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

Lihua Chen; Mou Gao; Hongtian Zhang; Wenjin Chen; Kai Sun; Ruxiang Xu

doi:10.1055/a-1768-3553

Journal of Neurological Surgery Part A: Central European Neurosurgery, Table of Contents

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

Authors

Lihua Chen‡^*

¹Department 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

²Department of Neurosurgery, the PLA General Hospital, Beijing, People's Republic of China
Hongtian Zhang‡^*

¹Department 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

¹Department 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

¹Department 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

¹Department 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

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

Full Text

References

References
1 Gökalp HZ, Arasil E, Kanpolat Y, Balim T. Meningiomas of the tuberculum sella. Neurosurg Rev 1993; 16 (02) 111-114
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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