Endoscopic Assisted Supraorbital Keyhole Approach or Endoscopic Endonasal Approach in Case of Tuberculum Sellae Meningioma: which Surgical Route Should be Favoured?

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Endoscopic Assisted Supraorbital Keyhole Approach or Endoscopic Endonasal Approach in Case of Tuberculum Sellae Meningioma: which Surgical Route Should be Favoured?

World Neurosurg. 2017 May 13;:

Authors: Linsler S, Fischer G, Skliarenko V, Stadie A, Oertel J

Abstract
OBJECTIVE: Keyhole approaches are currently under investigation for skull base tumor surgery. They are expected to have a low complication rate with the same successful resection rate compared to endoscopic endonasal procedures. In this study, the authors compare their current series of tuberculum sellae meningiomas resected via an endoscopic endonasal or microsurgical supraorbital keyhole approach.
METHODS: Between 2011 and 2016, 16 patients were treated using the supraorbital keyhole procedure and 6 patients received an endoscopic endonasal procedure. Both surgical techniques were analyzed and compared concerning complications, surgical radicality, endocrinological and ophthalmological outcome and recurrences in patients´ follow up.
RESULTS: The two different approaches yielded similar rates of gross total resection (endonasal 83% [5 of 6] versus supraorbital 87% [14 of 16]), near total resection (17% [1 of 6] versus 13% [2 of 16]) and visual recovery (endonasal 66% [2 of 3] versus supraorbital 60% [3 of 5]). An extension lateral to the internal carotid artery was noted in the supraorbital cases in 81% (13 of 16) and in none of endonasal cases. Tumor volume was 14.9ccm (±8.2ccm) for supraorbital tumors vs. 2.1ccm (±0.8ccm) for endonasal approach.
CONCLUSIONS: Both approaches provide minimally invasive surgical routes accessing meningiomas of the sellar region. The ideal approach should be tailored to the individual patient considering the tumor anatomy, lateral extension and the experience of the surgeon with both surgical approaches. The authors suggest using the supraorbital approach for larger meningiomas of sellar region with far lateral extension or broad vascular encasement.

PMID: 28512043 [PubMed - as supplied by publisher]

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