CC BY-NC-ND 4.0 · J Neurol Surg B 2018; 79(S 02): S225-S226
DOI: 10.1055/s-0037-1620245
Skull Base: Operative Videos
Georg Thieme Verlag KG Stuttgart · New York

Tuberculum Sellae Meningioma Resection: Technical Nuances on the Frontopterional Approach

Oriela Rustemi
1  Department of Neurosurgery, Padua University Hospital, Padua, Italy
,
Renato Scienza
1  Department of Neurosurgery, Padua University Hospital, Padua, Italy
,
Alessandro Della Puppa
1  Department of Neurosurgery, Padua University Hospital, Padua, Italy
› Author Affiliations
Funding None.
Further Information

Address for correspondence

Oriela Rustemi, MD
Department of Neurosurgery, Padua University Hospital
Azienda Ospedaliera di Padova, via Giustiniani, 2-35128, Padova
Italy   

Publication History

08 July 2017

12 December 2017

Publication Date:
15 January 2018 (eFirst)

 

Abstract

Tuberculum sellae meningioma remains a surgical challenge. Deep location of tumor, vascular and nerve encasement, and pituitary stalk involvement are the main technical issues. The frontopterional approach represents a natural, simple, and elegant approach to this area enabling surgeon to have a direct control on all anatomical structures. A 42-year-old woman was referred with a delayed diagnosis of tuberculum sellae meningioma due to the presence of HLA-B27-associated uveitis. She presented with 1/10 visual acuity in the left eye and no right visual function. A left frontopterional craniotomy was performed. Visual function improved postoperatively. The video illustrates the cisternal anatomy via pterional approach.

The link to the video can be found at: https://youtu.be/Hmbf5bt7A64.


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Zoom Image
Fig. 1 (A) Preoperative MRI shows a contrast-enhanced tuberculum sellae lesion, suspicious of meningioma. (B) The left optic nerve (II c.n.) is evidenced through a left pterional approach. The II c.n. is compressed by the meningioma. (C) The left optic canal is unroofed and the sign of optic nerve compression is indicated by blue asterisks (*). (D) Intraoperative image after removing the left part of the meningioma showing the left optic nerve, internal carotid artery (ICA) and posterior communicating artery (PCom). (E) Intraoperative image after the removal of the meningioma showing bilateral optic nerves and ICAs, and the tuberculum meningioma's base. (F) Final intraoperative view showing bilateral oculomotor nerve (III c.n.), left II c.n., left ICA, and the conserved pituitary stalk. (G) Postoperative CT shows the complete removal of the meningioma. CT, computed tomography; MRI, magnetic resonance imaging.

www.thieme.com/skullbasevideos

www.thieme.com/jnlsbvideos


Quality:

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Conflict of Interest

None.


Address for correspondence

Oriela Rustemi, MD
Department of Neurosurgery, Padua University Hospital
Azienda Ospedaliera di Padova, via Giustiniani, 2-35128, Padova
Italy   


  
Zoom Image
Fig. 1 (A) Preoperative MRI shows a contrast-enhanced tuberculum sellae lesion, suspicious of meningioma. (B) The left optic nerve (II c.n.) is evidenced through a left pterional approach. The II c.n. is compressed by the meningioma. (C) The left optic canal is unroofed and the sign of optic nerve compression is indicated by blue asterisks (*). (D) Intraoperative image after removing the left part of the meningioma showing the left optic nerve, internal carotid artery (ICA) and posterior communicating artery (PCom). (E) Intraoperative image after the removal of the meningioma showing bilateral optic nerves and ICAs, and the tuberculum meningioma's base. (F) Final intraoperative view showing bilateral oculomotor nerve (III c.n.), left II c.n., left ICA, and the conserved pituitary stalk. (G) Postoperative CT shows the complete removal of the meningioma. CT, computed tomography; MRI, magnetic resonance imaging.