A retrospective analysis was done on 53 patients 40 female with meningiomas originating from the tuberculum sellae who underwent surgery between 1991 and 2002. There were 16 women and 4 men ranging from 27 to 75 years. Diagnostic imaging although tuberculum sellae meningiomas follow the typical ct and mr imaging characteristics of meningiomas in general, in this region they can easily be confused for pituitary adenoma. Endoscopic endonasal resection of skull base meningiomas. Meningiomas of the tuberculum sellae arise from the limbus sphenoidale, chiasmatic sulcus, and tuberculum. Meningioma has an accelerated growth during pregnancy. Patients harboring a tuberculum sellae meningioma usually do not present with epileptic fits, and this symptom may point to the presence of an additional meningioma as was observed in 11. Tuberculum and diaphragma sella meningioma deepdyve. The optic nerves white arrow are seen lateral to the tumor t throughout their course. This study illustrates a number of important signs of how to distinguish a suprasellar mass from one arising from the pituitary. Ii depicts the smallest tumor which the authors had seen, an incidental observation at necropsy in a patient who died from other causes.
An mri scan of the brain and sella demonstrated a heterogeneously enhancing t1 isointense, t2 mixedintensity sellar mass with suprasellar extension measuring 3. A tumoral remnant grade iii or iv resection was intentionally left in four patients. Transsphenoidal versus transcranial approach for treatment. In cushing and eisenhardts 1 article on meningiomas arising from the tuberculum sellae, figure 70 illustrates schematically four stages in the development of these tumors fig. These tumors are a distinct clinical entity, displacing the optic pathways upward and laterally and, thus, occupying a subchiasmal location. Women are affected three times more often than men. Contrary to a prior report on this topic, edema along the optic tract is not only seen in craniopharyngiomas but may be seen although rarely in other common parasellar tumors, as in our case of a tuberculum sellae meningioma. Planum sphenoidale and tuberculum sellae meningiomas.
Tuberculum sellae meningiomas neurosurgery oxford academic. The female patient was 32yearold, suffering from progressive loss of vision for about 6 months. Tuberculum sella meningioma the neurosurgical atlas, by. Request pdf the contralateral subfrontal approach can simplify surgery and. Most of these benign tumors arise from the tuberculum sellae or the. Tuberculum sellae meningiomas are located not only on the limited surface between the prechiasmatic sulcus and and diaphragm sellae, but also on the limbus. A variable slight to prominent median elevation forming the posterior boundary of the chiasmatic groove and the anterior boundary of the hypophysial fossa. They originate from the dura mater of tuberculum sellae, planum sphenoidale, and chiasmatic sulcus and comprise 5% to 10% of all intracranial meningiomas 1. Magnetic resonance imaging, including contrastenhanced studies, is the most accurate preoperative radiologic modality. We report a case of tuberculum sellae meningioma with optic tract edema. Cureus endonasal endoscopic transsphenoidal resection of. Tuberculum sellae meningiomas tsms represent 5 to 10% of all intracranial meningiomas, invading the optic canals and displacing the. A 54yearold otherwise healthy man presented with progressive bitemporal hemianopsia. Here, we reported a case of tuberculum sellae meningioma with beak of kiwi bird enhancement in contrast mri at our department.
Tuberculum sellae meningiomas characteristically lie in a suprasellar subchiasmal midline position, displacing the optic chiasm posteriorly and slightly superiorly, and the optic nerves laterally. Stereotactic radiosurgery for skull base meningioma jstage. Modern surgical approaches to tuberculum sellae meningiomas coronal figure 1 skull base center clinical case report coronal contrastenhanced mri anterior a and more posterior b. Laterally is the optic canals and posterolaterally lies. Tuberculum sellae ts meningiomas arise from the dura of the ts, chiasmatic sulcus, limbus sphenoidale, and diaphragma sellae. Changes in the size of the sella turcica are frequently related to pathologies and syndromes. Tuberculum sellae meningiomas are a distinctive group of meningiomas in the suprasellar space, having dural attachments to the tuberculum sellae, chiasmatic sulcus, limbus sphenoidale, and. Although meningiomas of the tuberculum sellae had been described previously, cushing and eisenhardt 1 made the first extensive study of these tumors, emphasizing the fact that they seldom caused gross roentgen abnormalities. Tuberculum sellae meningiomas are more common in women than men, and diagnosis is typically made in the fifth to sixth decade of life. Hence, tuberculum sellae meningioma involvement of the aca junction without luminal narrowing, whether engulfment or encasement, is likely to be extraarachnoidal.
Delay in the diagnosis of meningiomas of the tuberculum sellae and planum sphenoidale is detrimental to the patient in terms of visual recovery, morbidity and mortality. Case of acute optic nerve compression caused by tuberculum sellae meningioma with optic canal involvement chai y1, yamazaki h1, kondo a2, oshitari t3, yamamoto s31department of ophthalmology, kohnodai hospital, national center for global health and medicine, chiba, 2department of neurosurgery, juntendo university, school of medicine, tokyo, 3department of ophthalmology and visual science. Unlike their counterparts that arise more laterally from the. Visual prognosis is variable, with most series reporting an improvement in visual function in 40% to 60% of cases after surgery.
Sphenoid wing meningiomas are the second most common meningiomas after the parasagittal subtype. Ac mri scan showed a case of tuberculum sellae meningioma, which was homogenously enhanced in contrast mri with obvious meninges tail sign. Dec 04, 2012 tuberculum sellae meningioma surgery the following are video recordings of surgical procedures from the department of neurosurgery of saint johns hospital of budapest. Ophthalmological society that combine the assessments of visual acuity and. Dengan insiden paling banyak pada usia pertengahan. Additionally, surgical approaches should combine good access and surgical aesthetic procedures 8, 96. Sep 30, 2018 representing 5 to 10% of intracranial meningiomas, tuberculum and diaphragm sellae meningiomas are intimately involved with the critical suprasellar structures. Oct 14, 2015 surgical resection of a tuberculum sellae meningioma. Tuberculum sellae ts and diaphragma sellae ds meningiomas represent 510% of all intracranial meningiomas.
Tuberculum sellae meningiomas frequently extend into the optic canals. Later, in 1929, cushing and eisenhardt classified the meningiomas of the tuberculum sellae in four stages, according to their size. But the tuberculum sellae meningioma tsm is a challenge for neurosurgeons. Anterior interhemispheric approach for tuberculum sellae. Correct diagnosis and management require an appreciation of the unique clinical, neuroimaging, and surgeryrelated features that distinguish these meningiomas from others of the anterior skull base. Based on this classification, meningiomas of this region can be divided into clinoidal, middle, or lateral sphenoid wing. A case of tuberculum sellae meningioma with beak of kiwi. Giant tuberculum sellae meningioma with unruptured. Planum sphenoidale meningiomas account for 510% of all intracranial meningiomas. More recently weyand and camp 2 and di chiro and lindgren 3 have shown that evidence of such tumors often can be detected by careful roentgenographic evaluation of. This can be avoided by meticulous internal decompression and. Slowly progressing visual deterioration is the most common initial complaint, and prompt treatment is directed at preserving and improving vision. Harvey cushing conducted the autopsy of one of his patients who had suffered most likely from a tuberculum sella or medial sphenoid wing meningioma circa 19image courtesy of the cushing brain tumor registry at yale university. Conclusions ectopic intraosseous meningiomas remain a rare neoplasm with only a few cases reported.
Meningiomas of the tuberculum and diaphragma sellae. We present a unique, welldocumented case of optic nerve strangulation by the a1 segment of the anterior cerebral artery in a patient with a tuberculum sellae meningioma. They are in a deep and sensitive location, proximity to critical neurovascular elements, hypothalamus with often dense and fibrous nature. A 43yrold woman presented to us 32 wk into her second pregnancy with a 2wk history of progressive visual impairment consisting of bitemporal emianopia and visual acuity decrease to 110 in the left eye and 410 in the right eye due to a tuberculum sellae meningioma tbm fig. Merging images with different central frequencies reduces. The standard surgical approach consisted of pterional. Optic tract edema in a meningioma of the tuberculum sellae.
It accounts for up to 10% of all intracranial meningiomas. Olfactory groove and tuberculum sella meningioma duration. Magnetic resonance imaging of the head revealed a large, homogeneously enhancing sellar and suprasellar mass consistent with a meningioma. Surgical management of tuberculum sellae and planum. Surgical management of tuberculum sellae meningiomas. The roentgenologic manifestations of meningiomas in the. Outcome determinants of pterional surgery for tuberculum sellae meningiomas. Although banding artifacts are visible in the basic and. Stereotactic radiosurgery is now a treatment option for meningiomas, especially for highrisk patients such as. The eyebrow supraorbital keyhole approach is gradually preferred to treat tuberculum sellae and planum sphenoidale meningiomas as a less invasive approach compared to the more traditional approaches. Visual impairment was the most common initial complaint. Tuberculum sellae meningiomas arising from the tuberculum sellae, chiasmatic sulcus, limbus sphenoidale, and diaphragm sellae are challenging lesions because of their proximity to many critical structures, such as visual pathway, hypothalamus, stalk, and acomm complex.
A 62yearold japanese woman reported a 1week history. Note the dural tail blue arrow, optic canal extension white arrowhead. Tuberculum sellae meningiomas tsms represent 5 to 10% of intracranial meningiomas 12,17,35,40,44,49. Modern surgical approaches to tuberculum sellae meningiomas.
Microsurgery of tuberculum sellae meningiomas sciencedirect. Fernandezmiranda, md, narrates surgery for a tuberculum sella meningioma using the endoscopic endonasal approach. Dorsum sellae definition of dorsum sellae by medical dictionary. Representing 5 to 10% of intracranial meningiomas, tuberculum and diaphragm sellae meningiomas are intimately involved with the critical suprasellar structures. Tuberculum sellae meningiomas represent approximately 5 to 10% of intracranial meningiomas 2, 12, 25, 28, 29, 33. Foremost authorities present the milestone text on meningioma management, now in a fully updated second edition almeftys meningiomas, second edition is the definitive guide to meningioma diagnosis, treatment, and surgery, and reflects over a decade of major advances in the diagnosis and management of both intracranial and spinal meningiomas. Suprasellar meningiomas account for 5%e10% of all meningiomas, a term. To evaluate the endocrinological and ophthalmological results of the tuberculum sellae meningioma surgery. Introduction although tuberculum sellae ts and diaphragma sellae ds meningiomas have different anatomical origins, they are frequently discussed as a single entity. The difficulty in surgically excising a tuberculum sellae meningioma comes from its anatomical relationship to the optic nerves and chiasm and to the anterior cerebral and internal carotid arteries and their perforators. A ct scan of the head demonstrated a large mixeddensity sellarsuprasellar mass with expansion of the sella turcica figure 1 and erosion of the dorsum sellae. Outcome assessment after surgical treatment of tuberculum. We report our experience on the treatment of tuberculum sellae meningiomas tsms regarding the involvement of the optic canal and clinical outcomes. Cushing and eisenhardt 1938 divided the sphenoidal ridge into three equal portions.
We present detailed ophthalmic findings in a case of tuberculum sellae meningioma with acute visual symptoms due to optic canal involvement. Surgical nuances for removal of tuberculum sellae meningiomas. We report a patient with a tuberculum sella meningioma with aca encasement, in whom a gross total excision was achieved through an endonasal endoscopic transsphenoidal transtuberculum, transplanum approach. The craniotomy in this approach incorporates the orbital rim, the anterior portion of the orbital roof, and the adjacent frontal bone. Our patient was a 57yearold female with progressive visual deterioration and a complex sellarsuprasellar lesion. Sphenoorbital meningiomas soms are secondary tumours of the orbit that originate from the dura of the sphenoid wing bone. Anterior interhemispheric approach, surgical removal, tuberculum sellae meningioma, visual impairment score, visual outcome neurosurgery 68ons suppl 1. The tuberculum sellae is the ridged process of the sphenoid bone which forms the anterior wall of the sella turcica gross anatomy relations. To present a large series of surgically treated tuberculum sellae meningiomas with particular regard to involvement of the optic canal and visual outcome. From 1991 to 2001, 20 patients harboring a meningioma of the tuberculum sellae were operated on. Tuberculum sellae ts meningiomas represent a distinct subgroup of anterior cranial fossa meningiomas with distinctive features. Oct 29, 2007 read tuberculum and diaphragma sella meningioma surgical technique and visual outcome in a series of 20 cases operated over a 2. The tuberculum sellae forms the anterior wall of the sella turcica, which houses the pituitary gland.
We report our personal case series of 38 patients with tuberculum sellae meningiomas. Tuberculum sellae and planum sphenoidale meningiomas represent 5% to 10% of intracranial meningiomas and represent a subgroup of anterior skull base meningiomas 10, 11, 19. On the superior surface of the sphenoid bone, behind the chiasmatic groove is an elevation, the tuberculum sell. Pdf case report surgical management of tuberculum sellae.
It is an elongated ridge located immediately posterior to the chiasmatic groove, hence is related to the optic chiasm and anterior portions of the optic. The optic nerves and chiasm may be elevated or displaced with the increasing size of the tumor. Tuberculum sellae meningiomas represent 3% to 10% of all meningiomas. Due to the anatomical relationship to the optic nerves and chiasm, those tumors become symptomatic with a size of 2 cm in diameter. Therefore, they must be distinguished from tumors arising from different sites, such as the olfactory groove, sphenoid planum, and anterior clinoid. They are traditionally grouped together with other suprasellar meningiomas including the more anterior planum sphenoidale ps meningiomas. The potential injury to the aca junction during eea is more often due to the avulsion of perforators from aca 4, 7, 1011. They arise from the tuberculum sellae, chiasmatic sulcus, limbus sphenoidale, and diaphragma sellae and grow in a subchiasmal position. The videos were made to assist with the training of neurosurgery, residents. Here we present the technical and anatomical nuances needed to perform an endoscopic endonasal removal of a tuberculum sellae meningioma. A report on management on the basis of a surgical experience with 70 patients objective. The first successful removal of a tuberculum sellae meningioma was performed by cushing in 1916. Figure 1 a case of tuberculum sellae meningioma with beak of kiwi bird enhancement in contrast mri. In 17 patients, progressive asymmetrical visual loss from 3 to 48 months was the symptom leading to medical consultation.
T he first case of a tuberculum sellae meningioma was reported by steward 27 in 1899 as an incidental autopsy finding. Meningioma, microsurgical anatomy, pterional craniotomy, tuberculum sellae, visual acuity neurosurgery 51. It is an elongated ridge located immediately posterior to the chiasmatic groove, hence is related to the optic chiasm and anterior portions of the optic tracts. Prospective study was done between january 2010 and january 2017 minimum 24month followup. The disease is diagnosed in the fourth or fifth decade. They are more common in women between the ages of 30 and 60 years. Tuberculum sellae meningioma growing during pregnancy. Early visual deterioration with optic canal infiltration occurs because of the site of dural origin. Due to the complex anatomy of the tuberculum sellae region, decision making is very difficult. Tuberculum sellae meningiomas is a serious challenge for neurosurgeons. In three patients, the meningioma was an incidental finding. Suprasellar meningioma resectiona complication and outcomebased. Simpson grade i or ii was achieved in 19 patients, and grade iii or iv was attained in four cases. Optic nerve vascular compression in a patient with a.
These facts combine to support the earliest possible diagnosis and rapid referral to an. Endoscopic endonasal approach for tuberculum sellae meningioma. University of pittsburgh center for skull base surgery associate director juan c. Several factors appear to influence the visual prognosis in patients who undergo surgery for removal of tuberculum sellae. Anterior cerebral artery aca encasement is often considered a contraindication for an endonasal endoscopic transsphenoidal approach. Tuberculum sellae meningioma s originate in the middle fossa unlike planum sphenoidale meningiomas which are in the anterior fossa. As they grow in the subchiasmal area compressing the optic nerves, ts meningiomas produce quite distinctive clinical, radiologic, and microsurgical features fig. D,e the tuberculum sellae meningioma was typically enhanced in contrast mri, and the shape of the enhanced meninges tail sign red arrow in d. Different microsurgical approaches to meningiomas of the anterior.
Meningiomas of the anterior skull base account for 40% of all intracranial meningiomas. Tuberculum sellae meningiomas tsms represent special surgical challenge for neurosurgeons. The tuberculum sellae is the anterior and upper border of the sella turcica and is one of the most frequent localization of meningiomas of the anterior skull base. We present a rare complication of bilateral caudate infarcts and necrosed nasoseptal flaps after endoscopic transsphenoidal resection of tuberculum sellae meningioma. Case of acute optic nerve compression caused by tuberculum. The tuberculum sellae or the tubercle of the sella turcica is a part of the sphenoid bone that is an elevation behind the chiasmatic groove. All patients underwent craniotomy, with an operating microscope being used in 62 cases. The contralateral subfrontal approach can simplify surgery and. Tuberculum sellae meningiomas tsms are not uncommon variety among the intracranial meningiomas. A total of 18 patients diagnosed with tuberculum sellae meningioma received surgical treatment at neurosurgery clinic at military medical. Meningiomas are benign and slow growing tumors that usually take years to produce clinical symptoms. The meningiomas were divided into group a planum sphenoidale meningioma psm, group b tuberculum sellae meningioma tsm and group c diaphragma sellae meningioma dsm, based on their.
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