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How I do it: optic canal unroofing in surgery for tuberculum sellae meningiomas with compression of the optic nerve

  • How I Do it - Tumor - Meningioma
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Abstract

Background

Tuberculum sellae meningiomas are challenging to treat when accompanied with altered vision due to compression of the optic nerve. These tumors mostly refer to be benign; therefore, gross total removal and excellent functional recovery are desired.

Method

We describe the microsurgical treatment of tuberculum sellae meningioma with altered vision function on the left eye. Intradural unroofing of the optic canal with gross total resection of the tumor led to immediate excellent recovery. Intraoperative video highlights key steps of our surgical approach.

Conclusion

Optic canal unroofing is in our opinion safe and mandatory when treating tuberculum sellae meningiomas with compression of optic nerve.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Faculty of Medicine, Comenius University and University Hospital Bratislava, Limbova 5, SK-833 05, Bratislava, Slovakia

    J. Kozák, I. Bízik & M. Novotný

  2. Department of Neurosurgery, Na Homolce Hospital, Prague, Czech Republic

    J. Klener

Authors
  1. J. Kozák
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  2. I. Bízik
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  3. M. Novotný
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  4. J. Klener
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Corresponding author

Correspondence to J. Kozák.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent was obtained from an individual participant included in the study.

Conflict of interest

The authors declare no competing interests.

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Key points

1. Correct position of head using gravity retraction, neuronavigation is not necessary.

2. Subfascial technique of preservation of facial nerve branches with retrograde disseaction of the temporal muscle to prevent muscle atrophy.

3. Dissection of proximal Sylvian fissure and opening of the arachnoid cisterns to achieve retractorless microsurgery.

4. Debulking of the tumor.

5. Early unroofing of the optic canal after initial debulking—before any dissection around ON is taken.

6. Removing of cottonoids before drilling to avoid entanglement to rotating drill.

6. Irrigation as long as repeated interruption of the drilling is mandatory in order to decrease the risk of thermal injury to the optic nerve.

7. Stop the drilling when there is still a thin plate of bone, which can be easily breakout with the disector.

8. Dissection of the falciform ligament and nerve sheet to deliberate the ON.

9. GTR of the tumor around the ON and surrounding structures.

10. Check for any suspicious communication with the sinus. When present, adequate closure is necessary.

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

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Kozák, J., Bízik, I., Novotný, M. et al. How I do it: optic canal unroofing in surgery for tuberculum sellae meningiomas with compression of the optic nerve. Acta Neurochir 164, 1397–1400 (2022). https://doi.org/10.1007/s00701-021-05083-9

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  • DOI: https://doi.org/10.1007/s00701-021-05083-9

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