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J Neurol Surg B Skull Base 2012; 73 - A025
DOI: 10.1055/s-0032-1312073

Decision Analysis: Endoscopic Versus Open Resection of Tuberculum Sellae Meningiomas

Leif-Erik Bohman 1, Sherman Stein 1, Jason G. Newman 1, James Palmer 1, Nithin Adappa 1, Aamir Khan 1, T. T. Sitterley 1, Diana Chang 1 John Y. Lee 1(presenter)
  • 1Philadelphia, USA

Introduction: Tuberculum sellae meningiomas (TSMs) are challenging tumors for neurosurgical resection. Open microsurgical approaches pose significant risk to the optic apparatus, which may be obviated by endoscopic approaches. However, endoscopic endonasal surgical resection is a relatively new procedure with its own Achilles heel–CSF leak.

Materials and Methods: MEDLINE and Embase online databases were searched for English-language articles containing key words related to tuberculum sellae meningiomas. Data were pooled, including five of our own patients. Meta-regression and a decision-analytical model was constructed to compare 3-year outcomes between open microsurgery and endoscopic endonasal approaches.

Results: The 3-year recurrence rates were not statistically different between the two approaches (P = 0.529). Meta-regression of 28 reports of open craniotomy suggested a 3-year recurrence rate of 4.6% (SD = 0.699, R2 = 35.5%, P = 0.005), and meta-regression of eight publications on endoscopy suggested a 3-year recurrence rate of 9.9% (SD = 0.396, R2 = 2.6%, P = 0.231). In addition, the overall quality of life (QOL) was not significant between the two surgical approaches (P = 0.410), despite significant differences in individual complication rates. The Monte Carlo simulation yielded an overall average QOL in craniotomy patients of 0.915 (SD = 0.020) and in endoscopic patients of 0.952 (SD = 0.019). Endoscopy had a higher CSF leak rate (26.8 vs. 3.5%, P < 0.001) but a lower rate of injury to the optic apparatus (1.4% vs. 9.2%, P < 0.001) compared with craniotomy.

Conclusion: Endoscopic endonasal resection of TSMs appears to be a comparable alternative to traditional open microsurgical resection. Rates of CSF leak appear to be higher than open resection, but visual complications are less common than in open resection. The data are insufficient to provide a meaningful comparison of recurrence rates; however, this issue may be resolved as longer follow-up is obtained.