to the size of the tumor (P = .057), the age of the patient (P = .94), or the tumor extension into the optic canal (P = .47). CONCLUSION The duration of preoperative visual deficit was found to be a strong predictor of poor visual outcomes after surgery in POMs Other predictors of poor visual outcomes are still needed and are currently under evaluation in a prospective study at our institution.
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Affiliation(s)
- Etienne Lefevre
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | | | - Olivier Bekaert
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - Adrien Simonneau
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - Alister Rogers
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | | | - Hervé Boissonnet
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - Gilles Robert
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - Guillaume Lot
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - Dorian Chauvet
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
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Ding L, Zhang F, He Q, Li Z, Shi X, Li R, Zhang X. Differentiation of suprasellar meningiomas from non-functioning pituitary macroadenomas by 18F-FDG and 13N-Ammonia PET/CT. BMC Cancer 2020; 20:564. [PMID: 32552842 PMCID: PMC7301455 DOI: 10.1186/s12885-020-06852-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 04/12/2020] [Indexed: 12/30/2022] Open
Abstract
Background Differentiation of suprasellar meningiomas (SSMs) from non-functioning pituitary macroadenomas (NFPMAs) is useful for clinical management. We investigated the utility of 13N-ammonia combined with 18F-FDG positron emission tomography (PET)/computed tomography (CT) in distinguishing SSMs from NFPMAs retrospectively. Methods Fourteen NFPMA patients and eleven SSM patients with histopathologic diagnosis were included in this study. Every patient underwent both 18F-FDG and 13N-ammonia PET/CT scans. The tumor to gray matter (T/G) ratios were calculated for the evaluation of tumor uptake. Results The uptake of 18F-FDG was higher in NFPMAs than SSMs, whereas the uptake of 13N-ammonia was obviously lower in NFPMAs than SSMs. The differences of 18F-FDG and 13N-ammonia uptake between the two groups were significant respectively (0.92[0.46] vs 0.59[0.29], P < 0.05, 18F-FDG; 1.58 ± 0.56 vs 2.80 ± 1.45, P < 0.05, 13N-ammonia). Tumor classification demonstrated a high overall accuracy of 96.0% for differential diagnosis. When the two traces were combined, only 1 SSM was misclassified into the NFPMA group. Conclusion SSMs and NFPMAs have different metabolic characteristics on 18F-FDG and 13N-ammonia PET images. The combination of these two tracers can effectively distinguish SSMs from NFPMAs.
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Affiliation(s)
- Lei Ding
- Department of the Medical Imaging, The First Affiliated Hospital, Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, Guangdong Province, 510080, People's Republic of China
| | - Fangling Zhang
- Department of the Medical Imaging, The First Affiliated Hospital, Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, Guangdong Province, 510080, People's Republic of China.,Department of Radiology, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Stomatology, 56#, Cemetery west Road, Guangzhou, Guangdong Province, 510055, People's Republic of China
| | - Qiao He
- Department of the Medical Imaging, The First Affiliated Hospital, Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, Guangdong Province, 510080, People's Republic of China
| | - Zhoulei Li
- Department of the Medical Imaging, The First Affiliated Hospital, Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, Guangdong Province, 510080, People's Republic of China
| | - Xinchong Shi
- Department of the Medical Imaging, The First Affiliated Hospital, Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, Guangdong Province, 510080, People's Republic of China
| | - Ruocheng Li
- Department of the Medical Imaging, The First Affiliated Hospital, Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, Guangdong Province, 510080, People's Republic of China
| | - Xiangsong Zhang
- Department of the Medical Imaging, The First Affiliated Hospital, Sun Yat-sen University, 58# Zhongshan Er Road, Guangzhou, Guangdong Province, 510080, People's Republic of China.
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Peto I, White TG, Dehdashti AR. How I do it: contralateral supraorbital approach for tuberculum sellae meningioma. Acta Neurochir (Wien) 2020; 162:613-616. [PMID: 31900657 DOI: 10.1007/s00701-019-04205-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 12/27/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND The resection of tuberculum sellae meningiomas poses a challenge particularly when dealing with the medial aspect of the optic nerve. Dissection of the tumor off the optic nerve is usually carried out in the blind spot "behind" the optic nerve. We describe a contralateral approach for asymmetric tuberculum sellae meningiomas, allowing direct visualization of the medial optic nerve. METHOD Contralateral lateral supraorbital approach was performed, and complete tumor resection was achieved without any injury to the optic nerve. CONCLUSION The contralateral approach for asymmetric tuberculum sellae meningioma is an efficient technique allowing improved visualization of the medial optic nerve.
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Affiliation(s)
- Ivo Peto
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, 33606, USA.
| | - Timothy G White
- Department of Neurosurgery, Hofstra Northwell School of Medicine, Manhasset, NY, 11030, USA
| | - Amir R Dehdashti
- Department of Neurosurgery, Hofstra Northwell School of Medicine, Manhasset, NY, 11030, USA
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Surgical management of Tuberculum sellae Meningiomas: Myths, facts, and controversies. Acta Neurochir (Wien) 2020; 162:631-640. [PMID: 31834502 DOI: 10.1007/s00701-019-04114-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/21/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The optimal management of tuberculum sellae (TS) meningiomas, especially the surgical strategy, continues to be debated along with several controversies that persist. METHODS A task force was created by the EANS skull base section committee along with its members and other renowned experts in the field to generate recommendations for the surgical management of these tumors on a European perspective. To achieve this, the task force also reviewed in detail the literature in this field and had formal discussions within the group. RESULTS The constituted task force dealt with the practice patterns that exist with respect to pre-operative radiological investigations, ophthalmological and endocrinological assessments, optimal surgical strategies, and follow-up management. CONCLUSION This article represents the consensually derived opinion of the task force with respect to the surgical treatment of tuberculum sellae meningiomas. Areas of uncertainty where further clinical research is required were identified.
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Kolev D, Hadzhiyanev A, Marinov M, Bussarsky A, Popov D, Karakostov V. Endoscopic surgical resection of tuberculum sellae meningiomas based on decision-making algorithms proposed in the literature. BIOTECHNOL BIOTEC EQ 2020. [DOI: 10.1080/13102818.2020.1824619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Danny Kolev
- Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Asen Hadzhiyanev
- Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Marin Marinov
- Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Asen Bussarsky
- Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Deyan Popov
- Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Vasil Karakostov
- Clinic of Neurosurgery, St. Ivan Rilski University Hospital, Medical University of Sofia, Sofia, Bulgaria
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Solari D, Cavallo LM, Cappabianca P. Commentary: Endoscopic Endonasal Removal of Primary/Recurrent Meningiomas in the Medial Optic Canal: Surgical Technique and Long-Term Visual Outcome. Oper Neurosurg (Hagerstown) 2019; 17:E192-E194. [PMID: 31058992 DOI: 10.1093/ons/opz080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/19/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Domenico Solari
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Luigi M Cavallo
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Paolo Cappabianca
- Division of Neurosurgery, Università degli Studi di Napoli "Federico II", Naples, Italy
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Sharma M, Ugiliweneza B, Boakye M, Andaluz N, Williams BJ. Feasibility of Bundled Payments in Anterior, Middle, and Posterior Cranial Fossa Skull Base Meningioma Surgery: MarketScan Analysis of Health Care Utilization and Outcomes. World Neurosurg 2019; 131:e116-e127. [PMID: 31323403 DOI: 10.1016/j.wneu.2019.07.078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of our study was to compare the health care utilization and outcomes after surgery for anterior cranial fossa skull base meningioma (AFM), middle cranial fossa skull base meningioma (MFM), and posterior cranial fossa skull base meningioma (PFM) across the United States. METHODS We queried the MarketScan database using International Classification of Diseases, Ninth Revision and Current Procedural Terminology 4, from 2000 to 2016. We included adult patients who had at least 24 months of enrollment after the surgical procedure. The outcome of interest was length of hospital stay, disposition, complications, and reoperation after the procedure. RESULTS A cohort of 1191 patients was identified from the database. Less than half of patients (43.66%) were in the AFM cohort, 32.24% were in the MFM cohort, and only 24.1% were in the PFM cohort. Patients who underwent surgery for PFM had longer hospital stay (P = 0.0009), high complication rate (P = 0.0011), and less likely to be discharged home (P = 0.0013) during index hospitalization. There were no differences in overall payments at 12 months and 24 months among the cohorts. There was no significant difference in 90-day median payments among the groups ($66,212 [AFM] vs. $65,602 [MFM] and $71,837 [PFM]; P = 0.198). Male gender, commercial insurance (compared with Medicare), and higher comorbidity scores (score 3 compared with score 0) were associated with higher 90-day payments in the PFM cohort. CONCLUSIONS Overall payments (at 12 months and 24 months) and 90-day payments were not different among the cohorts. Patients with PFM had longer hospital stay and higher complication rate and were less likely to be discharged home with higher utilization of outpatient services at 12 months and 24 months.
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Affiliation(s)
- Mayur Sharma
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | | | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Noberto Andaluz
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Brian J Williams
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA.
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Trans-eyebrow supraorbital keyhole approach to tuberculum sellae meningiomas: a series of 30 cases with long-term visual outcomes and recurrence rates. J Neurooncol 2019; 142:545-555. [DOI: 10.1007/s11060-019-03128-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/18/2019] [Indexed: 01/14/2023]
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Magill ST, Morshed RA, Lucas CHG, Aghi MK, Theodosopoulos PV, Berger MS, de Divitiis O, Solari D, Cappabianca P, Cavallo LM, McDermott MW. Tuberculum sellae meningiomas: grading scale to assess surgical outcomes using the transcranial versus transsphenoidal approach. Neurosurg Focus 2018; 44:E9. [DOI: 10.3171/2018.1.focus17753] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVETuberculum sellae meningiomas (TSMs) are surgically challenging tumors that can severely impair vision. Debate exists regarding whether the transcranial (TC) or endoscopic transsphenoidal (TS) approach is best for resecting these tumors, and there are few large series comparing these approaches.METHODSA retrospective chart review was performed at 2 academic centers comparing TC and TS approaches with respect to vision, extent of resection, recurrence, and complications. The authors report surgical outcomes and propose a simple preoperative tumor grading scale that scores tumor size (1–2), optic canal invasion (0–2), and arterial encasement (0–2). The authors performed univariate, multivariate, and recursive partitioning analysis (RPA) to evaluate outcomes.RESULTSThe TSMs were resected in 139 patients. The median follow-up was 29 months. Ninety-five (68%) cases were resected via a TC and 44 (32%) via a TS approach. Tumors treated via a TC approach had a higher tumor (p = 0.0007), artery (p < 0.0001), and total score (p = 0.0012) on the grading scale. Preoperative visual deficits were present in 87% of patients. Vision improved in 47%, stayed the same in 35%, declined in 10%, and was not recorded in 8%. The extent of resection was 65% gross-total resection, 23% near-total resection (95%–99% resection), and 12% subtotal resection (< 95%). A lower tumor score was significantly associated with better or stable vision postoperatively (p = 0.0052). The RPA confirmed low tumor score as the key predictor of postoperative visual improvement or stability. Multivariate analysis and RPA demonstrate that lower canal score (p < 0.0001) and TC approach (p = 0.0019) are associated with gross-total resection. Complications occurred in 20 (14%) patients, including CSF leak (5%) and infection (4%). There was no difference in overall complication rates between TC and TS approaches; however, the TS approach had more CSF leaks (OR 5.96, 95% CI 1.10–32.04). The observed recurrence rate was 10%, and there was no difference between the TC and TS approaches.CONCLUSIONSTuberculum sellae meningiomas can be resected using either a TC or TS approach, with low morbidity and good visual outcomes in appropriately selected patients. The simple proposed grading scale provides a standard preoperative method to evaluate TSMs and can serve as a starting point for selection of the surgical approach. Higher scores were associated with worsened visual outcomes and subtotal resection, regardless of approach. The authors plan a multicenter review of this grading scale to further evaluate its utility.
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Affiliation(s)
- Stephen T. Magill
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Ramin A. Morshed
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Calixto-Hope G. Lucas
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Manish K. Aghi
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | | | - Mitchel S. Berger
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Oreste de Divitiis
- 2Divsion of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Domenico Solari
- 2Divsion of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Paolo Cappabianca
- 2Divsion of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Luigi M. Cavallo
- 2Divsion of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Michael W. McDermott
- 1Department of Neurological Surgery, University of California, San Francisco, California; and
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Anterior skull base meningiomas: surgery related hypothalamic sequalae. How to avoid? ROMANIAN NEUROSURGERY 2018. [DOI: 10.2478/romneu-2018-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction: Surgical: morbidities related to anterior skull base meningiomas are widely addressed in the literature and mostly related to tumor relations to cranial nerves and vascular structures in this challenging area. However; there is infrequent complications related to hypothalamic insult either from direct affection or via manipulation of vascular supply of this area.
The aim of this study: is to address hypothalamic complications occurred after surgery for anterior skull base meningiomas, pitfalls in our surgical technique and the way to minimize such morbidities.
Patients and methods: Retrospective study was conducted on all patients who did surgery for anterior skull base meningiomas in the neurosurgery department, Mansoura University during the period from 2011 to 2016. All the patients clinical and radiological data before and after surgery were analyzed. All patients who developed transient or permeant hypothalamic manifestation were included in this study and data regarding their tumor morphology, surgical technique and post-operative early and late imaging were assessed.
Results: Among 93 patients who did surgery for anterior skull base meningiomas; 12 patients developed post-operative sequalae related to hypothalamic function. In 7 patients; tumor was recurrent and in 4 patients; conformal radiotherapy was given after the initial surgery. Complication was transient in 3 patients and permeant in 9 patients. 8 patients died from their hypothalamic sequalae. Early post-operative imaging showed hypothalamic infarction in 8 patients.
Conclusion: Through reviewing these cases we can address the importance of many factors in the tumours especially size, morphology, recurrence who increase hypothalamic insults. Factors in surgery include preservation of arachnoid plain, perforators, meticulous dissection for minimize this complication.
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Giammattei L, Messerer M, Belouaer A, Daniel RT. Surgical outcome of tuberculum sellae and planum sphenoidale meningiomas based on Sekhar-Mortazavi Tumor Classification. J Neurosurg Sci 2018; 65:190-199. [PMID: 29308630 DOI: 10.23736/s0390-5616.18.04167-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Results from surgical series of tuberculum and planum sphenoidale meningiomas tends to be heterogeneous. Sekhar-Mortazavi tumor classification system has been recently proposed in order to predict the surgical risk and outcome. METHODS We retrospectively reviewed a consecutive series of tuberculum and planum sphenoidale meningioma operated at our institution between 2009 and 2016. Sekhar-Mortazavi Tumor Classification was applied to classify these tumors and evaluate the outcome. RESULTS Twenty-seven patients were included in the study. There were 22 females (81%) and 5 males (19%). The mean age was 54 years (range 33-78). According to Sekhar-Mortazavi Tumor Classification: 14 patients (51.85%) were class I, 11 (40.74%) patients were in class II and 2 patients (7.41%) were in class III. Twenty-one patients (77.7%) presented with visual symptoms and deficits at preoperative neuro-ophthalmological examination. Sekhar-Mortazavi class I tumors had a postoperative visual improvement in 77.7% of cases while patients in Sekhar-Mortazavi class II-III had a postoperative visual improvement in 66.6% of cases (P=0.5). No patient had deterioration of optic nerve/chiasmal function following surgery. Gross total resection was obtained in 25 patients (92.5%) without any significative difference between class I and Class II-III tumors. Permanent endocrine dysfunction was observed only in one patient in SM Class II tumor. 3 patients (11%) showed a postoperative persistent cranial nerve deficit (2 patients were anosmic and one patient had a trochlear nerve deficit). None of the patients showed postoperative CSF leak. No onset of new seizures was observed postoperatively. There was no mortality or major morbidity in this series. CONCLUSIONS Transcranial surgery provided very satisfying results with respect to visual and endocrine outcomes with very low surgical morbidity. The Sekhar-Mortazavi classification showed a trend towards better visual outcomes in Class I tumors. The classification system is easy to apply and could therefore prove useful to compare results between studies reported in literature, especially when comparisons are made between transcranial and endonasal surgery.
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Affiliation(s)
- Lorenzo Giammattei
- Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Switzerland -
| | - Mahmoud Messerer
- Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Amani Belouaer
- Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Switzerland
| | - Roy T Daniel
- Department of Neurosurgery, University Hospital of Lausanne, Lausanne, Switzerland
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Muskens IS, Briceno V, Ouwehand TL, Castlen JP, Gormley WB, Aglio LS, Zamanipoor Najafabadi AH, van Furth WR, Smith TR, Mekary RA, Broekman MLD. The endoscopic endonasal approach is not superior to the microscopic transcranial approach for anterior skull base meningiomas-a meta-analysis. Acta Neurochir (Wien) 2018; 160:59-75. [PMID: 29127655 PMCID: PMC5735207 DOI: 10.1007/s00701-017-3390-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 10/31/2017] [Indexed: 12/02/2022]
Abstract
Object In the past decade, the endonasal transsphenoidal approach (eTSA) has become an alternative to the microsurgical transcranial approach (mTCA) for tuberculum sellae meningiomas (TSMs) and olfactory groove meningiomas (OGMs). The aim of this meta-analysis was to evaluate which approach offered the best surgical outcomes. Methods A systematic review of the literature from 2004 and meta-analysis were conducted in accordance with the PRISMA guidelines. Pooled incidence was calculated for gross total resection (GTR), visual improvement, cerebrospinal fluid (CSF) leak, intraoperative arterial injury, and mortality, comparing eTSA and mTCA, with p-interaction values. Results Of 1684 studies, 64 case series were included in the meta-analysis. Using the fixed-effects model, the GTR rate was significantly higher among mTCA patients for OGM (eTSA: 70.9% vs. mTCA: 88.5%, p-interaction < 0.01), but not significantly higher for TSM (eTSA: 83.0% vs. mTCA: 85.8%, p-interaction = 0.34). Despite considerable heterogeneity, visual improvement was higher for eTSA than mTCA for TSM (p-interaction < 0.01), but not for OGM (p-interaction = 0.33). CSF leak was significantly higher among eTSA patients for both OGM (eTSA: 25.1% vs. mTCA: 10.5%, p-interaction < 0.01) and TSM (eTSA: 19.3%, vs. mTCA: 5.81%, p-interaction < 0.01). Intraoperative arterial injury was higher among eTSA (4.89%) than mTCA patients (1.86%) for TSM (p-interaction = 0.03), but not for OGM resection (p-interaction = 0.10). Mortality was not significantly different between eTSA and mTCA patients for both TSM (p-interaction = 0.14) and OGM resection (p-interaction = 0.88). Random-effect models yielded similar results. Conclusion In this meta-analysis, eTSA was not shown to be superior to mTCA for resection of both OGMs and TSMs. Electronic supplementary material The online version of this article (10.1007/s00701-017-3390-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ivo S Muskens
- Brain Center Rudolf Magnus, Utrecht University Medical Center, Utrecht, The Netherlands.
- Department of Neurosurgery, University Medical Center Utrecht, HP G03.124, PO Box 85500, 3508GA, Utrecht, The Netherlands.
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Vanessa Briceno
- School of Pharmacy, Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, MA, USA
| | - Tom L Ouwehand
- Brain Center Rudolf Magnus, Utrecht University Medical Center, Utrecht, The Netherlands
- Department of Neurosurgery, University Medical Center Utrecht, HP G03.124, PO Box 85500, 3508GA, Utrecht, The Netherlands
| | - Joseph P Castlen
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - William B Gormley
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Linda S Aglio
- Department of Anesthesiology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Wouter R van Furth
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Timothy R Smith
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rania A Mekary
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- School of Pharmacy, Department of Pharmaceutical Business and Administrative Sciences, MCPHS University, Boston, MA, USA
| | - Marike L D Broekman
- Brain Center Rudolf Magnus, Utrecht University Medical Center, Utrecht, The Netherlands
- Department of Neurosurgery, University Medical Center Utrecht, HP G03.124, PO Box 85500, 3508GA, Utrecht, The Netherlands
- Cushing Neurosurgery Outcomes Center, Department of Neurosurgery Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Song SW, Kim YH, Kim JW, Park CK, Kim JE, Kim DG, Koh YC, Jung HW. Outcomes After Transcranial and Endoscopic Endonasal Approach for Tuberculum Meningiomas-A Retrospective Comparison. World Neurosurg 2017; 109:e434-e445. [PMID: 29017976 DOI: 10.1016/j.wneu.2017.09.202] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 09/27/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Degree of resection and visual outcome are the main concerns in the surgical resection of tuberculum sellae meningioma (TSM). In addition to the transcranial approach (TCA), the endoscopic endonasal approach (EEA) has been used increasingly. However, the controversy regarding the optimal surgical approach is not clearly resolved. METHODS We compared the surgical outcomes of each approach for TSMs from 44 patients receiving EEA and 40 patients receiving TCA in 2 institutions between 2004 and 2015. We analyzed the surgical outcomes and affecting factors for the relapse of tumor and visual outcome. RESULTS Gross total resection rates and relapse-free survival were not different between the 2 groups; however, the locations of residual or recurred tumor definitely differed. All recurrences in the TCA group were in the sella turcica, whereas residual tumors in EEA group were mainly located at lateral or superior to the clinoid process. The complete or partial improvement rate of visual function in the EEA group was 97.7%, but 9 patients (23.7%) in the TCA group experienced visual deterioration after surgery. EEA and younger age (<55 years) were associated with favorable visual outcome. Cerebrospinal fluid leakage occurred in only one case in the EEA group. CONCLUSIONS Surgical approaches do not affect the gross total resection rates, but the locations of residual tumor or recurrence differ according to surgical approaches. EEA is superior to TCA in visual outcome. At least in pure TSMs, the trend seems to be shifting in favor of EEA, considering the huge difference in visual outcome.
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Affiliation(s)
- Sang Woo Song
- Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Yong Hwy Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Jin Wook Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung Eun Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Gyu Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young-Cho Koh
- Department of Neurosurgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hee-Won Jung
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Karsy M, Raheja A, Eli I, Guan J, Couldwell WT. Clinical Outcomes with Transcranial Resection of the Tuberculum Sellae Meningioma. World Neurosurg 2017; 108:748-755. [PMID: 28951179 DOI: 10.1016/j.wneu.2017.09.090] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The tuberculum sellae is a relatively common location for meningiomas. We assessed our experience with the use of transcranial resection, which, although criticized for its more invasive nature compared with endonasal approaches, may be the ideal approach in selected patients with tuberculum sellae meningiomas (TSMs). METHODS We retrospectively reviewed the charts of patients with TSMs treated by frontotemporal or bifrontal open cranial resection. Clinical, radiographic, and surgical variables were analyzed. RESULTS Forty-nine patients with a TSM treated by frontotemporal or bifrontal open cranial resection were identified. The mean patient age was 53.2 ± 14.0 years, and the mean duration of follow-up was 42.3 ± 45.4 months. The mean tumor volume was 12.4 ± 18.0 cm3. Optic canal invasion was seen in 46.9% of the patients, and 91.8% presented with visual deficits. Gross total resection (GTR) was achieved in 42 patients (85.7%), and near-total resection was performed in 7 patients (14.3%). Postoperatively, visual outcomes improved in 17 patients (34.7%), remained stable in 22 (44.9%), were intact in 6 (12.2%), and worsened in 1 (2.0%). Good outcome (Glasgow Outcome Scale [GOS] ≥4) was achieved by 46 of 49 patients (93%) at discharge and by 39 of 41 patients (95.1%) at 6 months. A total of 16 manageable and self-limiting complications occurred in 16 patients. CONCLUSIONS In most patients undergoing a frontotemporal approach, a GTR/Simpson grade I resection with manageable and self-limiting surgical complications, a good 6-month GOS in most patients, and improved to stable vision were seen at follow-up. Various treatment approaches can be considered for TSM resection, but the ability to decompress the optic canal and achieve a GTR makes the frontotemporal approach attractive in many cases.
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Affiliation(s)
- Michael Karsy
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Amol Raheja
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA; Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ilyas Eli
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Jian Guan
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
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Lee S, Hong SH, Cho YH, Kim JH, Kim CJ. Anatomical Origin of Tuberculum Sellae Meningioma: Off-Midline Location and Its Clinical Implications. World Neurosurg 2016; 89:552-61. [PMID: 26875651 DOI: 10.1016/j.wneu.2016.02.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 02/02/2016] [Accepted: 02/03/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Tuberculum sellae meningiomas (TSM) arise from the dura mater of tuberculum sellae, limbus sphenoidale, and chiasmatic sulcus and cause asymmetric visual disturbances. In this study, we analyzed the laterality of the origin of TSM and discussed its clinical implications on immediate and long-term visual outcomes. METHODS Between 1994 and 2013, TSM was diagnosed in 100 patients after microsurgical resection. The medical records, radiologic features, and operative findings were retrospectively reviewed and analyzed in these patients. RESULTS Visual disturbances were evident in 95 patients (95%) after neuro-ophthalmologic testing. Among them, 89 patients (89%) showed marked asymmetric visual field defect, and 6 patients (6%) had relatively symmetric visual field defect. On intraoperative inspection, the origin of TSM was at the one lateral end portion of the tuberculum sellae in 85 patients (85%). In 15 patients (15%), the TSM originated from the midline region, including the central portion of the tuberculum sellae (n = 13) and diaphragm sellae (n = 2). Optic canal involvement was observed in 73 patients (73%). Preexisting visual field defects were improved in 70 patients (70%), were stationary in 25 patients (25%), and aggravated in 5 patients (5%) during postoperative follow-up (mean 58 months, 24∼122 months). The preoperative symptom duration, the laterality of the origin of TSM, and optic disc atrophy were associated with long-term poor visual outcomes. CONCLUSIONS Most TSMs that originated from the dura of one lateral end portion of the tuberculum sellae correlated with asymmetric visual symptoms and poor visual outcomes. This microsurgical feature should be considered in the planning of optimal surgical strategy to achieve favorable outcomes.
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Affiliation(s)
- Seungjoo Lee
- Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Seok Ho Hong
- Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Young Hyun Cho
- Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Jeong Hoon Kim
- Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Chang Jin Kim
- Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea.
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Ajlan AM, Choudhri O, Hwang P, Harsh G. Meningiomas of the tuberculum and diaphragma sellae. J Neurol Surg B Skull Base 2014; 76:74-9. [PMID: 25685653 DOI: 10.1055/s-0034-1390400] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 08/14/2014] [Indexed: 10/24/2022] Open
Abstract
Introduction Although tuberculum sellae (TS) and diaphragma sellae (DS) meningiomas have different anatomical origins, they are frequently discussed as a single entity. Here we review the radiologic and intraoperative findings of TS and DS meningiomas and propose a radiologic classification. Methods We retrospectively reviewed 10 consecutive TS and DS meningiomas. Data regarding clinical presentation, preoperative imaging, and intraoperative findings were analyzed. Three sellar dimensions were measured on magnetic resonance imaging (MRI): the tuberculum-sellar floor interval (TSFI), the planum-tuberculum interval (PTI), and the total height. Results Three distinct anatomical patterns were recognized: exclusively tubercular meningiomas (type A) were accompanied by elongation of the TSFI and, more significantly, of the PTI; combined TS and DS meningiomas (type B) were associated with relative elongation of both the PTI and TSFI; and the sole exclusively DS meningioma (type C) was associated with elongation of neither PTI nor TSFI. Conclusion Suprasellar meningiomas can be classified as tubercular, combined, or diaphragmatic based on preoperative MRI. Exclusively tubercular meningiomas (type A) require only a supradiaphragmatic approach. Tumor involvement of the sellar diaphragm (type B or C) requires resection of the diaphragm and thus a combined infra- and supradiaphragmatic approach.
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Affiliation(s)
- Abdulrazag M Ajlan
- Department of Neurosurgery, Stanford University, Stanford, California, United States ; Department of Neurosurgery, King Saud University, Riyadh, Saudi Arabia
| | - Omar Choudhri
- Department of Neurosurgery, Stanford University, Stanford, California, United States
| | - Peter Hwang
- Department of Otolaryngology, Stanford University, Stanford, California, United States
| | - Griffith Harsh
- Department of Neurosurgery, Stanford University, Stanford, California, United States
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Liu Y, Chotai S, Ming C, Jin S, Pan J, Qi S. Characteristics of midline suprasellar meningiomas based on their origin and growth pattern. Clin Neurol Neurosurg 2014; 125:173-81. [PMID: 25171391 DOI: 10.1016/j.clineuro.2014.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/01/2014] [Accepted: 08/02/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of the present study was to elucidate clinical and prognostic characteristics of the midline suprasellar meningiomas based on their origin and growth pattern. METHODS A retrospective review of the medical records was conducted for patients undergoing surgical resection of the midline suprasellar meningioma. The meningiomas were divided into group A - planum sphenoidale meningioma (PSM), group B - tuberculum sellae meningioma (TSM) and group C - diaphragma sellae meningioma (DSM), based on their growth pattern in relation to the optic pathway and pituitary stalk, group C was then divided into groups C1 and C2. RESULTS The mean age of 32 men and 74 women was 48.5±13.1 years (range, 20-78 years). The rate of visual impairment was highest in patients in group C2 and lowest in group A patients (P<0.001). The h-p axis impairment and MRI evidence of the pituitary stalk involvement was more frequent in patients with group C1 meningioma (P<0.001). The gross total resection (GTR) was achieved in 84/106 (79%) patients. The mean follow-up period was 70.4 months (median 86 months, range 64.5-76.3 months). The fronto-temporal approach was the only significant predictor of the postoperative visual acuity impairment (P=0.001, OR: 8.2, CI: 2.45-27.42) and visual field impairment (P=0.016, OR: 0.071, CI: 0.008-0.607). The meningiomas in groups B (P=0.024, OR: 0.198, CI: 0.049-0.812) and C1 (P=0.012, OR: 0.082, CI: 0.012-0.580) were significant predictors of the postoperative visual field deficits. The group C1 (P=0.036, OR: 0.244, CI: 0.065-0.912) and surgical approach employed (P=0.032, OR: 0.013, CI: 0.000-0.684) was significant predictors of the postoperative h-p function impairment. The mean recurrence free survival (RFS) time and rate were 102.9±3.2 months and 86%. The group C1 meningiomas had the lowest RFS rate and time (33.3% and 55.6±8.3 months). The subtotal resection and the group C1 meningioma (P=0.001, OR: 15.6, CI: 2.9-82.8) were the significant predictors of recurrence (P=0.008, OR: 0.08, CI: 0.014-0.529). CONCLUSION The group A meningioma had the high rate of complete resection and favorable RFS. Groups B and C2 involve optic pathway and optic canal predominately. The group C1 DSM was an independent predictor of subtotal resection, postoperative visual field and h-p axis impairment. The subtotal resection was an independent predictor of the recurrence.
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Affiliation(s)
- Yi Liu
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Silky Chotai
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chen Ming
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shi Jin
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jun Pan
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Songtao Qi
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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