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CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2018; 79(S 03): S269-S270
DOI: 10.1055/s-0038-1625939
Skull Base: Operative Videos
Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Endonasal Resection of Tuberculum Sellae Meningioma with Utilization of Indocyanine Green

Mostafa Shahein
1   Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, United States
,
Alaa S. Montaser
1   Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, United States
2   Department of Neurological Surgery, Ain Shams University Faculty of Medicine, Cairo, Egypt
,
Alexandre B. Todeschini
1   Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, United States
,
Juan M. Revuelta Barbero
1   Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, United States
,
Bradley A. Otto
1   Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, United States
3   Department of Otolaryngology–Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, United States
,
Ricardo L. Carrau
1   Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, United States
3   Department of Otolaryngology–Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, United States
,
Daniel M. Prevedello
1   Department of Neurological Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, United States
3   Department of Otolaryngology–Head and Neck Surgery, Wexner Medical Center at The Ohio State University, Columbus, Ohio, United States
› Author Affiliations
Further Information

Publication History

24 October 2017

13 December 2017

Publication Date:
14 February 2018 (online)

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Abstract

We present the case of a 67-year-old female with an incidental finding of a left-sided tuberculum sellae meningioma on a brain magnetic resonance imaging (MRI) for an unrelated complaint. Formal visual field testing showed a small defect in the inferior nasal and temporal fields of the left eye, compatible with mass effect on the optic nerve by the tumor.

An endoscopic endonasal transtuberculum approach with decompression of the left optic nerve was performed using a standard binostril four-hand technique, with the patient positioned supine with the head turned to the right side and tilted to the left, fixed in a three-pin head clamp, under imaging guidance. After exposure, we drilled the tuberculum sellae and the floor of the sella and after opening the dura, the tumor and optic nerve came into view. The tumor was completely removed and we confirmed the patency of all perforating vessels using indocyanine green. Reconstruction was done in a multilayered fashion, using collagen matrix and a nasoseptal flap.

Patient had an uneventful postoperative stay and was discharged on postoperative day 3, neurologically stable with no new hormonal deficits. Pathology report confirmed a WHO Grade I meningioma with K i-67 of 1% and 3-month postoperative MRI confirmed a gross total resection and visual fields exam showed a complete recovery.

The link to the video can be found at: https://youtu.be/zRmt2aIvX5c.

Keywords

endoscopic endonasal - tuberculum sellae meningioma - indocyanine green - ICG