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- Department of Neurosurgery, University of South Alabama, Mobile, Alabama, United States
Correspondence Address:
Jai Deep Thakur, MD Department of Neurosurgery, University of South Alabama, Mobile, Alabama, United States.
DOI:10.25259/SNI_284_2024
Copyright: © 2024 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.How to cite this article: Adnan Hussain Shahid, Danner Warren Butler, Garrett Dyess, Luke Harris, Ursula Noelle Hummel, Danielle Chason, Sudhir Suggala, Jai Deep Thakur. Endoscope-assisted supraorbital approach for excision of tuberculum sella meningioma: Technical nuances. 19-Jul-2024;15:245
How to cite this URL: Adnan Hussain Shahid, Danner Warren Butler, Garrett Dyess, Luke Harris, Ursula Noelle Hummel, Danielle Chason, Sudhir Suggala, Jai Deep Thakur. Endoscope-assisted supraorbital approach for excision of tuberculum sella meningioma: Technical nuances. 19-Jul-2024;15:245. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=13001
Date of Submission
12-Apr-2024
Date of Acceptance
29-Jun-2024
Date of Web Publication
19-Jul-2024
Abstract
Background: Tuberculum sellae meningiomas (TSMs) are benign dural-based lesions of the anterior cranial fossa, which mainly present with impaired visual acuity/field deficits secondary to compression of the optic apparatus. Surgical management is recommended as the optimal strategy for large compressive TSMs, with goals of safe maximal resection, optic nerve decompression, and potential vision restoration. The philosophy of adapting keyhole approaches for such resections is commonly highlighted; however, it comes with notable criticism of encountering major blind spots during surgical resection and limited anatomical exposure. Adding angled endoscopes enhances the expanded panoramic view of the skull base and provides a synergistic modality to microsurgery for maximizing total resection and navigating the blind spots.
Case Description : This video case presentation aims to highlight the technical nuances of endoscope-assisted microscopic supraorbital craniotomy for TSM resection invading bilateral optic canals in a 66-year-old female presenting with progressive right eye vision loss (OD Hand motion). The video emphasizes traditional skull-base surgical principles of TSM resection through the optics of a keyhole approach augmented by endoscopic tumor removal. Gross total resection was achieved, the patient’s vision improved to 20/25, and she was discharged home on postoperative day 2.
Conclusion: The endoscope-assisted supraorbital craniotomy offers a safe surgical corridor for TSM, using a limited craniotomy with minimal brain retraction in appropriately selected individuals, particularly with larger tumors with greater lateral extension and above the planum.
Keywords: Endoscopy, Minimally invasive, Supraorbital craniotomy, Tuberculum sella meningioma
Video 1
Annotations
000.08 – Clinical presentation 000.37 – Rational for the procedure 000.59 – Potential benefits and risks of the procedure 01.27 – Alternatives and reasons such approaches were not chosen 02.09 – Procedure set up 02.22 – Key surgical steps 03.09 – Disease background 03.39 – Surgical video 03.54 – Opening of opticocarotid cistern 04.12 – Opening of Sylvian fissure 04.34 – Decompression of ipsilateral optic nerve 05.19 – Tumor debulking 05.34 – Peeling of tumor from C/L optic nerve 05.54 – Preserving the arachnoid plane 08.30 – C/l optic nerve decompression 08.39 – Endoscopic inspection and tumor removal 09.01 – Clinical and imaging outcome
Ethical approval
The Institutional Review Board approval is not required.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
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The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.
