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J Neurol Surg A Cent Eur Neurosurg 2024; 85(01): 001-006
DOI: 10.1055/a-1768-3553
Original Article

Effect of Optic Canal Opening on Postoperative Visual Acuity in Patients with Tuberculum Sellae Meningiomas

Lihua Chen‡   *
1   Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
,
Mou Gao
2   Department of Neurosurgery, the PLA General Hospital, Beijing, People's Republic of China
,
Hongtian Zhang‡   *
1   Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
,
Wenjin Chen
1   Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
,
Kai Sun
1   Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
,
Ruxiang Xu
1   Department of Neurosurgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
› Author Affiliations Funding This study was supported by the “Construction of Standardized Healthy Brain and Diseased Brain Resource Bank of Sichuan Province,” the key research and development project of Sichuan Provincial Department of Science and Technology (No. 2021YFS0010).
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Abstract

Background Tuberculum sellae meningiomas (TSMs) account for 5 to 10% of all intracranial meningiomas. They typically invade the optic canal and displace the optic nerve upward and laterally. The transcranial approach has been the standard surgical approach, while the transsphenoidal approach has been proposed for its minimally invasive nature; however, some reservations concerning this approach remain.

Methods From January 2000 to December 2018, a total of 97 patients who were diagnosed with TSM with invasion of the optic canal were enrolled and underwent microsurgery for tumor removal with optic canal opening. A retrospective analysis was performed on the effect of optic canal opening on postoperative visual acuity improvement. The median follow-up was 17.4 months (range: 3–86 months).

Results Among the 97 patients with TSM involving the optic canal, optic canal invasion was seen on preoperative imaging in 73 patients and during intraoperative exploration in all patients. In total, 87/97 patients (89.7%) underwent optic canal opening to remove tumors involving the optic canal, and the rate of total macroscopic resection of tumors invading the optic canal was 100%. Among the 10 patients who did not undergo optic canal opening, the rate of total resection of tumors involving the optic canal was 80% (8/10, p < 0.001). There were no deaths or serious complications. The postoperative visual acuity improvement rate was 64.4%, 23.7% maintained the preoperative level, and the visual acuity deteriorated 11.9%.

Conclusion Intraoperative optic canal opening is the key to total resection of TSMs involving the optic canal and improving postoperative visual acuity.

Keywords

tuberculum sellae - meningioma - optic canal - visual acuity

* These authors contributed equally.




Publication History

Received: 15 May 2021

Accepted: 07 February 2022

Accepted Manuscript online:
10 February 2022

Article published online:
16 August 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
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  • References

  • 1 Gökalp HZ, Arasil E, Kanpolat Y, Balim T. Meningiomas of the tuberculum sella. Neurosurg Rev 1993; 16 (02) 111-114
    CrossrefPubMedGoogle Scholar
  • 2 Kuga D, Toda M, Yoshida K. Treatment strategy for tuberculum sellae meningiomas based on a preoperative radiological assessment. World Neurosurg 2018; 120: e1279-e1288
    CrossrefPubMedGoogle Scholar
  • 3 Karsy M, Raheja A, Eli I, Guan J, Couldwell WT. Clinical outcomes with transcranial resection of the tuberculum sellae meningioma. World Neurosurg 2017; 108: 748-755
    CrossrefPubMedGoogle Scholar
  • 4 Mortazavi MM, Brito da Silva H, Ferreira Jr M, Barber JK, Pridgeon JS, Sekhar LN. Planum sphenoidale and tuberculum sellae meningiomas: operative nuances of a modern surgical technique with outcome and proposal of a new classification system. World Neurosurg 2016; 86: 270-286
    CrossrefPubMedGoogle Scholar
  • 5 Makarenko S, Carreras EM, Akagami R. Craniotomy for perisellar meningiomas: comparison of simple (appropriate for endoscopic approach) versus complex anatomy and surgical outcomes. J Neurosurg 2017; 126 (04) 1191-1200
    CrossrefPubMedGoogle Scholar
  • 6 Chowdhury FH, Haque MR, Goel AH, Kawsar KA. Endoscopic endonasal extended transsphenoidal removal of tuberculum sellae meningioma (TSM): an experience of six cases. Br J Neurosurg 2012; 26 (05) 692-699
    CrossrefPubMedGoogle Scholar
  • 7 Magill ST, Morshed RA, Lucas CG. et al. Tuberculum sellae meningiomas: grading scale to assess surgical outcomes using the transcranial versus transsphenoidal approach. Neurosurg Focus 2018; 44 (04) E9
    CrossrefPubMedGoogle Scholar
  • 8 Turel MK, Tsermoulas G, Reddy D, Andrade-Barazarte H, Zadeh G, Gentili F. Endonasal endoscopic transsphenoidal excision of tuberculum sellae meningiomas: a systematic review. J Neurosurg Sci 2016; 60 (04) 463-475
    PubMedGoogle Scholar
  • 9 Yang C, Fan Y, Shen Z, Wang R, Bao X. Transsphenoidal versus transcranial approach for treatment of tuberculum sellae meningiomas: a systematic review and meta-analysis of comparative studies. Sci Rep 2019; 9 (01) 4882
    CrossrefPubMedGoogle Scholar
  • 10 Shin M, Kondo K, Saito N. Current status of endoscopic endonasal surgery for skull base meningiomas: review of the literature. Neurol Med Chir (Tokyo) 2015; 55 (09) 735-743
    CrossrefPubMedGoogle Scholar
  • 11 Nanda A, Patra DP, Savardekar AR, Mohammed N, Narayan V, Bir SC. Surgery of tuberculum sellae meningioma: a technical purview on pterional approach. J Neurol Surg B Skull Base 2018; 79 (Suppl. 03) S265-S266
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Liu HC, Qiu E, Zhang JL. et al. Surgical indications of exploring optic canal and visual prognostic factors in neurosurgical treatment of tuberculum sellae meningiomas. Chin Med J (Engl) 2015; 128 (17) 2307-2311
    CrossrefPubMedGoogle Scholar
  • 13 Kalyvas A, Almeida JP, Mohan N, O'Halloran PJ, Vescan A, Gentili F. Expanded endoscopic endonasal approach for removal of a tuberculum sella meningioma. World Neurosurg 2020; 142: 62
    CrossrefPubMedGoogle Scholar
  • 14 Sakata K, Takeshige N, Nagata Y. et al. Endoscopic endonasal removal of primary/recurrent meningiomas in the medial optic canal: surgical technique and long-term visual outcome. Oper Neurosurg (Hagerstown) 2019; 17 (05) 470-480
    CrossrefPubMedGoogle Scholar
  • 15 Mathiesen T, Kihlström L. Visual outcome of tuberculum sellae meningiomas after extradural optic nerve decompression. Neurosurgery 2006; 59 (03) 570-576 , discussion 570–576
    CrossrefPubMedGoogle Scholar
  • 16 Nozaki K, Kikuta K, Takagi Y, Mineharu Y, Takahashi JA, Hashimoto N. Effect of early optic canal unroofing on the outcome of visual functions in surgery for meningiomas of the tuberculum sellae and planum sphenoidale. Neurosurgery 2008; 62 (04) 839-844 , discussion 844–846
    CrossrefPubMedGoogle Scholar
  • 17 Sade B, Lee JH. High incidence of optic canal involvement in tuberculum sellae meningiomas: rationale for aggressive skull base approach. Surg Neurol 2009; 72 (02) 118-123 , discussion 123
    CrossrefPubMedGoogle Scholar
  • 18 Arai H, Sato K, Okuda O. et al. Transcranial transsphenoidal approach for tuberculum sellae meningiomas. Acta Neurochir (Wien) 2000; 142 (07) 751-756 , discussion 756–757
    CrossrefPubMedGoogle Scholar
  • 19 Schick U, Hassler W. Surgical management of tuberculum sellae meningiomas: involvement of the optic canal and visual outcome. J Neurol Neurosurg Psychiatry 2005; 76 (07) 977-983
    CrossrefPubMedGoogle Scholar
  • 20 Attia M, Kandasamy J, Jakimovski D. et al. The importance and timing of optic canal exploration and decompression during endoscopic endonasal resection of tuberculum sella and planum sphenoidale meningiomas. Neurosurgery 2012; 71 (1, Suppl Operative): 58-67
    PubMedGoogle Scholar
  • 21 Mortini P, Barzaghi LR, Serra C, Orlandi V, Bianchi S, Losa M. Visual outcome after fronto-temporo-orbito-zygomatic approach combined with early extradural and intradural optic nerve decompression in tuberculum and diaphragma sellae meningiomas. Clin Neurol Neurosurg 2012; 114 (06) 597-606
    CrossrefPubMedGoogle Scholar
  • 22 Nimmannitya P, Goto T, Terakawa Y. et al. Characteristic of optic canal invasion in 31 consecutive cases with tuberculum sellae meningioma. Neurosurg Rev 2016; 39 (04) 691-697
    CrossrefPubMedGoogle Scholar