CC BY-NC-ND 4.0 · J Neurol Surg B 2018; 79(S 02): S221-S222
DOI: 10.1055/s-0038-1623528
Skull Base: Operative Videos
Georg Thieme Verlag KG Stuttgart · New York

Microsurgical Resection of Lateral Tuberculum Sellae Meningioma: Operative Video

Duarte N. C. Cândido
1  Hospital Universitário Evangélico de Curitiba, Department of Neurosurgery, Curitiba, Paraná, Brazil
,
Paulo E. H. Nakashima
1  Hospital Universitário Evangélico de Curitiba, Department of Neurosurgery, Curitiba, Paraná, Brazil
,
Jean Gonçalves de Oliveira
3  Hospital Beneficência Portuguesa de São Paulo, São Paulo, São Paulo, Brazil
,
Luis A. B. Borba
1  Hospital Universitário Evangélico de Curitiba, Department of Neurosurgery, Curitiba, Paraná, Brazil
2  Federal University of Parana, Department of Neurosurgery, Curitiba, Paraná, Brazil
› Author Affiliations
Further Information

Publication History

15 October 2017

07 December 2017

Publication Date:
18 January 2018 (eFirst)

  

Abstract

Tuberculum Sellae Meningiomas (TSMs) are lesions dramatically related to the optic apparatus once the principal clinical complain remains on visual alterations. This is the main picture on decision making to evaluate the best time, risk-benefit, and surgical approaches to the patient treatment. In this video, we present a 65 years old female with 30 days complaint of unilateral (right) complete blindness and complete impaired right eye field test. On physical examination, there were normal pupillary function to light tests. The scans demonstrated the presence of a TSM mostly related to the right optic nerve and encasing it altogether with the right internal carotid artery. Promptly, surgery was addressed using a modified one piece cranio-orbital-zygomatic approach with extra-dural anterior clinoidectomy, as this is the procedure of choice of the senior author (LB), with easy access to decompression of the optic canal and nerve. As demonstrated on the video, the optic nerve was encased by the tumor and pushed upwards against the falciform ligament. Complete resection and decompression was established with step by step dissection, starting unroofing the optic canal, opening the ligament and finally with carefully tumor debulking. Pathology demonstrated a grade one meningioma. The patient improved remarkably her visual acuity and visual field tests on the postoperative period, emphasizing the importance of early treatment for nerve function outcome.

The link to the video can be found at: https://youtu.be/pALZqDUkltQ.