Decision Analysis: Endoscopic Versus Open Resection of Tuberculum Sellae Meningiomas

• Main Authors: Bohman, Leif-Erik, Stein, Sherman, Newman, Jason G., Palmer, James, Adappa, Nithin, Khan, Aamir, Sitterley, T. T., Chang, Diana, Lee, John Y.
• Format: Conference Proceeding
• Language: English
• ISSN: 2193-6331; 2193-634X
• DOI: 10.1055/s-0032-1312073

Introduction: Tuberculum sellae meningiomas (TSMs) are challenging tumors for neurosurgical resection. Open microsurgical approaches pose significant risk to the optic apparatus, which may be obviated by endoscopic approaches. However, endoscopic endonasal surgical resection is a relatively new procedure with its own Achilles heel–CSF leak. Materials and Methods: MEDLINE and Embase online databases were searched for English-language articles containing key words related to tuberculum sellae meningiomas. Data were pooled, including five of our own patients. Meta-regression and a decision-analytical model was constructed to compare 3-year outcomes between open microsurgery and endoscopic endonasal approaches. Results: The 3-year recurrence rates were not statistically different between the two approaches ( P =  0.529). Meta-regression of 28 reports of open craniotomy suggested a 3-year recurrence rate of 4.6% (SD = 0.699, R2 = 35.5%, P =  0.005), and meta-regression of eight publications on endoscopy suggested a 3-year recurrence rate of 9.9% (SD = 0.396, R2 = 2.6%, P =  0.231). In addition, the overall quality of life (QOL) was not significant between the two surgical approaches ( P =  0.410), despite significant differences in individual complication rates. The Monte Carlo simulation yielded an overall average QOL in craniotomy patients of 0.915 (SD = 0.020) and in endoscopic patients of 0.952 (SD = 0.019). Endoscopy had a higher CSF leak rate (26.8 vs. 3.5%, P