13 Year Experience Summary Of Surgical Treatment Of Tuberculum Sellae Meningiomas With Supraorbital Keyhole Approach(Single Centre)

Objectives To stdudy the relationship between image characteristics and pathological types of tuberculum sellae meningiomas and the effect of the supraorbital keyhole approach and Cavitron Ultrasonic Surgical Aspirator(CUSA) in surgical treatment of tuberculum sellae meningiomas.Methods The clinical data of 97 patients with tuberculum sellae meningiomas from January, 2003 to December, 2015 were analyzed retrospectively.Analyze image characteristics of them.Of them,34 underwent microsurgery through the supraorbital keyhole approach. of them,the resection were assisted by CUSA in 26 cases.Result Image:50 cases received conventional CT examination.47 cases received MR examination.Anterior cerebral and internal carotid arteries were encased by the tuberculum sellae meningiomas in 35 cases(36.1%).Optic nerve was compressed by the tuberculum sellae meningiomas in 86 cases(88.7%) Of them,the lesions showed isointense,hypointense,hypo-isointensein, slight hypointense in 45(95.7%) on T1 WI.Isointense,hyperintense,slight hyperintense,hyper-isointensein in 42(89.4%) on T2 WI.After contrast injection, enhancement was noticed in All 61 cases on MRI,of them,homogeneous enhancement in 56(91.8%) and heterogeneous enhancement in 5(10.6%),dural tail sign found in 36(59.0%).After contrast injection,enhancement was noticed in All 28 cases on CT,of them,homogeneous enhancement in 25(89.3%) and heterogeneous enhancement in 3(10.7%),dural tail sign found in 6(21.4%). Postoperative pathological types:meningiothelial in 52 cases(53.6%),fibrous in 6(6.2%),transitional in 20(20.6%),psammomatous in 5(5.2%),angiomatous in 5(5.2%),secretory in 1(1.0%),lymphoplasmacyte-tich in 1(1.0%),clear cell in 1,atypical in 3(3.1%).Postoperative visual out-Comes:42 cases(43.3%) were improved,43(44.3%) unchanged and 12(12.4%) worsened.For the postoperative visual out-Comes of the cases through the supraorbital keyhole approach,13 cases(38.2%) were improved,13(38.2%) unchanged and 8(23.5%) worsened.For the postoperative visual out-Comes of the cases not through the supraorbital keyhole approach,27 cases(45.0%) were improved,29(48.3%) unchanged and 4(6.7%) worsened.For the postoperative visual out-Comes of the cases assisted by CUSA,8 cases(30.8%) were improved,14(53.8%) unchanged and 4(15.4%) worsened.For the postoperative visual out-Comes of the cases not assisted by CUSA,34 cases(47.9%) were improved,29(40.8%) unchanged and 8(11.3%) worsened.Chi-square test of the postoperative visual out-Comes was made between the supraorbital keyhole approach and the not keyhole approach, c2=5.563,p=0.062>0.05,the postoperative visual out-Comes of supraorbital keyhole approach is similar to the not keyhole approach.The postoperative visual out-Comes is similar between assisted by CUSA and not(c2=2.274,p=0.321>0.05). The degree of tumor resection:simpson Ⅰ-Ⅱ in 90 cases(92.8%),simpson Ⅲ-Ⅳ in 7 cases(7.2%).Chi-square test of the degree of tumor resection was made between the supraorbital keyhole approach and the not keyhole approach,P=1.000>0.05.the degree of tumor resection of supraorbital keyhole approach is similar to the not keyhole approach.The pdegree of tumor resection is similar between assisted by CUSA and not(p=0.184>0.05). Amout of bleeding:The average amout of bleeding of the supraorbital keyhole approach was less than the not keyhole approach(t=-2.671,p=0.009<0.05)..For the cases that Anterior cerebral and internal carotid arteries were encased by the tuberculum sellae meningiomas,the average amout of bleeding of the means assisted by CUSA was less than not assisted by CUSA(t=-2.441,p=0.021<0.05).unchanged and 12(12.4%) worsened. The postoperative complications:For the postoperative complications in all 97 cases,derebrospinal flui fistulas from the incision in 2 cases(2.1%),intracranial infection in 3 cases(3.1%),diabetes insipidus in 3 cases(3.1%),lung infection in 4 cases(4.1%),death after serious complications in 4 cases(4.1%),no deaths.For the supraorbital keyhole approach,derebrospinal flui fistulas from the incision in 2 cases(5.9%) and,diabetes insipidus in 3 cases(8.8%),no lung infection cases, death after serious complications in 1 case(2.9%),no intracranial infection.Conclusion The tuberculum sellae meningiomas owned their image characteristics relative to their pathological.This is very important for Diagnosis, differential diagnosis and treatment plan of tuberculum sellae meningiomas.It is similar in the degree of tumor resection and the postoperative visual out-comes between the supraorbital keyhole approach and the not keyhole approach.The supraorbital keyhole approach has many advantages such as less bleeding, less trauma and promote recovery.CUSA can reduce the amout of bleeding when anterior cerebral and internal carotid arteries were encased by the tuberculum sellae meningiomas.CUSA can protect important organizational structure,ruduce the postoperative complications.The tactics of complication prevention and treatment is crucial to the recovery of the tuberculum sellae meningioma patients.The surgical treatment of tuberculum sellae meningiomas with the supraorbital keyhole approach is demanding for surgeon’s skill level.skilled and meticulous operation is crucial to reducing complications.