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Adrian Florian Bălașa, Rareș Chinezu and Dorin Nicolae Gherasim

Abstract

Introduction: Tuberculum sellae and planum sfenoidale meningiomas represent 5% to 10% of intracranial meningiomas and represent a subgroup of anterior skull base meningiomas. Approximately two thirds of patients complain of failing vision in one eye as the first symptom, and monocular blindness may be present in half of patients before surgery. Due to the constant antomical relationship of these tumors with the optic nerves there is a classic presentation of these tumors represented by the chiasmal syndrome.

Material and methods: In this study, we have retrospectively analyzed 18 cases consecutively operated between 2006 and 2012 at the Targu Mures Neurosurgery Department. Considering the length of the visual disturbances we have divided the study group in two categories: early decompression with visual distubances expressed within at most 12 months prior to surgery, and late decompression with visual disturbances of more than 1 year.

Surgical technique: Sugical approach has been performed on the side with the most visual deficit, and if visual deterioration was found to be approximative on both sides we chose the right side for surgical approach. In all the patients, we have performed a fronto-pterional craniotomy. In all the cases we chose a subfrontal approach. Tumor has been further resected using standard microsurgical techniques, total tumoral resection being the preoperative goal in all surgical interventions

Results: Out of the 18 cases operated, 13 cases were of tuberculum sellae meningiomas, while 5 cases were of planum sphenoidale meningiomas.

All patients in the early decompression group (9 cases) have presented visual improvement, whilst of the late decompression group 5 cases (55,5%) presented constant visual deficit, 2 cases (22,25%) presented visual improvement and 2 cases (22,25%) presented a decrease of the visual deficit.

The visual disturbances have improved in 11 cases (61.1%), in 5 cases (27,7%) the visual deficit has remained constant, and in 2 cases (11,2%) the visual deficit has worsened postoperatively. Conclusions: We consider that the optimal approach should be based on tumor anatomy and surgeon experience and from this point of view frontolateral and pterional approaches provide remarkable improvement compared to the bifrontal approach. Regardless of the selected surgical approach it is essential to avoid injury to the blood supply of the optic apparatus.Endoscopy will have a role in skull base surgery with

Open access

Chinezu Rareş, Berhouma Moncef, Jacquesson Timothée, Raverot Gerard and Jouanneau Emmanuel

Abstract

Objective: The purely transnasal endoscopic approach has taken in the last decade a paramount importance in the treatment of pituitary adenomas, but some authors have been linked it to an increase in vascular complications. The aim of this paper is to provide a stepwise description of the vascular risks and steps required to avoid them.

Method: We present the minimal invasive technique used by the senior author in over 900 transnasal purely endoscopic approaches focusing on the relevant vascular landmarks, preoperative and operative steps taken in order to avoid vascular injury and the management of vascular injury from a multitude of sources.

Conclusion: Endoscopy has brought a wider field of view, with numerous vascular structures well inside the operating field. This represents control but also higher risk. Solid knowledge of the skull base anatomy and proper preoperative imaging coupled with an experienced surgeon can greatly reduce the vascular risks associated with surgery.