Transcranial transsphenoidal approach for tuberculum sellae meningiomas

Objective. A series of 21 patients with tuberculum sellae meningioma who re ceived surgical treatment is reported. Patients and Methods. All 9 females and 12 males (mean age 49 years) presen ted visual disturbances of varying degrees in either one or both eyes. Eigh teen of the tumours were less than 3 cm in size, and 3 were larger. Tumour resection of uniform surgical technique was performed in all cases. Followi ng a bicoronal scalp incision, bifrontal craniotomy combined with removal o f the orbital rim bilaterally was performed. The frontal dura was opened bi laterally? and the most anterior portion of the superior sagittal sinus was transected. Bifrontal retraction and arachnoid dissection along the proxim al olfactory tracts brought the tumour into view. Additional dissection of the interhemispheric fissure extended the operative field to the anterior c ommunicating artery. The anterior skull base was drilled out to resect the basal part of the tumour. In all cases, the optic canal and sphenoid sinus, and additionally in some cases the ethmoid sinus were opened. The tumour u niformly extended inferomedially to the optic nerve, and direct. Visualizat ion of this portion of the tumour was possible with our approach. The opene d paranasal sinuses were reconstructed with adipose tissue harvested from t he patient's abdomen and the pericranial flap. Results. In all patients, total or almost total resection of the tumour was accomplished. Postoperatively, visual function was improved in 11 patients , was unchanged in 8, and worsened in 2. There were no operative deaths. Ce rebrospinal fluid leakage was occurred in two patients but could be conserv atively managed. In a mean 3-year follow-up, tumour recurrence was observed in only one patient who presented a malignant histology. Conclusions. We are confident that our surgical approach has great clinical value in surgical resection of tuberculum sellae meningioma. The good acce ssibility to a tumour extending inferomedially to the optic nerve should, i n particular, be stressed.