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J Neurol Surg B Skull Base
DOI: 10.1055/a-2505-8048
Original Article

Midterm Outcomes of the Endoscopic Endonasal Approach for Treating Tuberculum Sellae Meningiomas: The Impact of Malleable Forceps and Predictors of Surgical Success

Authors

  • Kenta Nakase 

    1   Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan

  • Tetsuya Nagatani

    1   Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan

  • Takayuki Ishikawa

    1   Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan

  • Nobuyasu Kato

    1   Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan

  • Yuichiro Isozawa

    1   Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan

  • Tomiyuki Miyake

    1   Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan

  • Yosuke Sakai

    2   Department of Neurosurgery, Komaki City Hospital, Komaki, Aichi, Japan

  • Hayato Yokoyama

    1   Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan

  • Tetsuya Tsukada

    1   Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan

  • Yusuke Sakamoto

    1   Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan

  • Yoshio Araki

    1   Department of Neurosurgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan

  • Yukio Seki

    3   Department of Neurosurgery, Daido Hospital, Nagoya, Aichi, Japan
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Abstract

Objective To evaluate the midterm surgical outcomes and factors associated with the extent of resection (EOR), postoperative visual improvement, and risk factors for postoperative cerebrospinal fluid (CSF) leaks in cases of the endoscopic endonasal approach (EEA) for tuberculum sellae meningiomas (TSMs), including cases utilizing the malleable forceps.

Design Retrospective clinical study.

Setting Single-center tertiary referral hospital.

Participants Twenty-two patients who underwent the EEA for TSMs between November 2013 and April 2024.

Main Outcome Measures Patient characteristics, intraoperative findings, and postoperative outcomes were evaluated. Predictors of the EOR, postoperative visual improvement, and postoperative CSF leaks were investigated.

Results The median age was 58 years, with 77.2% being women. The median follow-up was 70.5 months, and the mean tumor size was 23.5 mm. Gross total resection (GTR) was achieved in 18 patients (81.8%), with no recurrence. Adhesion to the optic nerve was significantly associated with the EOR (p = 0.001). The malleable forceps were used in 14 out of 22 cases, and the GTR rate increased to 92.8% (13 out of 14 cases) with this instrument._Postoperative visual improvement was achieved in 16 of 19 patients (84.2%) and was significantly associated with tumor size (p = 0.02) and the duration of preoperative visual disturbances (p = 0.002). Two patients (9.0%) experienced postoperative CSF leaks, significantly associated with sex (p = 0.04) and Simpson grade (p = 0.032).

Conclusion The EEA yielded favorable outcomes and significant postoperative visual improvement for TSMs, supporting early intervention for symptomatic TSMs and radical treatment for GTR. The malleable forceps can enhance the management of complex procedures.

Keywords

tuberculum sellae meningiomas - endoscopic endonasal approach - midterm outcomes - visual impairment - cerebrospinal fluid leaks - malleable forceps

Authors' Contributions

All authors contributed to the study conceptualization and design. Formal analysis and investigation: K.N., T.N.; writing—original draft preparation: K.N., T.N.; writing—review and editing: K.N., T.N., T.I.; supervision: N.K., Y.I., T.M., Y.S., H.Y., T.T., Y.S., Y.A., T.N., Y.S.


Data Availability

The data supporting the findings of this study are available from the corresponding author, T.N., upon reasonable request.


Code Availability

The code supporting the findings of this study is available from the corresponding author upon reasonable request.




Publication History

Received: 11 October 2024

Accepted: 16 December 2024

Article published online:
15 January 2025

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