Contralateral Transcranial Approach to Tuberculum Sellae Meningiomas: Long-Term Visual Outcomes and Recurrence Rates

• Published in: World neurosurgery 2018-08, Vol.116, p.e1066-e1074
• Main Authors: Engelhardt, Julien, Namaki, Houman, Mollier, Olivier, Monteil, Pascal, Penchet, Guillaume, Cuny, Emmanuel, Loiseau, Hugues
• Format: Article
• Language: English
• Subjects: Contralateral approach; Craniotomy; Meningioma; Tuberculum sellae; Visual outcome
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.05.166

One of the most challenging aspects of the surgical treatment of tuberculum sellae meningioma is to control the involvement of the inferomedial side of the optic nerve, which is not directly visualized by an ipsilateral approach and thus requires optic nerve mobilization. Between 2003 and 2017, 21 consecutive patients were operated on using this approach. The surgical technique is described and the visual outcomes, resection and recurrence rates, and complications are analyzed. Twenty patients were included, with a median follow-up of 5.6 years. Regarding visual outcomes, among the 19 patients who had a visual impairment before surgery, 14 (74%) improved, 2 were stabilized (10%), and 2 (10%) showed a worsening of the most-compromised optic nerve and 1 (5%) of the less-compromised optic nerve. Gross total resection was achieved in 18 patients (90%) and 1 patient experienced recurrence 10 years after the initial surgery. This approach allowed lower mobilization of the compromised optic nerve, better preservation of the vascularization of the visual pathways, and direct access to the inferomedial side of the optic nerve. •The control of the intracanalar infiltration is one of the most challenging aspect of tuberculum sellae meningioma surgery.•The contralateral to the most compromised optic nerve approach provides a better visualization of this part of the tumor.•This approach led to high rates of visual improvement with an acceptable risk regarding the noncompromised optic nerve.