Topographic anatomy and operative surgery of meningiomas and arterial aneurysms of around-sellar localization

  • S O. Lytvak The SI Romodanov Neurosurgery Institute NAMS of Ukraine
  • Z.M. Nykyforak The SI Romodanov Neurosurgery Institute NAMS of Ukraine
  • A.O. Mumliev The SI Romodanov Neurosurgery Institute NAMS of Ukraine
Keywords: around-sellar localization, topographic anatomy, meningioma, arterial aneurysm, surgical treatment.

Abstract

Objective – optimisation of surgical treatment of meningiomas (M) and arterial aneurysms (AA) of around sellar localization (ASL), according to the analysis of individual topographic and anatomical peculiarities.

Materials and methods. The results of diagnostics and surgical treatment of 383 patients: 137 (35.8 %) with MASL (97 (70.8 %) women and 40 (29.2 %) men, the average age – 51.8 years) and 246 (64.2 %) with AA ASL (138 (56.1 %) women and 108 (43.9 %) men, the average age – 52.0 years) have been analyzed. All patients were operated at the SI Romodanov Neurosurgery Institute NAMS of Ukraine during the period from 01.01.2010 to 31.11.2016.

Results. AA ASL proceeded from various segments of the internal carotid artery – 98 (39.8 %) cases, the anterior cerebral-anterior connective artery complex – 145 (59.0 %), bifurcation of the main arteria – 3 (1.2 %). Complex AA ASL was recorded in 52 (21.1 %) observations. Approaches to AA ASL: pterional – in 202 (82.1 %) cases, orbito-zygomatic – in 4 (1.6 %), pterional with anterior clinoidectomy – in 32 (13.0 %), subtemporal – in 8 (3.3 %). The following surgical approaches were used to remove MASL in patients: subfrontal – in 28 (20.4 %) observations, pterional – in 71 (51.9 %), frontoorbitozygomatic and its variants – in 38 (27.7 %). Total removal was achieved in 57 (41.6 %) patients, subtotal – in 22 (16.1 %), partial – in 58 (42.3 %). Improvement was observed in 38 cases and the preservation of the function of the optic nerves at the preoperative level was achieved in 78 cases. The achieved improvement in patients’ quality of life, in general, was characterized by a regression of neurological deficits, restoration of functional disorders and a high degree of social adaptation.

Conclusions. The choice of craniotomy to AA ASL was dependent on localization and geometric parameters of AA relatively to the bone structures of the skull base, the volume and location of intracranial hemorrhage, the planned microsurgical corridor, the choice of an approach in MASL – relatively to topographic anatomy peculiarities of tumors, their sizes and surrounding anatomical structures. The choice of operative access for meningioma of ASL was due to the topographic and anatomical features of the tumors, their size, the relationship with the surrounding anatomical structures.

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Published
2017-12-01
How to Cite
Lytvak, S. O., Nykyforak, Z., & Mumliev, A. (2017). Topographic anatomy and operative surgery of meningiomas and arterial aneurysms of around-sellar localization. Ukrainian Interventional Neuroradiology and Surgery, 22(4), 28-43. https://doi.org/10.26683/2304-9359-2017-4(22)-28-43