Extended endoscopic endonasal approach for resection of suprasellar meningiomas

Abstract

Background
Suprasellar meningiomas are classically removed through several different surgical transcranial approaches, including the pterional transsylvian route. Recently, the indications for the transsphenoidal technique, traditionally proposed only for the treatment of intrasellar lesions, have been extended to include lesions located in the supra- and parasellar areas and, among them, suprasellar meningiomas. We describe the surgical technique for the purely endoscopic endonasal transsphenoidal approach to suprasellar meningiomas.


Purpose
To evaluate the endoscopic endonasal technique in resection of suprasellar meningiomas and to elucidate the factors that favor this approach selection.


Methods
This is a prospective study of collected data of Nineteen consecutive patients who underwent endoscopic endonasal approach (EEA) for suprasellar meningiomas (SSM) at our institution. The details of the surgical technique have been described. In this study, we analyze a series of consecutive patients who underwent endoscopic endonasal resection of SSM, evaluating both preoperative radiological parameters and intraoperative findings. We introduced new imaging predictive factors that may facilitate surgical planning and improve patient selection for EEA. Additionally, we assessed the impact of tumor size and consistency on the surgical time, extent of resection, and postoperative complications, with a particular focus on cerebrospinal fluid (CSF) leak rates and visual outcomes.


Results
Gross total removal of the lesion, without the need for brain retraction and with minimal neurovascular manipulation, was achieved in 18/19 (94.7%) patients. Seventeen patients with preoperative visual function defects had complete recovery, whereas in 2 patients’ vision was stabilized. Three patients had a postoperative cerebrospinal fluid leak; they were controlled conservatively. Soft closure (5 cases): 60% (3/5) had postoperative CSF leaks. Rigid closure (14 cases): 0% (0/14) had postoperative CSF leaks. Mean operative time: 300 min (range: 210 –450 min). Mean hospital stay: 5 days (range: 3 − 7 days). No mortality or major vascular injuries.


Conclusion
In carefully selected patients, the extended endoscopic endonasal approach may constitute a viable alternative to transcranial approaches for suprasellar meningiomas.