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العنوان
Endoscopic Transtuberculum Transplanum Approach to Suprasellar Meningiomas /
المؤلف
Elsawy,Ahmad Mohamad.
هيئة الاعداد
باحث / Ahmad Mohamad Elsawy
مشرف / Hossam El Huseiny Khalil
مشرف / Omar Yousef Hammad
مشرف / Hamdy Ibrahim Khalil
تاريخ النشر
2018
عدد الصفحات
119p.:
اللغة
الإنجليزية
الدرجة
الدكتوراه
التخصص
جراحة
تاريخ الإجازة
1/1/2018
مكان الإجازة
جامعة عين شمس - كلية الطب - جراحة المخ والأعصاب
الفهرس
Only 14 pages are availabe for public view

from 119

from 119

Abstract

Extended endoscopic approaches to suprasellar meningiomas have been proposed recently as a viable option or alternative to traditional microsurgical transcranial approaches. Endoscopic approaches have been presented as a minimally invasive route to such formidable lesions of the skull base, obviating the need of large craniotomies & brain retraction. Endoscopic approaches were shown to provide comparable rates of gross total resection, in selected cases, better visual outcomes than transcranial approaches, on the other hand high CSF leak rate was a major cornerstone for criticism for endoscopic approaches.
The objective of this study was to assess the feasibility of extended endoscopic transtuberculum transplanum approach to suprasellar meningiomas. The study also aimed at defining the criteria for proper patient selection to endoscopic endonasal approaches.
Twenty-three patients were included in our study, evaluated for Gross Total Resection (GTR), visual outcome, CSF leak rates, endocrine & other interventional morbidities.
Among the studied 23 patients, 15 (65.2%) had the lesion in tuberculum sella, 6 (26.1%) in planum/tuberculum and 2 (8.7%) in planum sphenoidale. Visual presentation was significantly more frequent in tuberculum sella cases (P<0.05),while incidental presentation was significantly more frequent in planum/tuberculum cases (P<0.05). Gross total resection was achieved in 73.9% of patients. Patients with gross total resection had significantly lower maximum diameter (P<0.05) and significantly less frequent vascular encasement (P<0.05). Visual improvement was achieved in 81.3% of patients with no incidence of visual deterioration in the study. CSF leak was the most common complication in our study occurring in 4 patients (17%). Lumbar drainage was sufficient to control the CSF leak in 2 patients while the other 2 patients required surgical repair of the skull base reconstruct. Eventually all cases of CSF leak were managed adequately with no series sequelae. Transient diabetes insipidus occurred in 2 patients (8.7%) in our study.
In conclusion, the extended endoscopic approaches to suprasellar meningiomas are safe & feasible with good outcomes & minimal morbidity. Gross Total Resection in endoscopic approaches can be limited by tumors with larger maximum diameter extending lateral to the clinoidal ICA. In addition vascular encasement with lack of cortical cuff can pose significant challenge for GTR. On the other hand intra-canalicular involvement is not a significant limitation for GTR in endoscopic approaches contrary to transcranial approaches. Visual outcomes are consistently superior in extended endoscopic approaches compared to transcranial approaches. This is probably explained by 1) early extradural bilateral optic canal decompression 2) scarce vascular supply to the undersurface of the optic apparatus & the superior visualization of sub-chiasmatic blood supply allowing its preservation. CSF leak rates are main concern for endoscopic approaches. Vascularized naso-septal flaps significantly reduced high rates of CSF leak reported in earlier series. Routine lumbar drainage is recommended in high-risk patients defined as 1) defect size > 1cm 2) extensive arachnoid dissection 3) breaching a cistern or a ventricle. Extended endoscopic approaches require a steep learning curve, which when overcome, a significant improvement in outcomes occurs. Careful patient selection is of utmost importance for optimization of outcomes. Extended endoscopic approaches offer a viable option or alternative with some advantages over the transcranial route, especially in the visual aspect, in smaller tumors without significant lateral extension or vascular encasement.