Surgical management of tuberculum sellae meningioma: Transcranial approach or endoscopic endonasal approach?

BackgroundTuberculum sellae meningioma (TSM), a common benign tumor in the sellae region, usually causes neurological deficits, such as vision impairment, by squeezing the peripheral neurovascular structures. Surgical management is recommended as the optimal strategy for TSM treatment and vision res...

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Main Authors: Kang Qian, Chuansheng Nie, Wende Zhu, Hongyang Zhao, Fangcheng Zhang, Haijun Wang, Xiaobing Jiang
Format: Article
Language:English
Published: Frontiers Media S.A. 2022-08-01
Series:Frontiers in Surgery
Subjects:
Online Access:https://www.frontiersin.org/articles/10.3389/fsurg.2022.979940/full
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author Kang Qian
Chuansheng Nie
Wende Zhu
Hongyang Zhao
Fangcheng Zhang
Haijun Wang
Xiaobing Jiang
author_facet Kang Qian
Chuansheng Nie
Wende Zhu
Hongyang Zhao
Fangcheng Zhang
Haijun Wang
Xiaobing Jiang
author_sort Kang Qian
collection DOAJ
description BackgroundTuberculum sellae meningioma (TSM), a common benign tumor in the sellae region, usually causes neurological deficits, such as vision impairment, by squeezing the peripheral neurovascular structures. Surgical management is recommended as the optimal strategy for TSM treatment and vision restoration. However, it remains challenging to resect TSM in the traditional transcranial approach (TCA). Recently, the endoscopic endonasal approach (EEA) has emerged as an effective option in skull base surgeries. Besides the effectivity, the advantages and limitations of EEA in TSM surgery remain controversial.ObjectWe compared the surgical outcomes and complications between TCA and EEA surgeries to identify the principles in TSM surgical management.MethodsRetrospective analysis was performed on the patients, who underwent TSM surgery in Wuhan Union Hospital between January 2017 and December 2021. The patients were assigned to TCA or EEA group according to the surgery they experienced. All patients were analyzed with the extent of tumor resection, vision outcome, postoperative complications, and follow-up results.ResultsA total of 112 patients were enrolled in this study, including 78 in TCA group and 34 in EEA group. The mean follow-up was 20.5 months (range 3–36 months). There were no statistically significant differences in patient demographic data, preoperative symptoms, and tumor characteristics between TCA and EEA groups. Both TCA and EEA surgeries are effective in TSM resection with relatively high gross total resection rates (85.9% in TCA vs. 91.2% in EEA, p > .05). Meanwhile, EEA surgery has a better outcome in vision restoration or stabilization than TCA surgery (74.6% in TCA vs. 93.1% in EEA, p < .05). Whereas EEA surgery causes more occurrences of cerebrospinal fluid (CSF) leakage than TCA surgery (0% in TCA vs. 11.8% in EEA, p < .05).ConclusionBoth TCA and EEA surgeries are effective in TSM resection. EEA surgery has a better outcome in vision restoration or stabilization than TCA surgery, but induces higher risk of CSF leakage. As each approach has unique advantages and limitations, we must take all aspects into consideration, including approach feathers, tumor characteristics, and clinical requirements, to make the optimal choice in TSM surgical management.
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spelling doaj.art-08fc5e3b341544099748fd2c4a1577f02022-12-22T02:25:38ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2022-08-01910.3389/fsurg.2022.979940979940Surgical management of tuberculum sellae meningioma: Transcranial approach or endoscopic endonasal approach?Kang QianChuansheng NieWende ZhuHongyang ZhaoFangcheng ZhangHaijun WangXiaobing JiangBackgroundTuberculum sellae meningioma (TSM), a common benign tumor in the sellae region, usually causes neurological deficits, such as vision impairment, by squeezing the peripheral neurovascular structures. Surgical management is recommended as the optimal strategy for TSM treatment and vision restoration. However, it remains challenging to resect TSM in the traditional transcranial approach (TCA). Recently, the endoscopic endonasal approach (EEA) has emerged as an effective option in skull base surgeries. Besides the effectivity, the advantages and limitations of EEA in TSM surgery remain controversial.ObjectWe compared the surgical outcomes and complications between TCA and EEA surgeries to identify the principles in TSM surgical management.MethodsRetrospective analysis was performed on the patients, who underwent TSM surgery in Wuhan Union Hospital between January 2017 and December 2021. The patients were assigned to TCA or EEA group according to the surgery they experienced. All patients were analyzed with the extent of tumor resection, vision outcome, postoperative complications, and follow-up results.ResultsA total of 112 patients were enrolled in this study, including 78 in TCA group and 34 in EEA group. The mean follow-up was 20.5 months (range 3–36 months). There were no statistically significant differences in patient demographic data, preoperative symptoms, and tumor characteristics between TCA and EEA groups. Both TCA and EEA surgeries are effective in TSM resection with relatively high gross total resection rates (85.9% in TCA vs. 91.2% in EEA, p > .05). Meanwhile, EEA surgery has a better outcome in vision restoration or stabilization than TCA surgery (74.6% in TCA vs. 93.1% in EEA, p < .05). Whereas EEA surgery causes more occurrences of cerebrospinal fluid (CSF) leakage than TCA surgery (0% in TCA vs. 11.8% in EEA, p < .05).ConclusionBoth TCA and EEA surgeries are effective in TSM resection. EEA surgery has a better outcome in vision restoration or stabilization than TCA surgery, but induces higher risk of CSF leakage. As each approach has unique advantages and limitations, we must take all aspects into consideration, including approach feathers, tumor characteristics, and clinical requirements, to make the optimal choice in TSM surgical management.https://www.frontiersin.org/articles/10.3389/fsurg.2022.979940/fulltuberculum sellae meningiomatranscranial approachendoscopic endonasal approachgross total resectioncerebrospinal fluid leakage
spellingShingle Kang Qian
Chuansheng Nie
Wende Zhu
Hongyang Zhao
Fangcheng Zhang
Haijun Wang
Xiaobing Jiang
Surgical management of tuberculum sellae meningioma: Transcranial approach or endoscopic endonasal approach?
Frontiers in Surgery
tuberculum sellae meningioma
transcranial approach
endoscopic endonasal approach
gross total resection
cerebrospinal fluid leakage
title Surgical management of tuberculum sellae meningioma: Transcranial approach or endoscopic endonasal approach?
title_full Surgical management of tuberculum sellae meningioma: Transcranial approach or endoscopic endonasal approach?
title_fullStr Surgical management of tuberculum sellae meningioma: Transcranial approach or endoscopic endonasal approach?
title_full_unstemmed Surgical management of tuberculum sellae meningioma: Transcranial approach or endoscopic endonasal approach?
title_short Surgical management of tuberculum sellae meningioma: Transcranial approach or endoscopic endonasal approach?
title_sort surgical management of tuberculum sellae meningioma transcranial approach or endoscopic endonasal approach
topic tuberculum sellae meningioma
transcranial approach
endoscopic endonasal approach
gross total resection
cerebrospinal fluid leakage
url https://www.frontiersin.org/articles/10.3389/fsurg.2022.979940/full
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