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tuberculum sellae

Yang Ji-Hu, Huang Guo-Dong, Ji Tao, Wang Hai-Dong, Liu Yu-Fei, Guo Jian, Li Zhen, Li Wei-Ping
OBJECTIVE: To explore the surgical methods and clinical effect of endoscopic endonasal approaches for the treatment of invasive pituitary adenomas(IPA). METHODS: A retrospective analysis of the clinical data of 74 patients(75 procedures) with invasive pituitary adenomas treated by different endoscopic endonasal approaches at the Department of Neurosurgery, the First Affiliated Hospital of Shenzhen University from May 2014 to August 2017. The data include clinical manifestation, imaging features, surgical methods and complications, resection rate, cure rate, prognosis and complications in different Knosp classifications and Hardy stages...
March 7, 2018: World Neurosurgery
X L Zheng, Z Q Jiang, Y Han, T Sun, T Zhang, S J Zhang, F Y Lou
Objective: To explore the surgical technique and curative effect of microsurgical resection of large anterior skull base meningioma via unilateral subfrontal and interhemispheric approach. Method: The clinical data of 14 patients with large anterior skull base meningioma who received surgical treatment in the Department of neurosurgery in First Affiliated Hospital of Bengbu Medical College from April 2015 to September 2017 were analysed retrospectively.Of 9 cases were olfactory groove meningioma and 5 cases were tuberculum sellae meningioma...
February 13, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
De-Zhi Kang, Ping Chen, Qing-Song Lin, Yuan-Xiang Lin, Xi-Yue Wu, Pei-Sen Yao
OBJECTIVE: To investigate the value of 3D printed models with pathological entities in enhancing the learning curve of surgery of tuberculum sellae meningioma. METHODS: We printed four 3D printed models of tuberculum sellae meningiomas based on radiological data using a 3D printer. Participants were allocated to 3D group and atlas group. In the 3D group, participants learned surgery with the assistance of 3D models. In the atlas group, participants used only two-dimensional materials to assist their learning...
February 9, 2018: World Neurosurgery
Oriela Rustemi, Renato Scienza, Alessandro Della Puppa
Tuberculum sellae meningioma remains a surgical challenge. Deep location of tumor, vascular and nerve encasement, and pituitary stalk involvement are the main technical issues. The frontopterional approach represents a natural, simple, and elegant approach to this area enabling surgeon to have a direct control on all anatomical structures. A 42-year-old woman was referred with a delayed diagnosis of tuberculum sellae meningioma due to the presence of HLA-B27-associated uveitis. She presented with 1/10 visual acuity in the left eye and no right visual function...
February 2018: Journal of Neurological Surgery. Part B, Skull Base
Mirza Pojskić, Kenan I Arnautović
In this video clip, the authors present the resection of a tuberculum sellae meningioma with compression of the left optic nerve and a chiasm ( Fig. 1 ) through a standard cranial orbital (CO) skull base approach. 1 2 3 The key step in the tumor resection was microsurgical dissection of left and right A1 segments of the anterior cerebral artery and the anterior communicating artery and the separation of the tumor from these vascular structures. This was followed by careful separation of the meningioma from both optic nerves, the chiasm and the pituitary stalk...
February 2018: Journal of Neurological Surgery. Part B, Skull Base
Duarte N C Cândido, Paulo E H Nakashima, Jean Gonçalves de Oliveira, Luis A B Borba
Tuberculum Sellae Meningiomas (TSMs) are lesions dramatically related to the optic apparatus once the principal clinical complain remains on visual alterations. This is the main picture on decision making to evaluate the best time, risk-benefit, and surgical approaches to the patient treatment. In this video, we present a 65 years old female with 30 days complaint of unilateral (right) complete blindness and complete impaired right eye field test. On physical examination, there were normal pupillary function to light tests...
February 2018: Journal of Neurological Surgery. Part B, Skull Base
Alexander Yang, Mohammed Aref, A Samy Youssef
This is a case of an extensive tuberculum sella meningioma involving the circle of Willis down to the basilar artery that presented with bilateral visual loss worse on the right than left side. A one-piece right orbitopterional approach along the worse eye was used to gain access to the three cranial fossae. The orbitotomy facilitates access to the midline structures and contralateral base of the tumor with minimal brain retraction. Tumor resection is initiated by first identifying the tumor capsule, followed by piecemeal debulking via ultrasonic aspiration...
February 2018: Journal of Neurological Surgery. Part B, Skull Base
Ihsan Dogan, Melih Ucer, Mustafa Kemal Başkaya
Microsurgical treatment of suprasellar tumors, in particular tuberculum sellae meningiomas, poses significant challenge. These tumors are surrounded by vital neurovascular structures, such as optic apparatus, pituitary stalk, internal carotid artery and its branches, and anterior cerebral arteries. In large and complex cases, early identification and decompression of these structures may facilitate safer dissection and resection. Therefore, extradural anterior clinoidectomy with optic unroofing facilitates the internal carotid artery exposure and optic nerve decompression...
February 2018: Journal of Neurological Surgery. Part B, Skull Base
James K Liu, Kentaro Watanabe
The optimal approach for surgical resection of tuberculum sellae meningiomas remains controversial. Approach selection is largely based on a variety of factors, such as tumor size, extent and location relative to the optic canal and internal carotid artery, the presence of vascular encasement, and surgeon's preference. In this operative video manuscript, the authors demonstrate the importance of an open transcranial approach when the tumor extends lateral to the optic nerve over the internal carotid artery into the opticocarotid triangle, which is a difficult region to safely access with a purely endoscopic endonasal approach...
February 2018: Journal of Neurological Surgery. Part B, Skull Base
Justin R Davanzo, Neerav Goyal, Brad E Zacharia
This video abstract demonstrates the use of the expanded endoscopic endonasal approach for the resection of a retrochiasmatic craniopharyngioma. These tumors are notoriously difficult to treat, and many approaches have been tried to facilitate safe and effective resection. The endoscopic endonasal approach has been increasingly utilized for selected sellar/suprasellar pathology. We present the case of a 39-year-old man who was found to have a cystic, partially calcified suprasellar mass consistent with a craniopharyngioma...
February 2018: Journal of Neurological Surgery. Part B, Skull Base
Umit Kocaman, Tayfun Dalbasti, Mehmet Haluk Ozer, Hakan Yilmaz, Muhammet Bahadir Yilmaz, Ibrahim Burak Atci, Servet Celik
PURPOSE: Lateral supraorbital approach is a simpler and quicker method than pterional approach. It provides a more anterior projection when compared to the pterional approach. There are some minor differences of the modified lateral supraorbital approach when compared to lateral supraorbital approach. It is directed more subfrontally and anterior than the pterional and lateral supraorbital approach. MATERIAL AND METHODS: We used modified lateral supraorbital approach in 100 cases between 2012 and 2015 in Medical Park İzmir Hospital/Turkey...
December 6, 2017: British Journal of Neurosurgery
Sudha Menon, Girish Menon
Postoperative visual loss is a dreaded complication following transcranial excision of tuberculum sella meningioma. Visual deterioration is commonly noticed immediately after surgery, and delayed deterioration after 72 h is uncommon. We report a case of delayed postoperative deterioration in a 48-year-old female and discuss the possible mechanisms.
October 2017: Journal of Neurosciences in Rural Practice
Ivo S Muskens, Vanessa Briceno, Tom L Ouwehand, Joseph P Castlen, William B Gormley, Linda S Aglio, Amir H Zamanipoor Najafabadi, Wouter R van Furth, Timothy R Smith, Rania A Mekary, Marike L D Broekman
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...
November 10, 2017: Acta Neurochirurgica
Cristian Ferrareze Nunes, André Beer-Furlan, Francesco Doglietto, Ricardo Luis Carrau, Daniel Monte-Serrat Prevedello
BACKGROUND: The McConnell's capsular arteries (MCCA) were first described in 1953. They consist of medial branches of the cavernous internal carotid artery (ICA) and are divided in anterior and inferior capsular arteries. OBJECTIVE: To highlight the anatomy of the MCCA and its importance in the surgical treatment of tuberculum sellae and planum sphenoidale tumors through an endoscopic endonasal approach. METHODS: Ten cadaveric specimens fixed in formalin and perfused with colored silicone were dissected...
October 13, 2017: Operative Neurosurgery (Hagerstown, Md.)
Khaled Elshazly, Varun R Kshettry, Christopher J Farrell, Gurston Nyquist, Marc Rosen, James J Evans
BACKGROUND: In select cases, the endoscopic endonasal approach (EEA) has distinct advantages for resection of tuberculum sella meningiomas (TSM). OBJECTIVE: To report the extent of resection (EOR), complication rates, and outcomes in a large series of TSM treated by the EEA. METHODS: Twenty-five consecutive TSM cases treated by EEA from 2008 to 2016 were retrospectively reviewed. Patient history, imaging, volumetric EOR, complications, and outcomes are presented...
October 10, 2017: Operative Neurosurgery (Hagerstown, Md.)
Joel Bierer, Amparo Wolf, Donald H Lee, Brian W Rotenberg, Neil Duggal
BACKGROUND: We present a rare complication of bilateral caudate infarcts and necrosed nasoseptal flaps after endoscopic transsphenoidal resection of tuberculum sellae meningioma. This case highlights the importance of early and accurate diagnosis and treatment of a postoperative cerebrospinal fluid (CSF) leak and associated bacterial meningitis, and reviews any existing guidelines regarding its management. CASE DESCRIPTION: A 54-year-old otherwise healthy man presented with progressive bitemporal hemianopsia...
2017: Surgical Neurology International
Sang Woo Song, Yong Hwy Kim, Jin Wook Kim, Chul-Kee Park, Jung Eun Kim, Dong Gyu Kim, Young-Cho Koh, Hee-Won Jung
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...
October 7, 2017: World Neurosurgery
Yishui Zhang, Wen Yang
BACKGROUND: Complications of the ICA in surgeries are rare but severe. This study aims to locate the ICA with 5 stationary bony structures in the sellar region: the anterior clinoid process (ACP), the tuberculum sellae, the bottom of the hypophyseal fossa, the posterior edge of the hypophyseal fossa and the post clinoid process and do measurements to determine their anatomic relationship with the ICA. METHODS: After multiple planar reconstructions on computer tomographic angiography images of 120 ICA in 60 individuals, we defined the 5 bony structures as 5 origins in horizontal, sagittal and vertical planes with the 3D coordinate system and got the cross-sections of bilateral ICA on the coronal plane passing through each origin...
October 3, 2017: World Neurosurgery
Gabriel Zada, Vance L Fredrickson, Bozena B Wrobel
Meningiomas are the most prevalent primary intracranial tumor, with 3%-10% arising from the tuberculum sellae. Optimal management consists of total microsurgical resection with preservation of surrounding structures. The authors present a 64-year-old woman with progressive bilateral vision loss, including visual acuity deficits and bitemporal hemianopsia. MRI revealed a 2-cm tuberculum sellae meningioma causing optic apparatus compression. An extended endoscopic endonasal transtuberculum approach was utilized for gross-total resection, including microdissection of tumor from the optic chiasm and infundibulum...
October 2017: Neurosurgical Focus
Gabriel Zada, Mustafa K Başkaya, Mitesh V Shah
Meningiomas represent the most common primary intracranial neoplasm treated by neurosurgeons. Although multimodal treatment of meningiomas includes surgery, radiation-based treatments, and occasionally medical therapy, surgery remains the mainstay of treatment for most symptomatic meningiomas. Because of the intricate relationship of the dura mater and arachnoid mater with the central nervous system and cranial nerves, meningiomas can arise anywhere along the skull base or convexities, and occasionally even within the ventricular system, thereby mandating a catalog of surgical approaches that neurosurgeons may employ to individualize treatment for patients...
October 2017: Neurosurgical Focus
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