Format

Send to:

Choose Destination
See comment in PubMed Commons below
World Neurosurg. 2014 Jul-Aug;82(1-2):186-95. doi: 10.1016/j.wneu.2013.02.032. Epub 2013 Feb 9.

The transplanum transtuberculum approaches for suprasellar and sellar-suprasellar lesions: avoidance of cerebrospinal fluid leak and lessons learned.

Author information

  • 1Department of Neurosurgery, Brain and Spine Center, Brain and Mind Research Institute, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
  • 2Department of Radiology, Brain and Spine Center, Brain and Mind Research Institute, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
  • 3Department of Otolaryngology, Brain and Spine Center, Brain and Mind Research Institute, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
  • 4Department of Neurosurgery, Brain and Spine Center, Brain and Mind Research Institute, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA; Department of Neurology and Neuroscience, Brain and Spine Center, Brain and Mind Research Institute, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA; Department of Otolaryngology, Brain and Spine Center, Brain and Mind Research Institute, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA. Electronic address: schwarh@med.cornell.edu.

Abstract

OBJECTIVE:

To present a large series of patients and examine the learning curve of the endonasal endoscopic transplanum, transtuberculum approach for primarily suprasellar or sellar-suprasellar tumors.

METHODS:

We identified 122 patients who underwent 126 surgeries using the transplanum, transtuberculum approach. Extent of resection was determined with volumetric analysis of magnetic resonance imagings. Results concerning vision, endocrine function, and complications were noted.

RESULTS:

Average tumor volume was 14 cm(3). The most frequent pathologies were pituitary macroadenoma (51.6%), craniopharyngioma (20.6%), and meningioma (15.9%). A total of 73% patients presented with visual compromise. Rates of gross total resection (GTR) and near total resection for the group as a whole were 58.1% and 13.7%, and for the patients in whom GTR was intended (n = 90), rates of GTR and near total resection were 77.5% and 12.5% for a total of 90%. Extent of resection in this group was 97.6%. Vision improved in 52.4% and deteriorated in 4.8%. Favorable endocrine outcome occurred in 63.5%. The cerebrospinal fluid leak rate was 3.1% for the series as a whole. It improved from 6.3% in the first half of the series to 0 in the second half. Leak rates varied with technique from 11% (fat graft only) to 4.2% (gasket seal only) to 1.8% (fat plus nasoseptal flap) to 0 (gasket plus nasoseptal flap). The rate of other complications was 14.3% in the first half of the series and 1.6% in the second half. There was one infection (0.8%).

CONCLUSIONS:

The endonasal endoscopic transtuberculum transplanum approach is a safe and effective minimal access approach to midline pathology in the suprasellar cistern.

Copyright © 2014 Elsevier Inc. All rights reserved.

KEYWORDS:

Craniopharyngioma; Endonasal transsphenoidal approach; Meningioma; Planum sphenoidale; Rathke cleft cyst; Skull base; Tuberculum sellae

PMID:
23403355
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Write to the Help Desk