The standard surgical approach consisted of pterional. Fernandezmiranda, md, narrates surgery for a tuberculum sella meningioma using the endoscopic endonasal approach. Tsms most commonly present with insidious and progressive visual symptoms, including visual loss 98 %, optic nerve atrophy 78 %, and visual. The following are video recordings of surgical procedures from the department of neurosurgery of saint johns hospital of. Such tumors are typically found in the convexity, and rarely appear in the tuberculum sellae region. Tuberculum and diaphragma sella meningioma deepdyve. The pterional approach in a case of planum sphenoidale meningioma 119 clinical case the pterional approach in a case of planum sphenoidale meningioma tabita larisa cazac1, d. Although, many authors prefer the transcranial approach for intrasellar meningiomas, kinjo et al suggested the transcranialtranssphenoidal approach because of its wider exposure and safer hemostasis 3. Midline based meningioma arrised from the tuberculum sellae. Tuberculum sellae ts meningiomas arise from the dura of the ts, chiasmatic sulcus, limbus sphenoidale, and diaphragma sellae. Despite cushings accurate description of the anatomic origin of tuberculum sellae meningiomas, many subsequent authors have included. Large tumors extend frequently toward the planum sphenoidale, onto the diaphragma sellae, the anterior clinoid process, and the sphenoid wing and can be difficult to differentiate from tsm2. Tuberculum sellae and planum sphenoidale meningiomas represent 5% to 10% of intracranial meningiomas and represent a subgroup of anterior skull base meningiomas 10, 11, 19.
Although, many authors prefer the transcranial approach for intrasellar meningiomas, kinjo et al suggested the transcranialtranssphenoidal approach because of its wider exposure and safer. Pdf tuberculum sellae meningiomas surgical considerations. Objective in tuberculum sellae meningioma tsm surgery, endonasal approaches are claimed to have a superior visual outcome. A bimanual teleoperated system for endonasal skull base. Endoscopic endonasal approach for tuberculum sellae. North american neuroophthalmology society 36th annual. Tuberculum sellae meningiomas tsms are lesions dramatically related to the optic apparatus once the principal clinical complain remains on visual alterations. As they grow in the subchiasmal area compressing the optic. Figure 1 a case of tuberculum sellae meningioma with beak of kiwi bird enhancement in contrast mri. But the tuberculum sellae meningioma tsm is a challenge for neurosurgeons. Optic nerve vascular compression in a patient with a.
The pterional approach in a case of planum sphenoidale meningioma 119 clinical case the pterional approach in a case of planum sphenoidale meningioma tabita larisa. In the majority of patients with tuberculum sellae meningiomas, total resection may be. Microsurgical nuances of resecting tuberculum sellae. Tuberculum askep meningioma pdf sphenoorbital meningiomas soms are secondary tumours of the orbit that originate from the dura of the sphenoid wing bone.
Apr 05, 20 complete tumor resection with preservation or improvement of visual function is the goal of tuberculum sellae meningioma tsm treatment. We present detailed ophthalmic findings in a case of tuberculum sellae meningioma with acute visual symptoms due to optic canal involvement. The authors report on the clinical outcome after surgical treatment of tuberculum sellae meningiomas in our neurosurgical department. Optic tract edema in a meningioma of the tuberculum sellae. Case report clinical features and surgical treatment of. Sphenoorbital meningiomas soms are secondary tumours of the orbit that originate from the dura of the sphenoid wing bone. The difficulty in surgically excising a tuberculum sellae meningioma comes from its anatomical relationship to the optic nerves and chiasm and to the anterior cerebral and internal carotid arteries and their. After studying the cadavers, we made several revisions to the previously.
Endonasal approach to the pituitary gland using a straight tool. The pathogenesis of this edema in meningioma is controversial. Tuberculum sellae meningiomas tsms represent 5 to 10% of all intracranial meningiomas, invading the optic. Outcome assessment after surgical treatment of tuberculum sellae meningiomasa preliminary report abstract we present the outcomes of tuberculum sellae meningioma surgery conducted by a single. Surgical management of tuberculum sellae and planum.
Tuberculum sellae definition of tuberculum sellae by. The tuberculum sellae is the ridged process of the sphenoid bone which forms the anterior wall of the sella turcica gross anatomy relations. University of pittsburgh center for skull base surgery associate director juan c. The tuberculum sellae or the tubercle of the sella turcica is a part of the sphenoid bone that is an elevation behind the chiasmatic groove. In a recent article, our experience and knowledge of the clinical picture, microsurgical anatomy, and longterm surgical outcome of resecting tuberculum sellae meningiomas was described. Tuberculum sella meningiomas tsm represent 410 % of this entire cohort and are considered one of the more common intra cranial meningiomas 1, 2.
Anterior interhemispheric approach for tuberculum sellae meningioma background. Pituitary adenomas, craniopharyngiomas and tuberculum sellae meningioma, are by far the most common tumors of the sellar region, comprising 90% of all such tumors. Tuberculum sella meningioma the neurosurgical atlas, by. In order to study clinical features and surgical treatment of calcified meningiomas cms, fiftyeight patients with cms who were surgically treated were analyzed and tumor characteristics and. It accounts for up to 10% of all intracranial meningiomas. Lee, md of penn neurosurgery narrates a surgical video depicting the minimally.
Meningiomas are benign and slow growing tumors that usually take years to produce clinical symptoms. We report a case of tuberculum sellae meningioma with optic tract edema. A variable slight to prominent median elevation forming the. Here, we reported a case of tuberculum sellae meningioma with beak of kiwi bird enhancement in contrast mri at our department.
Surgical outcome of tuberculum sellae and planum sphenoidale. Complete tumor resection with preservation or improvement of visual function is the goal of tuberculum sellae meningioma tsm treatment. Harvey cushing conducted the autopsy of one of his patients who had suffered most likely from a tuberculum sella or medial sphenoid wing meningioma circa 19image. Minimally invasive endoscopic endonasal resection of. A case of tuberculum sellae meningioma with beak of kiwi. Dec 04, 2012 midline based meningioma arrised from the tuberculum sellae. All patients underwent craniotomy, with an operating microscope being used in 62 cases. North american neuroophthalmology society 36th annual meeting. Minimally invasive endoscopic endonasal resection of tuberculum sellae meningiomas overview john y. Objective in tuberculum sellae meningioma tsm surgery, endonasal approaches are claimed to have a superior visual outcome compared. Dumitrescu2 1the university of medicine and pharmacy carol davila, bucharest, romania.
Harvey cushing conducted the autopsy of one of his patients who had suffered most likely from a tuberculum sella or medial sphenoid wing meningioma circa 19image courtesy of the cushing brain tumor registry at yale university. Note that the diaphragma sellae is not pushed up as it would have been with a macroadenoma, but rather is depressed, indicating this mass is of suprasellar origin. Tuberculum sellae meningiomas tsms are known to arise from the dura of the tuberculum sellae, chiasmatic sulcus, limbus sphenoidale, and diaphragm sellae. Fernandezmiranda, md, carlos pinheironieto, md, paul a. A 62yearold japanese woman reported a 1week history.
Lateral supraorbital approach applied to sellar tumors in 23. Due to the complex anatomy of the tuberculum sellae region, decision making is very difficult. Representing 5 to 10% of intracranial meningiomas, tuberculum and diaphragm sellae meningiomas are intimately involved with the critical suprasellar structures. Endoscopic endonasal approach for tuberculum sellae meningioma juan c. Slowly progressing visual deterioration is the most common initial complaint, and prompt treatment is directed at preserving and improving vision. Oct 29, 2007 read tuberculum and diaphragma sella meningioma surgical technique and visual outcome in a series of 20 cases operated over a 2. A case of tuberculum sellae chordoid meningioma treated. May 19, 2015 university of pittsburgh center for skull base surgery associate director juan c. Outcome assessment after surgical treatment of tuberculum sellae meningiomasa preliminary report abstract we present the outcomes of tuberculum sellae meningioma surgery conducted by a single neurosurgeon, with a particular focus on visual disturbances and hypothalamicpituitary function 21,22. Surgical management of tuberculum sellae meningiomas. Microsurgical nuances of resecting tuberculum sellae meningiomas. Some authors have distinguished between diaphragma and tuberculum as two separate categories of tumor origin 19. The tuberculum sellae meningioma tsm arises from the tuberculum sellae, chiasmatic sulcus, and limbus sphenoidale. Note that the diaphragma sellae is not pushed up as it would.
The difficulty in surgically excising a tuberculum sellae meningioma comes from. The tuberculum sellae forms the anterior wall of the sella turcica, which houses the pituitary gland. The videos were made to assist with the training of neurosurgery, residents. Visual impairment was the most common initial complaint. Magnetic resonance imaging, including contrastenhanced studies, is the most accurate preoperative radiologic modality.
As they grow in the subchiasmal area compressing the optic nerves, ts meningiomas produce quite distinctive clinical, radiologic, and microsurgical features fig. Endoscopic endonasal approach for tuberculum sellae meningioma. We now present our surgical technique in a pictorial and video format for the benefit of neurosurgeons in training, as well as for general critique. Tuberculum sellae meningiomas characteristically lie in a suprasellar subchiasmal midline position, displacing the optic chiasm posteriorly and slightly superiorly, and the optic nerves laterally.
Original article minimal invasive transeyelid approach to. Chordoid meningioma cm is a rare subtype of meningioma, categorized as who grade ii due to its high recurrence rate and proliferative ability. The nasal cavity has to be prepared in order to gain access through the sphenoid sinus. Fernandezmiranda, md, narrates surgery for a tuberculum sella meningioma using the endoscopic. Anterior interhemispheric approach for tuberculum sellae. The anatomic variations and surgical windows among optic. The female patient was 32yearold, suffering from progressive loss. Lee, md of penn neurosurgery narrates a surgical video depicting the minimallyinvasive endonasal removal of a benign tuberculum sellae meningioma that has enveloped nervous and vascular structures near the optic chiasm. To retrospectively analyze patients withtsm who underwent surgery via an.
Case of acute optic nerve compression caused by tuberculum sellae meningioma with optic canal involvement chai y1, yamazaki h1, kondo a2, oshitari t3, yamamoto s31department of. Tuberculum sellae meningiomas represent approximately 5 to 10% of intracranial meningiomas 2, 12, 25, 28, 29, 33. Tuberculum sellae meningiomas have proved difficult to treat, partly because of their intimate association with the optic nerves and chiasma, hypothalamus, and. To present a large series of surgically treated tuberculum sellae meningiomas with particular regard to involvement of the optic canal and visual outcome. The difficulty in surgically excising a tuberculum sellae meningioma comes. Ac mri scan showed a case of tuberculum sellae meningioma, which was homogenously enhanced in contrast mri with obvious meninges tail sign. Tuberculum sella meningiomas represent a unique set of surgical challenges due to their threedimensional relationship with the optic. Tuberculum sellae meningiomas are a classic tumor of the anterior fossa that present in patients with gradual visual deterioration secondary to optic apparatus. Well defined suprasellar solid mass seen which shows homogenous enhancement and a broad dural attachment to the planum sphenoidale. The anatomic variations and surgical windows among optic chiasmnerves and carotid arteries in the sellar region play a role in choosing the best surgical approaches. They arise from the tuberculum sellae, chiasmatic sulcus, limbus sphenoidale, and diaphragma sellae and grow in a subchiasmal position. Mar 16, 2015 minimally invasive endoscopic endonasal resection of tuberculum sellae meningiomas overview john y. Two patients died from causes unrelated to the tumour.
Outcome assessment after surgical treatment of tuberculum. We think that for critical evaluation of surgical results and outcome, accurate classification on the basis of the anatomy of. Tuberculum sellae meningiomas are located not only on the limited surface between the prechiasmatic sulcus and and diaphragm sellae, but also on the limbus. The following are video recordings of surgical procedures from the department of neurosurgery of saint johns hospital of budapest. The female patient was 32yearold, suffering from progressive loss of vision for about 6 months.
Case of acute optic nerve compression caused by tuberculum. Ac mri scan showed a case of tuberculum sellae meningioma, which was homogenously enhanced. Complete tumor excision with preservation or improvement of visual function is the goal of tuberculum sellae meningioma tsm treatment. We present a unique, welldocumented case of optic nerve strangulation by the a1 segment of the anterior cerebral artery in a patient with a tuberculum sellae meningioma. The tuberculum sellae meningioma tsm arises from the tuberculum sellae, chiasmatic sulcus, and limbus. Sep 30, 2018 representing 5 to 10% of intracranial meningiomas, tuberculum and diaphragm sellae meningiomas are intimately involved with the critical suprasellar structures. Tuberculum sellae meningiomas neurosurgery oxford academic. The tuberculum sellae forms the anterior wall of the sella. Contrary to a prior report on this topic, edema along the optic tract is not only seen in craniopharyngiomas but may be seen although rarely in other common parasellar tumors, as in our case of a tuberculum sellae meningioma.
Tuberculum meningioma ucla pituitary tumor program. Our patient was a 57yearold female with progressive visual deterioration and a complex sellarsuprasellar lesion. Case of acute optic nerve compression caused by tuberculum sellae meningioma with optic canal involvement chai y1, yamazaki h1, kondo a2, oshitari t3, yamamoto s31department of ophthalmology, kohnodai hospital, national center for global health and medicine, chiba, 2department of neurosurgery, juntendo university, school of medicine, tokyo, 3department of ophthalmology and visual science. A bimanual teleoperated system for endonasal skull base surgery. Patients harboring a tuberculum sellae meningioma usually do not present with epileptic fits, and this symptom may point to the presence of an additional meningioma as was observed in 11. Optic nerve vascular compression in patients with suprasellar tumor is a known entity but is rarely described in the literature. Transsphenoidal versus transcranial approach for treatment of. Apr 01, 2005 in a recent article, our experience and knowledge of the clinical picture, microsurgical anatomy, and longterm surgical outcome of resecting tuberculum sellae meningiomas was described in detail.
D,e the tuberculum sellae meningioma was typically enhanced in contrast mri, and the shape of the enhanced meninges tail sign red arrow in d. Tuberculum sellae meningiomas surgical considerations. Endoscopic resection of tuberculum sellae meningiomas. Tuberculum sellae meningiomas present a special challenge because of their proximity to arteries of the anterior circulation, anterior visual pathways, and the hypothalamus. Read tuberculum and diaphragma sella meningioma surgical technique and visual outcome in a series of 20 cases operated over a 2. A variable slight to prominent median elevation forming the posterior boundary of the chiasmatic groove and the anterior boundary of the hypophysial fossa. Tuberculum sellae meningiomas is a serious challenge for neurosurgeons. Tuberculum sella meningiomas represent a surgical challenging due to their relationship with surrounding vital structure especially the optic pathway, internal carotid arteries. A retrospective analysis was done on 53 patients 40 female with meningiomas originating from the tuberculum sellae who underwent surgery between 1991 and 2002. Contrary to a prior report on this topic, edema along the optic tract is not only seen in. Snyderman, md departments of neurological surgery and otolaryngology, university of pittsburgh medical center. Regions where tuberculum sellae meningiomas occur are almost inaccessible endonasally with current surgical tools.