Analysis Of The Clinical Efficacy Of The Pterion Approach And The Fronto-basal Interhemispheric Approach For Tuberculum Sellae Meningiomas

Objective:To investigate the surgical outcome of postoperative complications and prognosis of tuberculum sellae meningiomas with pterion approach and fronto-basal interhemispheric approach.Methods:Retrospective analysis of 19 cases of patients with sellar meningioma from September 2015 to December 2017 in Department of Neurosurgery,First Affiliated Hospital of Kunming Medical University,divided into 11 cases with pterion approach and anterior longitudinal splitting approach Eight patients in two groups were compared with intraoperative blood loss,length of surgery,postoperative hospital stay,total surgical rate,postoperative visual recovery,postoperative complications,and tumor recurrence rate.Results:Comparison of pterion approach and fronto-basal interhemispheric approach for the treatment of tuberculum sellar meningioma.The amount of the intraoperative blood loss in the pterion approach was 653.33±97.82ml,the length of operation was 6.21±1.76h,and the postoperative hospital stay was 18.24±3.35d,the amount of intraoperative blood loss in the fronto-basal interhemispheric approach was 550.00±70.71ml,the length of operation was 6.25±2.47h,and postoperative hospital stay was 16.54±2.97d.According to the Simpson classification,19 patients in this group of patients underwent total resection in 12 cases,approximately 86.2%,no deaths,11 cases with pterion approach,total resection in 8 cases,and subtotal resection in 2 cases.Partial resection of 1 case,about 72.7%,8 cases of fronto-basal interhemispheric approach,total resection in 6 cases,subtotal resection in 1 case,partial resection in 1 case,about 75%,19 cases of patients with varying degrees of visual field of vision Obstacles,among them,the visual acuity of the pterion approach improved in 7 cases,and fronto-basal interhemispheric approach improved in 6 cases.The other 5 eyes had no significant changes in visual acuity compared with preoperative ones.In the pterion approach,1 case was lower than before surgery.One patient with pterion approach had an intracranial hematoma and underwent intracranial hematoma removal.Her postoperative care was improved and discharged.One patient with fronto-basal interhemispheric approach had unilateral olfactory nerve injury.Two patients with pterional approach and one case with fronto-basal interhemispheric approach had postoperative urinary collapse and were completely recovered after symptomatic treatment with antidiuretic hormone.One patient with pterion approach and one case with fronto-basal interhemispheric approach considered possible intracranial infection and recovered after symptomatic treatment with active anti-infective therapy.There were 1 case of postoperative recurrence in the pterion approach and fronto-basal interhemispheric approach.Conclusions:There was no significant difference in intraoperative blood loss,operation time,and postoperative hospital stay between the two surgical approaches.The total cut rate of the tuberculum sellae meningiomas,the postoperative visual recovery and the probability of postoperative complications were not clearly related to the choice of these two surgical approaches.There are no absolute advantages or disadvantages of the pterional approach and the fronto-basal interhemispheric approach,which can make the meningioma get a good exposure,and the appropriate surgical approach and skilled surgical techniques can increase the operation to some extent the chance of total tumor removal and prevention of postoperative complications.