Clinical Research Of Microsurgical Removal Of Tumors In Sellar Region Via Anterior Interhemispheric Approach

Objective: To analyze the clinical data of the patients who underwent microsurgical removal of tumors in sellar region via anterior interhemispheric approach retrospectively and explore the surgical techniques, effect and complications in order to do further evaluation on the indications and merits and demerits.Methods:58 cases with anterior interhemispheric approach of microsurgery for sellar region tumors from January,2006 to October,2010 in Qi Lu Hospital of Shandong University were retrospectively analyzed. The patients'cases include 26 cases of craniopharyngiomas,22 cases of pituitary tumors and 10 cases of meningiomas. By bi-frontal coronal incision or right frontal arch incision, right frontal craniotomy was performed. The longitudinal fissure was detached for exposing the region between the sphenoidal planum and the genu of the corpus callum, and the tumor was removed through the lamina terminalis, optic nerve-internal carotid artery, optic chiasm-anterior communicating artery space and the anterior space of optic chiasma according to the location of the tumor.Results:Total or subtotal removal of the tumor was achieved in 18 cases (69.2%) of craniopharyngiomas,15 cases (68.2%) of pituitary tumors and 7 cases (70%) of meningiomas; Partial removal in 8,7,3 separately; No deaths. The bilateral olfactory nerves were reserved in 47 cases (81%), and the unilateral in 9 cases. The pituitary stalk was reserved in 52 cases (86.6%). Visual acuity got varying degree of improvement in 48 cases of 53 (90.6%), yet no change in 5 cases. Diabetes insipidus in 45 cases (77.6%) and electrolyte disturbances in 39 cases (67.2%) were well controlled with medication.Conclusion:Anterior interhemispheric approach is a good choice for tumors located in sellar region and the important anatomic structures could be preserved. Compared with subfrontal and pterion approach, by anterior interhemispheric approach, the anterior skull base and the sellar region could be displayed maximally under microscope and the tumor could be removed with high percentage total resection.