Topographic anatomy and operative surgery of meningiomas and arterial aneurysms of around-sellar localization
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.
Medvedev JuA, Zabrodskaja JuM. Novaja koncepcija proishozhdenija bifurkacionnyh anevrizm arterij os- novanija golovnogo mozga (Rus). Sankt-Peterburg : Jeskulap, 2000:67.
Mischenko TS. Epidemiologija nevrologichnyh zahvor- juvan v Ukraini (Ukr). Nejro News (Ukr). 2008;3:76-7.
Krylov VV, Vinokurov AG, Godkov IM i dr. Hirurgija anevrizm golovnogo mozga: v 3 t; pod red. Krylova VV (Rus). M., 2011;1:423 c.
Hakuba A, Tanaka K, Suzuki T, Nishimura S. A combined orbitozygomatic infratemporal epidural and subdural approach for lesions involving the entire cavernous sinus. J. Neurosurg. 1989 Nov;71(5 Pt 1):699-704. PubMed PMID: 2809723.
Al-Mefty O, Ayoubi S. Clinoidal Meningiomas. Acta Neurochirurgica Supplementum [Internet]. 1991;92-7. Available from: http://dx.doi.org/10.1007/978-3- 7091-9183-5_16
Bondy M, Ligon BL. Epidemiology and etiology of intracranial meningiomas: A review. J. Neurooncol. 1996;29:197-205.
Cushing H. The meningiomas (dural endotheliomas): their source and favored seats of origin (Cavendish Lecture). Brain. 1922;45:282-316.
Longstreth WT Jr, Dennis LK, McGuire VM et al. Epidemiology of intracranial meningioma. Cancer. 1993;72:639-48.
Alessandro GD, Giovanni MD, Iannizzi L et al. Epidemiology of primary intracranial tumors in the Valle d’Aosta (Italy) during the 6-year period 1986-1991. Neuroepidemiol. 1995;14:139-46.
Steiner T, Juvela S, Unterberg A et al. European Stroke Organization Guidelines for the Management of Intracranial Aneurysms and Subarachnoid Haemorrhage. Cerebrovasc. Dis. 2013;35:93-112. doi: 10.1159/000346087. Epub 2013 Feb 7.
Rohringer M, Sutherland GR, Louw DF et al. Incidence and clinicopathological features of meningioma. J. Neurosurg. 1989;71:665-72.
Perlmutter D, Rhoton A. Microsurgical anatomy of anterior cerebral - anterior communicating recurrent artery complex. J. Neurosurg. 1976;45,3:259-72.
Mortazavi MM, Brito da Silva H, Ferreira M Jr, Bather JK,
Pridgeon JS, Sekhar LN. Planum sphenoidale and tuberculum sellae meningiomas: Operative nuances of a modern surgical technique with outcome and proposal of a new classification system. World Neurosurg. 2016 Feb;86:270-86. doi: 10.1016/j.wneu.2015.09.043. Epub 2015 Sep 25. PubMed PMID: 26409085.
Laakso A, Hernesniemi J, Yonekawa Y, Tsukahara T. Surgical management of cerebrovascular disease. Springer Science & Business Media, 2010:107.
Mortini P, Barzaghi LR, Serra C, Orlandi V, Bianchi S, Losa M. Visual outcome after fronto-temporo-orbi- to-zygomatic approach combined with early extradural and intradural optic nerve decompression in tuberculum and diaphragma sellae meningiomas. Clin. Neurol .Neurosurg. 2012 Jul;114(6):597-606. doi: 10.1016/j.clineuro.2011.12.021. Epub 2012 Jan 4. PubMed PMID: 22225973.
This work is licensed under a Creative Commons Attribution 4.0 International License.