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Lateral supraorbital versus pterional approach for parachiasmal meningiomas: surgical indications and esthetic benefits

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Abstract

The lateral supraorbital (LSO) approach is a minimally invasive modification of the pterional approach. The authors assess the surgical indications and esthetic benefits of the LSO approach in comparison with the pterional approach for parachiasmal meningiomas. From April 2013 to May 2017, a total of 64 patients underwent surgery for parachiasmal meningiomas. Among them, tumor resection was performed with the LSO approach for 34 patients and pterional approach for 30 patients. A retrospective analysis was done on tumor characteristics, surgical outcome, approach-related morbidity, and esthetic outcome between the two approaches. Gross total resection was achieved in 33 of 34 patients (97.1%) with the LSO approach. There were no differences in tumor size, origin, consistency, internal carotid artery encasement, cranial nerve adhesion, and optic canal invasion between the two approaches. The most common tumor origin was the tuberculum sellae for both the LSO and pterional approaches. For tumors with preoperative visual compromise, immediate visual outcome improved or remained stable in 76% and 80.9% with the LSO and pterional approaches, respectively. Surgery time, surgical bleeding, hospital length of stay, and esthetic outcome were significantly shorter and superior with the LSO approach. There were no differences in surgical morbidity and brain retraction injury between the two approaches. The LSO approach can provide a safe, rapid, and minimally invasive exposure for parachiasmal meningiomas compared with the pterional approach. Surgeons must consider tumor size, origin, and extent in determining the resectability of the tumor rather than the extent of exposure.

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Acknowledgments

The authors would like to thank Dong-Su Jang, MFA, (Medical Illustrator, Medical Research Support Section, Yonsei University College of Medicine, Seoul, Korea) for his help with the illustrations.

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Authors and Affiliations

  1. Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University Health System, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea

    Hun Ho Park, Kyu-Sung Lee & Chang-Ki Hong

  2. Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea

    Kyoung Su Sung

  3. Department of Neurosurgery, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Ju Hyung Moon, Eui Hyun Kim, Sun Ho Kim & Jong Hee Chang

  4. Brain Tumor Center, Yonsei University Health System, Seoul, Republic of Korea

    Ju Hyung Moon, Eui Hyun Kim, Sun Ho Kim & Jong Hee Chang

  5. Brain Research Institute, Yonsei University Health System, Seoul, Republic of Korea

    Ju Hyung Moon, Eui Hyun Kim, Sun Ho Kim & Jong Hee Chang

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  1. Hun Ho Park
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  2. Kyoung Su Sung
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Correspondence to Chang-Ki Hong or Jong Hee Chang.

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The study was approved by the institutional review board and conducted in accordance with the ethical guidelines of the Declaration of Helsinki.

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The data was analyzed retrospectively after obtaining informed consent from every patient.

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Park, H.H., Sung, K.S., Moon, J.H. et al. Lateral supraorbital versus pterional approach for parachiasmal meningiomas: surgical indications and esthetic benefits. Neurosurg Rev 43, 313–322 (2020). https://doi.org/10.1007/s10143-019-01147-8

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  • DOI: https://doi.org/10.1007/s10143-019-01147-8

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