The Expanded Endoscopic Endonasal Approach For Treatment Of Tuberculum Sellae Meningioma

Object: Compared with traditional craniotomy,the expanded endoscopic endonasal approach(EEEA)has advantages for tuberculum sellae meningioma(TSM)treatment.We described our experience of the therapeutic effect of endoscopic TSM treatment.Methods: We reviewed the clinical characteristics and imaging data of patients with a TSM who received EEEA-based treatment at our institution from August 2015 to December 2019.Forty patients with a TSM revealed by preoperative imaging and confirmed by pathology studies postoperatively formed the study cohort.All patients were treated by a surgical procedure for the first time.EEA outcome in TSM treatment was analyzed.Results: Among 39 patients with visual impairment,38(97.4%)improved their visual function to some extent after the EEEA,and one case had no significant change in visual acuity.Among all patients,38(95.0%)achieved gross total resection(GTR)and 2(5.0%)achieved near-total resection(NTR).In six patients(15.0%),the tumor invaded the optic canal.Thirty-four patients(85.0%)had a complete arachnoid plane,and six patients(15.0%)lacked an arachnoid plane.Cerebrospinal fluid(CSF)leakage occurred in three patients(7.5%)and meningitis(post-CSF leakage)in two patients(5.0%).Eight patients(20.0%)suffered postoperative hyposmia,three of whom developed long-term hyposmia.One patient(2.5%)suffered from bleeding of the branch of the anterior cerebral artery intraoperatively leading to postoperative acute cerebral infarction.Conclusion: The EEEA is a safe and reliable minimally invasive method for TSM removal.Compared with traditional craniotomy,the EEEA has better visual outcomes and a higher prevalence of GTR,but carries the risk of CSF leakage.For patients with hyposmia without CSF leakage after the EEEA,early nasal irrigation in recommended.