ABSTRACT
The transsphenoidal approach is the preferred method for removal of pituitary tumors.
Suprasellar tumors may also be approached transsphenoidally in the setting of an expanded
sella turcica. Suprasellar tumors that are fibrous and not associated with an expanded
sella are generally treated with craniotomy. However, transcranial resection of suprasellar
meningiomas carries significant risk to the optic apparatus. The transsphenoidal approach
may be modified to provide access for resection of suprasellar meningiomas. A consecutive
series of patients with suprasellar meningiomas who underwent a transsphenoidal transtuberculum
sellae approach were reviewed retrospectively. From January 2000 to July 2002, six
patients underwent the transsphenoidal transtuberculum sellae approach. All patients
underwent thorough preoperative and postoperative ophthalmologic and endocrinologic
testing. Magnetic resonance imaging of all patients was obtained preoperatively, 6
weeks to 3 months postoperatively, and annually. Two patients presented with visual
dysfunction and one had signs of endocrine dysfunction. Tumor diameter ranged from
1.5 to 2.5 cm with a mean diameter of 2.1 cm and all tumors revealed magnetic resonance
evidence of chiasmatic compression. Gross total resection was accomplished in four
of six (67%) patients and no patient has experienced recurrence. Vision improved in
both patients who presented with visual dysfunction and one patient with normal vision
preoperatively experienced a mild bitemporal hemianopsia. Vision remained normal or
improved in 83%. No patient required pituitary hormone replacement postoperatively
and no patient experienced cerebrospinal fluid rhinorrhea. The transsphenoidal transtuberculum
sellae approach represents a viable alternative to craniotomy for selected suprasellar
meningiomas.
KEYWORDS
Transsphenoidal approach - meningioma - tuberculum sellae - neuroendoscopy
