Features of surgical interventions for around-sellar meningiomas
Abstract
Objective — to improve surgical tactics in patients with around-sellar meningiomas (ASM) and removal of these tumors.
Materials and methods. The features of surgical treatment of 137 patients with ASM were stu-died. Male population was 40 (29.2 %), female — 97 (70.8 %). The average age was (51.8 ± 0.9) years. Selection criteria: meningiomas of the Turkish sella, the small wing of the sphenoid bone and the anterior clinoidal process, the medial parts of the large wing of the sphenoid bone and the lateral wall of the cavernous sinus. When choosing an approach, the size of the tumor, the localization and the relationship with the surrounding neural structures were taken into account.
Results. The results of the treatment of ASM were satisfactory. Total removal was achieved in 57 (41.6 %) patients, subtotal — in 77 (56.2 %), partial — in 3 (2,2 %). In 93 patients (67.9 %) with the spread of ASM in the optic canal, bone decompression was performed. The function of the optic nerve improved in 38 (27.7 %) patients. The Karnofsky score of 70 points and below before the operation was recorded in 27 (19.7 %) patients, after surgery — in 11 (8.0 %), 80 points and above — respectively 110 (80.3 %) and 126 (92.0 %).
Conclusions. The key to a successful surgical intervention under ASM is the adequate surgical approach. The choice of approach is influenced by the topography of tumors, size and direction of growth. The spreading ASM to the optic nerve canаl requires the bone decompression of the optic nerve.
Downloads
References
Bondy M, Ligon BL. Epidemiology and etiology of intracranial meningiomas: a review. J. Neurooncol. 1996 Sep;29(3):197-205. Review. PubMed PMID: 8858525.
Longstreth WT Jr, Dennis LK, McGuire VM, Drangsholt MT, Koepsell TD. Epidemiology of intracranial meningioma. Cancer. 1993 Aug 1;72(3):639-48. Review. PubMed PMID: 8334619.
Kutin MA, Kadashev BA, Kalinin PL, et al. Assessment of optic nerve decompression efficiency in resection of sellar region meningiomas via intradural subfrontal approach. Zh. Vopr. Neirokhir. im NN Burdenko [in Russian] 2014;78(4):14-30. PubMed PMID: 25406806.
Al-Mefty O, Ayoubi S. Clinoidal meningiomas. Acta Neurochirurgica Supplementum [Internet]. Vienna: Springer, 1991;92-7. Available from: http://dx.doi.org/10.1007/978-3-7091-9183-5_16
Nimmannitya P, Goto T, Terakawa Y, et al. Characteristic of optic canal invasion in 31 consecutive cases with tuberculum sellae meningioma. Neurosurg. Rev. 2016;39(4):691-7. doi: 10.1007/s10143-016-0735-6. Epub 2016 Apr 27. PubMed PMID: 27118377.
Mathiesen T, Kihlström L. Visual outcome of tuberculum sellae meningiomas after extradural optic nerve decompression. Neurosurgery. 2006;59(3):570-6;discussion 570-6. PubMed PMID: 16955039.
Taha AN, Erkmen K, Dunn IF, et al. Meningiomas involving the optic canal: pattern of involvement and implications for surgical technique. Neurosurg. Focus. 2011;30(5):E12. doi: 10.3171/2011.2.FOCUS1118. PubMed PMID: 21529168.
Mortazavi MM, Brito da Silva H, Ferreira M Jr, et al. 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;86:270-86. doi: 10.1016/j.wneu.2015.09.043. Epub 2015 Sep 25. PubMed PMID: 26409085.
Kalinin PL, Kutin MA, Fomichev DV, et al. Changes in visual and oculomotor impairments after endoscopic endonasal transsphenoidal removal of pituitary adenomas (Rus). Vestn. Oftalmol. (Rus). 2009;125(4):23-7. PubMed PMID: 19824443.
Nozaki K, Kikuta K, Takagi Y, et al. Effect of early optic canal unroofing on the outcome of visual functions in surgery for meningiomas of the tuberculum sellae and planum sphenoidale. Neurosurgery. 2008;62(4):839-44; discussion 844-6. doi: 10.1227/01.neu.0000318169.75095.cb. PubMed PMID: 18496190
Mariniello G, de Divitiis O, Bonavolontà G, Maiuri F. Surgical unroofing of the optic canal and visual outcome in basal meningiomas. Acta Neurochir. (Wien). 2013;155(1):77-84. doi: 10.1007/s00701-012-1485-z. Epub 2012 Sep 4. Erratum in: Acta Neurochir (Wien). 2013;155(1):85-6. PubMed PMID: 22945895.
Mortini P, Barzaghi LR, Serra C, et al. Visual outcome after fronto-temporo-orbito-zygomatic approach combined with early extradural and intradural optic nerve decompression in tuberculum and diaphragma sellae meningiomas. Clin. Neurol. Neurosurg. 2012;114(6):597-606. doi: 10.1016/j.clineuro.2011.12.021. Epub 2012 Jan 4. PubMed PMID: 22225973.
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;71(5 Pt 1):699-704. PubMed PMID: 2809723.
Dolenc VV. A combined epi- and subdural direct approach to carotid-ophthalmic artery aneurysms. J. Neurosurg. 1985;62(5):667-72. PubMed PMID: 3989589.
Lehmberg J, Krieg SM, Meyer B. Anterior clinoidectomy. Acta Neurochir (Wien). 2014;156(2):415-9; discussion 419. doi: 10.1007/s00701-013-1960-1. Epub 2013 Dec 10. Review. PubMed PMID: 24322583.
Froelich SC, Aziz KM, Levine NB, et al. Refinement of the extradural anterior clinoidectomy: surgical anatomy of the orbitotemporal periosteal fold. Neurosurgery. 2007;61(5 Suppl 2):179-85; discussion 185-6. doi: 10.1227/01.neu.0000303215.76477.cd. PubMed PMID: 18091231.
This work is licensed under a Creative Commons Attribution 4.0 International License.
