Skip to main content
SpringerLink
Log in

Trans-eyebrow supraorbital keyhole approach to tuberculum sellae meningiomas: a series of 30 cases with long-term visual outcomes and recurrence rates

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Background

Approach selection paradigm for tuberculum sellae meningiomas (TSMs) is still a point of discussion. The trans-eyebrow supraorbital keyhole approach (TSKA) is a minimally invasive transcranial approach and has been used for the treatment of TSMs during recent years. In this study, we presented a series of 30 cases of TSMs treated via TSKA with a long-term follow-up.

Method

Thirty patients with TSMs underwent surgery via TSKA between December 2006 and August 2018. The medical data and follow-up results were retrospectively analyzed.

Results

A total of 5 males and 25 females were included in this study. Three patients presented with recurrent TSMs. The mean tumor size was 25.3 ± 7.3 mm (range, 10–48 mm). The mean follow-up period was 58.0 months (interquartile range, 33.5–86.3 months). Gross total resection (GTR) was achieved in 27 patients (90.0%). One recurrence (3.3%) occurred 9 years after surgery. Out of 29 patients with preoperative visual impairment, 17 (58.6%) improved, eight (27.6%) remained stable, and four (13.8%) deteriorated. No peri-operative death, CSF rhinorrhea, or permanent endocrine dysfunction occurred. All patients exhibited satisfactory cosmetic results. At the last follow-up, the glasgow outcome scale score was five in 27 patients (90.0%).

Conclusion

The TSKA is characterized by minimal invasion with a satisfactory cosmetic outcome. Based on the tumor characteristics and surgeon’s experience, this approach can be employed as an alternative minimally invasive approach for the treatment of TSMs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Jallo GI, Benjamin V (2002) Tuberculum sellae meningiomas: microsurgical anatomy and surgical technique. Neurosurgery 51:1432–1439 (1439–1440)

    Article  PubMed  Google Scholar 

  2. Kane AJ, Sughrue ME, Rutkowski MJ, Shangari G, Fang S, McDermott MW et al (2011) Anatomic location is a risk factor for atypical and malignant meningiomas. Cancer 117:1272–1278

    Article  PubMed  Google Scholar 

  3. Margalit NS, Lesser JB, Moche J, Sen C (2003) Meningiomas involving the optic nerve: technical aspects and outcomes for a series of 50 patients. Neurosurgery 53:523–532 (532–533)

    Article  PubMed  Google Scholar 

  4. Song SW, Kim YH, Kim JW, Park CK, Kim JE, Kim DG et al (2018) Outcomes after transcranial and endoscopic endonasal approach for tuberculum meningiomas-a retrospective comparison. World Neurosurg 109:e434–e445

    Article  PubMed  Google Scholar 

  5. Engelhardt J, Namaki H, Mollier O, Monteil P, Penchet G, Cuny E et al (2018) Contralateral transcranial approach to tuberculum sellae meningiomas: long-term visual outcomes and recurrence rates. World Neurosurg 116:e1066–e1074

    Article  PubMed  Google Scholar 

  6. Nanda A, Ambekar S, Javalkar V, Sharma M (2013) Technical nuances in the management of tuberculum sellae and diaphragma sellae meningiomas. Neurosurg Focus 35:E7

    Article  PubMed  Google Scholar 

  7. Gardner PA, Kassam AB, Thomas A, Snyderman CH, Carrau RL, Mintz AH et al (2008) Endoscopic endonasal resection of anterior cranial base meningiomas. Neurosurgery 63:36–52 (52–54)

    Article  PubMed  Google Scholar 

  8. Fahlbusch R, Schott W (2002) Pterional surgery of meningiomas of the tuberculum sellae and planum sphenoidale: surgical results with special consideration of ophthalmological and endocrinological outcomes. J Neurosurg 96:235–243

    Article  PubMed  Google Scholar 

  9. Nakamura M, Roser F, Struck M, Vorkapic P, Samii M (2006) Tuberculum sellae meningiomas: clinical outcome considering different surgical approaches. Neurosurgery 59:1019–1028 (1028–1029)

    Article  PubMed  Google Scholar 

  10. Chokyu I, Goto T, Ishibashi K, Nagata T, Ohata K (2011) Bilateral subfrontal approach for tuberculum sellae meningiomas in long-term postoperative visual outcome. J Neurosurg 115:802–810

    Article  PubMed  Google Scholar 

  11. Romani R, Laakso A, Kangasniemi M, Niemela M, Hernesniemi J (2012) Lateral supraorbital approach applied to tuberculum sellae meningiomas: experience with 52 consecutive patients. Neurosurgery 70:1504–1518 (1518–1519)

    Article  PubMed  Google Scholar 

  12. Telera S, Carapella CM, Caroli F, Crispo F, Cristalli G, Raus L et al (2012) Supraorbital keyhole approach for removal of midline anterior cranial fossa meningiomas: a series of 20 consecutive cases. Neurosurg Rev 35:67–83

    Article  PubMed  Google Scholar 

  13. Reisch R, Perneczky A (2005) Ten-year experience with the supraorbital subfrontal approach through an eyebrow skin incision. Neurosurgery 57:242–255

    PubMed  Google Scholar 

  14. Fatemi N, Dusick JR, de Paiva NM, Malkasian D, Kelly DF (2009) Endonasal versus supraorbital keyhole removal of craniopharyngiomas and tuberculum sellae meningiomas. Neurosurgery 64:269–284 (284–286)

    PubMed  Google Scholar 

  15. Borghei-Razavi H, Truong HQ, Fernandes-Cabral DT, Celtikci E, Chabot JD, Stefko ST et al (2018) Minimally invasive approaches for anterior skull base meningiomas: supraorbital eyebrow, endoscopic endonasal, or a combination of both? Anatomic study, limitations, and surgical application. World Neurosurg 112:e666–e674

    Article  PubMed  Google Scholar 

  16. Laufer I, Anand VK, Schwartz TH (2007) Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions. J Neurosurg 106:400–406

    Article  PubMed  Google Scholar 

  17. Bander ED, Singh H, Ogilvie CB, Cusic RC, Pisapia DJ, Tsiouris AJ et al (2018) Endoscopic endonasal versus transcranial approach to tuberculum sellae and planum sphenoidale meningiomas in a similar cohort of patients. J Neurosurg 128:40–48

    Article  PubMed  Google Scholar 

  18. Linsler S, Fischer G, Skliarenko V, Stadie A, Oertel J (2017) Endoscopic assisted supraorbital keyhole approach or endoscopic endonasal approach in cases of tuberculum sellae meningioma: which surgical route should be favored? World Neurosurg 104:601–611

    Article  PubMed  Google Scholar 

  19. de Divitiis E, Esposito F, Cappabianca P, Cavallo LM, de Divitiis O (2008) Tuberculum sellae meningiomas: high route or low route? A series of 51 consecutive cases. Neurosurgery 62:556–563

    Article  PubMed  Google Scholar 

  20. Ottenhausen M, Rumalla K, Alalade AF, Nair P, La Corte E, Younus I et al (2018) Decision-making algorithm for minimally invasive approaches to anterior skull base meningiomas. Neurosurg Focus 44:E7

    Article  PubMed  Google Scholar 

  21. Mortazavi MM, Brito DSH, Ferreira MJ, Barber JK, Pridgeon JS, Sekhar LN (2016) Planum sphenoidale and tuberculum sellae meningiomas: operative nuances of a modern surgical technique with outcome and proposal of a new classification system. World Neurosurg 86:270–286

    Article  PubMed  Google Scholar 

  22. Soni RS, Patel SK, Husain Q, Dahodwala MQ, Eloy JA, Liu JK (2014) From above or below: the controversy and historical evolution of tuberculum sellae meningioma resection from open to endoscopic skull base approaches. J Clin Neurosci 21:559–568

    Article  PubMed  Google Scholar 

  23. Figueiredo EG, Deshmukh V, Nakaji P, Deshmukh P, Crusius MU, Crawford N et al (2006) An anatomical evaluation of the mini-supraorbital approach and comparison with standard craniotomies. Neurosurgery 59:S212–S220

    Google Scholar 

  24. Cheng CM, Noguchi A, Dogan A, Anderson GJ, Hsu FP, McMenomey SO et al (2013) Quantitative verification of the keyhole concept: a comparison of area of exposure in the parasellar region via supraorbital keyhole, frontotemporal pterional, and supraorbital approaches. J Neurosurg 118:264–269

    Article  PubMed  Google Scholar 

  25. Igressa A, Pechlivanis I, Weber F, Mahvash M, Ayyad A, Boutarbouch M et al (2015) Endoscope-assisted keyhole surgery via an eyebrow incision for removal of large meningiomas of the anterior and middle cranial fossa. Clin Neurol Neurosurg 129:27–33

    Article  PubMed  Google Scholar 

  26. Gazzeri R, Nishiyama Y, Teo C (2014) Endoscopic supraorbital eyebrow approach for the surgical treatment of extraaxialand intraaxial tumors. Neurosurg Focus 37:E20

    Article  PubMed  Google Scholar 

  27. Alekseev AG, Pichugin AA, Danilov VI (2017) A supraorbital trans-eyebrow approach in surgery of chiasmatic-sellar and anterior cranial fossa tumors. Zh Vopr Neirokhir Im N N Burdenko 81:36–45

    Article  CAS  PubMed  Google Scholar 

  28. Esterman B (1982) Functional scoring of the binocular field. Ophthalmology 89:1226–1234

    Article  CAS  PubMed  Google Scholar 

  29. Cai M, Ye Z, Ling C, Zhang B, Hou B (2018) Trans-eyebrow supraorbital keyhole approach in suprasellar and third ventricular craniopharyngioma surgery: the experience of 27 cases and a literature review. J Neurooncol 141:363–371

    Google Scholar 

  30. Clark AJ, Jahangiri A, Garcia RM, George JR, Sughrue ME, McDermott MW et al (2013) Endoscopic surgery for tuberculum sellae meningiomas: a systematic review and meta-analysis. Neurosurg Rev 36:349–359

    Article  PubMed  Google Scholar 

  31. Mahmoud M, Nader R, Al-Mefty O (2010) Optic canal involvement in tuberculum sellae meningiomas: influence on approach, recurrence, and visual recovery. Neurosurgery 67:s108–s118 (s118–s119)

    Google Scholar 

  32. Kitano M, Taneda M, Nakao Y (2007) Postoperative improvement in visual function in patients with tuberculum sellae meningiomas: results of the extended transsphenoidal and transcranial approaches. J Neurosurg 107:337–346

    Article  PubMed  Google Scholar 

  33. Zhang MZ, Wang L, Zhang W, Qi W, Wang R, Han XD et al (2004) The supraorbital keyhole approach with eyebrow incisions for treating lesions in the anterior fossa and sellar region. Chin Med J (Engl) 117:323–326

    Google Scholar 

  34. Koutourousiou M, Fernandez-Miranda JC, Stefko ST, Wang EW, Snyderman CH, Gardner PA (2014) Endoscopic endonasal surgery for suprasellar meningiomas: experience with 75 patients. J Neurosurg 120:1326–1339

    Article  PubMed  Google Scholar 

  35. Rogers L, Barani I, Chamberlain M, Kaley TJ, McDermott M, Raizer J et al (2015) Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review. J Neurosurg 122:4–23

    Article  PubMed  PubMed Central  Google Scholar 

  36. Bassiouni H, Asgari S, Stolke D (2006) Tuberculum sellae meningiomas: functional outcome in a consecutive series treated microsurgically. Surg Neurol 66:37–44 (44–45)

    Article  PubMed  Google Scholar 

  37. Schick U, Hassler W (2005) Surgical management of tuberculum sellae meningiomas: involvement of the optic canal and visual outcome. J Neurol Neurosurg Psychiatry 76:977–983

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Ruggeri AG, Cappelletti M, Fazzolari B, Marotta N, Delfini R (2016) Frontobasal midline meningiomas: is it right to shed doubt on the transcranial approaches? Updates and review of the literature. World Neurosurg 88:374–382

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Meiqin Cai, Bo Hou and Lun Luo have contributed equally to this work.

Authors and Affiliations

  1. Departments of Neurosurgery, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tian he Road, Guangzhou, 510630, Guangdong, China

    Meiqin Cai, Bo Hou, Lun Luo, Baoyu Zhang & Ying Guo

Authors
  1. Meiqin Cai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bo Hou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lun Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Baoyu Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ying Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ying Guo.

Ethics declarations

Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cai, M., Hou, B., Luo, L. et al. Trans-eyebrow supraorbital keyhole approach to tuberculum sellae meningiomas: a series of 30 cases with long-term visual outcomes and recurrence rates. J Neurooncol 142, 545–555 (2019). https://doi.org/10.1007/s11060-019-03128-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-019-03128-9

Keywords

Search

Navigation