Endoscopic Endonasal Approach for Tuberculum Sellae Meningiomas: Surgical Results

Objective: Tuberculum sellae meningiomas (TSM) arise from the tuberculum sellae, limbus sphenoidale, and chiasmatic sulcus, and because of its location surrounded by the optic nerves and internal carotid arteries are surgically challenging tumors even in small sizes. Advancements in endoscopic endonasal skull base surgery as the development of the transtuberculum–transplanum corridor, that offers direct and immediate exposure to the tumor and medial optic nerves without brain retraction and crossing of neurovascular structures have added another perspective to the treatment of TSM.

Methods: Retrospective review was performed from January 2014 to August 2022 to identify all patients who underwent extended endoscopic endonasal resection for TSM.

Results: A total of sixty-two patients that underwent EEA for TSM were included in our cohort. Population characteristics included 37 women (61.6%), median age of 50.5 years, and an average body mass index of 30.6. The median follow-up was 31 months. The most common symptom at presentation was visual deficit (72.5%). Gross-total resection was achieved in 50 patients (80%), and optic nerve decompression was achieved in all cases. Vision improved in 72.5% of cases, with the preoperative deficit being stable in 27.5% of cases. Regarding hormonal outcomes, 11% of patients had transient diabetes insipidus. The most common complication was CSF leak that occurred in two patients (0.3%) and stroke in one patient (0.15%).

Conclusions: The EEA for resection of TSM is a safe and effective surgical option with rates of tumor resection and complications similar to the transcranial approaches.

Publication History

Article published online:
01 February 2023