Preoperative Evaluation of the Interface Between Tuberculum Sellae Meningioma and the Optic Nerves on Fast Imaging with Steady-state Acquisition for Extended Endoscopic Endonasal Transsphenoidal Surgery.

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Preoperative Evaluation of the Interface Between Tuberculum Sellae Meningioma and the Optic Nerves on Fast Imaging with Steady-state Acquisition for Extended Endoscopic Endonasal Transsphenoidal Surgery.

World Neurosurg. 2017 Apr 06;:

Authors: Hayashi Y, Kita D, Fukui I, Sasagawa Y, Oishi M, Tachibana O, Ueda F, Nakada M

Abstract
INTRODUCTION: Endoscopic endonasal transsphenoidal surgery (EETS) is increasingly applied to treat tuberculum sellae meningiomas. However, if the tumor adheres firmly to the optic nerve, dissection of the interface between both structures should be prudent to preserve visual function. The purpose of this study was to investigate whether tumor adhesion to the optic nerve can be predicted preoperatively by fast imaging with steady-state acquisition (FIESTA).
METHODS: Twenty-two patients with tuberculum sellae meningioma treated with EETS were retrospectively identified. Clinical characteristics, radiological studies, intraoperative findings, and outcomes were reviewed from their clinical charts.
RESULTS: Patients' symptoms included visual function impairment in 18 patients and headaches in 4 patients. Symptoms were resolved in 19 patients after operation. Preoperative radiological evaluation was performed in 44 sides (22 patients) of the interface between tumors and the optic nerves, and revealed absence of peritumoral hyperintensity on FIESTA in 7 sides in 7 patients. In 5 out of the 7 sides, tumor dissection was complicated by firm adhesion to the optic nerves. Among these cases, visual functions were unchanged in 1 patient after complete removal of the adhesion, however, substantially improved in 3 patients after partial resection. In the remaining 37 sides with preoperative peritumoral hyperintensity, no adhesion was found between both structures intraoperatively.
CONCLUSION: Absence of peritumoral hyperintensity between tuberculum sellae meningioma and the optic nerve on FIESTA may indicate firm adhesion at the interface, severely complicating complete removal. Preoperative recognition of this adhesion is important for safe tumor removal and preservation of visual functions.

PMID: 28392496 [PubMed - as supplied by publisher]

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