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Anterior Interhemispheric Approach for Tuberculum Sellae Meningioma

Terasaka, Shunsuke MD*; Asaoka, Katsuyuki MD†; Kobayashi, Hiroyuki MD*; Yamaguchi, Shigeru MD*

doi: 10.1227/NEU.0b013e31820781e1
Operative Technique

BACKGROUND: The tuberculum sellae meningioma (TSM) arises from the tuberculum sellae, chiasmatic sulcus, and limbus sphenoidale.

OBJECTIVE: To retrospectively analyze patients with TSM who underwent surgery via an anterior interhemispheric approach, with special attention to visual outcomes.

METHODS: Nine consecutive patients between April 2004 and December 2009 were examined. Visual impairment score (VIS) was used to analyze the visual status of the patients. A VIS is the sum of the scores in specific tables for visual acuity and visual field defects. Visual status was sequentially evaluated in the preoperative period and within 2 weeks of the operation. Any change in the VIS was considered an improvement or deterioration of visual function. All tumors were removed via an anterior interhemispheric approach. Following the wide dissection of the interhemispheric fissure, the tumor was first detached from its origin and debulked with the ultrasonic aspirator starting at the midline. The debulking continued until the arachnoid plane separating the nerve and tumor was visualized.

RESULTS: Gross total resection (Simpson I + II) was achieved in all 9 patients. The average VIS was 56.1 in the preoperative period and 26.3 in the postoperative period. Among 9 patients, 8 patients had an improvement of the VIS after surgery. VIS was unchanged in 1 patient, and no patients experienced visual deterioration. Other nonvisual complications, such as rhinoliquorrhea, venous infarction, and permanent anosmia, occurred in 3 patients.

CONCLUSION: Despite the small number of patients, a high resection rate and favorable visual outcome support the suitability of this approach for resection of TSM.

*Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan; †Department of Neurosurgery, Teine Keijinkai Medical Center, Sapporo, Japan

Received, February 16, 2010.

Accepted, August 6, 2010.

Correspondence: Shunsuke Terasaka, MD, Department of Neurosurgery, Graduate School of Medicine, Hokkaido University, North 15 West 7, Kita-ku, Sapporo 060-8638, Japan. E-mail:

Copyright © by the Congress of Neurological Surgeons