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Tuberculum sellae meningioma surgery: visual outcomes and surgical aspects of contralateral approach

Neurosurgical Review volume 44, pages 995–1001 (2021)Cite this article

Abstract

The main purpose of surgery for tuberculum sellae meningioma (TSM) is the improvement and/or stabilization of patients’ visual function. Options for the side of lateral approaches usually were restricted for nondominant right-sided craniotomy or to the side of impaired vision (ipsilateral approaches). Although the safety and effectiveness of ipsilateral transcranial approach was proved, there are some doubts and discussions about the contralateral craniotomy. We retrospectively analyzed the series of contralateral surgeries of TMS and their visual outcomes comparing with ipsilateral approach. Twenty-six patients with TSM were operated on from 2010 to 2019 (F/M 20/6, mean age 49 years), in 17 (65%) we performed contralateral and in 9 (35%) ipsilateral approach. All procedures were performed via fronto-lateral craniotomy. Gross total resection (GTR) was achieved in 21 (81%) cases and in all but one patient we noticed visual improvement after surgery (96%). Optic canal unroofing with mobilization of more affected visual nerve was necessary in 5/9 pts of ipsilateral vs 3/17 pts of contralateral group. We had no significant postoperative complications.

There was no difference in outcome between ipsilateral and contralateral fronto-lateral approaches for TSM resection; thus, contralateral approach was at least as safe and effective as ipsilateral.

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Affiliations

  1. Center of Neurosurgery, Clinical Hospital “Feofaniya”, Zabolotny str, 21, Kyiv, 03143, Ukraine

    Oleksandr Voznyak, Andrii Lytvynenko, Oleg Maydannyk, Roman Ilyuk & Yaroslav Zinkevych

  2. Department of Neurosurgery, Shupyk National Medical Academy of Postgraduate Education, Dorohozhytska St., 9, Kyiv, 04112, Ukraine

    Nazarii Hryniv

Authors
  1. Oleksandr Voznyak
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  2. Andrii Lytvynenko
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  3. Oleg Maydannyk
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  4. Roman Ilyuk
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  5. Yaroslav Zinkevych
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  6. Nazarii Hryniv
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Correspondence to Oleksandr Voznyak.

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The authors declare that there is no conflict of interest.

Ethical approval

The study was approved in accordance with ICH/GCP provisions by the Expert Commission of the Clinical Hospital “Feofaniya” of the State Administration of Affairs (Quality Management System Certificate UA126Q01 19 076 01).

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Informed consent was not deemed necessary by the local expert commission in view of the retrospective design of the study and the application of patient privacy regulations operating in our center.

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Voznyak, O., Lytvynenko, A., Maydannyk, O. et al. Tuberculum sellae meningioma surgery: visual outcomes and surgical aspects of contralateral approach. Neurosurg Rev 44, 995–1001 (2021). https://doi.org/10.1007/s10143-020-01278-3

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  • DOI: https://doi.org/10.1007/s10143-020-01278-3

Keywords

  • Tuberculum sellae meningioma
  • Fronto-lateral approach
  • Visual outcome
  • Optic canal unroofing