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How I do it: anterior interhemispheric approach to tuberculum sellae meningiomas

  • How I Do it - Tumor - Meningioma
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Abstract

Background

Tuberculum sellae meningiomas are deep-seated tumors difficult to access, located in close relation with important neurovascular structures. While the transsphenoidal approach is linked to specific complications, the different reported transcranial approaches are associated with advantages and drawbacks due to the respective angle of attack, with some areas adequately exposed and others partially hidden.

Method

We report the technical aspects of the anterior interhemispheric approach we practice.

Conclusion

This approach has the advantage of providing full control over all the vasculo-nervous structures involved and of allowing access to the medial aspect of both optic canals tangentially to the dorsum sellae.

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Abbreviations

ACA:

anterior cerebral artery

AIH:

anterior interhemispheric

CSF:

cerebrospinal fluid

FS:

frontal sinus

ICA:

internal carotid artery

OC:

optic canal

ON:

optic nerve

TS:

tuberculum sellae

TSM:

tuberculum sellae meningioma

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium

    Michaël Bruneau, Flavie Grenier-Chantrand & Matteo Riva

  2. Cliniques Universitaires de Mont-Godinne, Université Catholique de Louvain, Yvoir, Belgium

    Matteo Riva

Authors
  1. Michaël Bruneau
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  2. Flavie Grenier-Chantrand
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  3. Matteo Riva
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Corresponding author

Correspondence to Michaël Bruneau.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Informed patient consent

The authors received consent of the patients.

Additional information

Key points

1. Select the approach side depending on bridging veins location and opposite to the most lateral tumor extension.

2. Use neuronavigation to locate anatomical structures.

3. Target first the tumor anterior aspect on the midline.

4. Debulk the tumor first on the midline to the TS.

5. Resect the tumor gently from the midline in ONs direction with an ultrasonic aspirator without lateral stretching.

6. Debulk the tumor largely to make the remnant mobile before making a centripetally peripheral dissection.

7. Obtain early proximal and distal vascular control.

8. Respect all microvessels.

9. Remove any tumor extension inside the OC(s).

10. Remove as extensively as possible the pathological dura mater.

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This article is part of the Topical Collection on Tumor—Meningioma

Supplementary information

This video illustrates the case illustrated in the Figs. 2-3. (MP4 110,661 kb)

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Bruneau, M., Grenier-Chantrand, F. & Riva, M. How I do it: anterior interhemispheric approach to tuberculum sellae meningiomas. Acta Neurochir 163, 643–648 (2021). https://doi.org/10.1007/s00701-020-04653-7

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  • DOI: https://doi.org/10.1007/s00701-020-04653-7

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