Turkish Neurosurgery
Endoscopic Endonasal Approach Limitations and Evolutions for Tuberculum Sellae Meningiomas: Data from Single-Center Experience of Sixty Patients
Melih Caklili1, Atakan Emengen2, Eren Yilmaz3, Hamza Genc3, Burak Cabuk3, Ihsan Anik3, Savas Ceylan3
1Taksim Education and Research Hospital, Neurosurgery, Istanbul,
2Kocaeli State Hospital, Neurosurgery, Kocaeli,
3Kocaeli University, Neurosurgery, Kocaeli,
DOI: 10.5137/1019-5149.JTN.38489-22.2

Introduction: New detailed scoring systems have been introduced for surgical technique selection. These are greatly helpful and detailed but complex classifications. Despite developments and advances in the endoscopic technique, there are still debates on which of the methods used in surgery in tuberculum sellae meningiomas. Limitations of approaches are not clearly defined. Materials and Methods: We reviewed the medical data, radiological images, and surgical videos of the patients with pathologically confirmed meningiomas originating from the tuberculum sellae and they were operated via endoscopic endonasal approach between August 1997 and December 2020. We used our endoscopic classification based on infrachiasmatic corridor. In this classification, tumors were divided into those within the infrachiasmatic corridor and proximity of the optic nerve, internal carotid artery, and anterior artery complex and those outside the infrachiasmatic corridor. Results: Gross total resection was achieved in 45/60 (75%) patients. We found that tumor consistency was statistically significant on resection rates. Simultaneously, tumor median diameters on the anteroposterior (≤21.15 mm), transverse (≤19.75 mm), and superoinferior (≤15 mm) axes were statistically significant on resection rates. Conclusion: In summary, the most important factor in selecting the surgical technique is the tumor size. Infrachiasmatic corridor boundaries are the limitations of endoscopic approach. These limitations can change based on surgeon’s experience. Also, tumor consistency is a factor that affecting degree of tumor resection rates.

Corresponding author : Savas Ceylan