CC BY-NC-ND 4.0 · J Neurol Surg B 2018; 79(S 02): S213-S214
DOI: 10.1055/s-0037-1606553
Skull Base: Operative Videos
Georg Thieme Verlag KG Stuttgart · New York

Modified One-Piece Extended Transbasal Approach for Endoscopic-Assisted Microsurgical Resection of Tuberculum Sellae Meningioma: Operative Video and Technical Nuances

James K. Liu
1  Department of Neurological Surgery, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, Newark, New Jersey
,
Kentaro Watanabe
1  Department of Neurological Surgery, Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, Newark, New Jersey
› Author Affiliations
Further Information

Address for correspondence

James K. Liu, MD
Department of Neurological Surgery
Rutgers University, New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, New Jersey 07103

Publication History

Publication Date:
01 November 2017 (eFirst)

 

Abstract

The optimal approach for surgical resection of tuberculum sellae meningiomas remains controversial. Approach selection is largely based on a variety of factors, such as tumor size, extent and location relative to the optic canal and internal carotid artery, the presence of vascular encasement, and surgeon's preference. In this operative video manuscript, the authors demonstrate the importance of an open transcranial approach when the tumor extends lateral to the optic nerve over the internal carotid artery into the opticocarotid triangle, which is a difficult region to safely access with a purely endoscopic endonasal approach. We present a case of an endoscopic-assisted microsurgical resection of a tuberculum sellae meningioma using a modified one-piece extended transbasal approach in a patient with unilateral visual loss. The approach allows both interhemispheric and subfrontal routes to the suprasellar region. Early optic nerve decompression and division of the falciform ligament is critical to optimize visual outcomes. This video atlas demonstrates the operative technique and surgical nuances of the skull base approach, optic nerve decompression, tumor-arachnoid dissection, and safe handling of the neurovascular structures. A gross total resection was achieved and the patient had restoration of normal vision with normal pituitary function. In summary, the modified one-piece extended transbasal approach with endoscopic assistance is an important strategy in the armamentarium for surgical management of tuberculum sellae meningiomas.

The link to the video can be found at: https://www.youtube.com/watch?v=jKNtRzMSFVE.


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Zoom Image
Fig. 1 Preoperative (A and B) and postoperative (C and D) post-gadolinium T1-weighted MRI of a tuberculum sellae meningioma removed via a modified one-piece extended transbasal approach.
Zoom Image
Fig. 2 (A) Intraoperative microsurgical view of tumor removal via the right subfrontal route. (B) Endoscopic view of suprasellar region after tumor removal.

www.thieme.com/skullbasevideos

www.thieme.com/jnlsbvideos


Quality:

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Conflict of Interest

None declared.


Address for correspondence

James K. Liu, MD
Department of Neurological Surgery
Rutgers University, New Jersey Medical School, 90 Bergen Street, Suite 8100, Newark, New Jersey 07103


  
Zoom Image
Fig. 1 Preoperative (A and B) and postoperative (C and D) post-gadolinium T1-weighted MRI of a tuberculum sellae meningioma removed via a modified one-piece extended transbasal approach.
Zoom Image
Fig. 2 (A) Intraoperative microsurgical view of tumor removal via the right subfrontal route. (B) Endoscopic view of suprasellar region after tumor removal.