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Transpalpebral approach for microsurgical removal of tuberculum sellae meningiomas
EANS Academy. Dzhindzhikhadze R. Sep 27, 2019; 276045; EP04027
Abstract
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Background: It is well known, that surgical approach for the most tuberculum sellae meningiomas (TSM) performed through a large visible fronto-temporal skin incision and extended temporal muscle dissection. Main goals of surgery are radical removal of the tumor with preserving the visual pathways and normal vascular structures.
Materials and methods: Our work presents the experience of using transpalpebral approach (TPA) in 15 patients with TSM. The degree of radical removal of meningiomas was assessed by the Simpson grade and by MRI with contrast enhancement.
All patients underwent careful preoperative planning: facial and bone anatomy, frontal sinus topography. Follow-up assessment of functional and cosmetic outcomes was performed. Also reviewed time of surgery, intraoperative blood loss, and surgery-related complications.
Results: All meningiomas were removed by Simpson II. There were no serious complications or death. Of the 15 patients there were 10 women (66,7%), 5 men (33,7%). The mean age was 57,1 years. Visual improvement noted in 10 cases (66,7%), no improvement in 4 cases (26,7%), 1 case (6,6%) had transient visual worsening for 4 days and slow visual recovery in 1 month. Frontal hypesthesia for 3-5 months was reported in all patients (100%), permanent deficit was not reported. Transient palsy of the frontal muscle for 6-8 months was reported for 4 patients. No deaths were identified in follow-up at 12 months. The average value of mRS was 1,4. Mean length of stay in hospital was 7,06. Postoperative CSF leakage is not noted. Mean surgical time - 226 min, mean blood loss - 110 ml. Cosmetic outcomes assessed as excellent.
Conclusion: Minimally invasive approaches are becoming increasingly prevalent in skull base surgery. TPA is technically difficult and require some experience to work in a small deep surgical corridor. This technique can be good alternative to traditional fronto-lateral, supraorbital keyhole craniotomies and endonasal approaches.
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