The Transsphenoidal Transtuberculum Sellae Approach for Suprasellar Meningiomas

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Abstract
The transsphenoidal approach is the preferred method for removal of pituitary tumors. Suprasellar tumors may also be approached transsphenoidally in the setting of an expanded sella turcica. Suprasellar tumors that are fibrous and not associated with an expanded sella are generally treated with craniotomy. However, transcranial resection of suprasellar meningiomas carries significant risk to the optic apparatus. The transsphenoidal approach may be modified to provide access for resection of suprasellar meningiomas. A consecutive series of patients with suprasellar meningiomas who underwent a transsphenoidal transtuberculum sellae approach were reviewed retrospectively. From January 2000 to July 2002, six patients underwent the transsphenoidal transtuberculum sellae approach. All patients underwent thorough preoperative and postoperative ophthalmologic and endocrinologic testing. Magnetic resonance imaging of all patients was obtained preoperatively, 6 weeks to 3 months postoperatively, and annually. Two patients presented with visual dysfunction and one had signs of endocrine dysfunction. Tumor diameter ranged from 1.5 to 2.5 cm with a mean diameter of 2.1 cm and all tumors revealed magnetic resonance evidence of chiasmatic compression. Gross total resection was accomplished in four of six (67%) patients and no patient has experienced recurrence. Vision improved in both patients who presented with visual dysfunction and one patient with normal vision preoperatively experienced a mild bitemporal hemianopsia. Vision remained normal or improved in 83%. No patient required pituitary hormone replacement postoperatively and no patient experienced cerebrospinal fluid rhinorrhea. The transsphenoidal transtuberculum sellae approach represents a viable alternative to craniotomy for selected suprasellar meningiomas.

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