ENDONASAL VERSUS SUPRAORBITAL KEYHOLE REMOVAL of CRANIOPHARYNGIOMAS and TUBERCULUM SELLAE MENINGIOMAS

ENDONASAL VERSUS SUPRAORBITAL KEYHOLE REMOVAL of CRANIOPHARYNGIOMAS and TUBERCULUM SELLAE MENINGIOMAS

Author Fatemi, Nasrin Google Scholar
Dusick, Joshua R. Google Scholar
Paiva Neto, Manoel A. de Autor UNIFESP Google Scholar
Malkasian, Dennis Google Scholar
Kelly, Daniel F. Google Scholar
Institution St Johns Hlth Ctr
Univ Calif Los Angeles
Universidade Federal de São Paulo (UNIFESP)
Abstract OBJECTIVE: Endonasal and supraorbital eyebrow craniotomies are increasingly being used to remove craniopharyngiomas and tuberculum sellae meningiomas. Herein, we assess the relative advantages, disadvantages, and selection criteria of these 2 keyhole approaches.METHODS: All consecutive patients who had endonasal or supraorbital removal of a 1 craniopharyngioma or tuberculum sellae meningioma were analyzed.RESULTS: of 43 patients, 22 had a craniopharyngioma (18 endonasal, 4 supraorbital), and 21 had a meningioma (12 endonasal, 7 supraorbital, 2 both routes); 33% had prior surgery. Craniopharyngiomas were primarily retrochiasmal in location in 78% of endonasal cases versus 25% of supraorbital cases (P = 0.08). Meningiomas were larger when approached by the supraorbital route versus the endonasal route (33 10 versus 25 +/- 8 mm, respectively; P = 0.008). Endoscopy was used in 84% of endonasal approaches and in 31% of supraorbital approaches (P = 0.001). of patients having p first-time surgery for a craniopharyngioma (n = 14) or meningioma (n = 15), total/near total removal was achieved in 83% and 80% of patients by the endonasal route and in 50% and 80% of patients by the supraorbital route, respectively. Vision improved in 87% and 70% of patients who had surgery by an endonasal versus supraorbital route, i respectively (P = 0.3). Visual deterioration occurred in 2 patients with meningiomas, 1 1 by endonasal (7%), and 1 by supraorbital (11%) removal. the endonasal approach was associated with a higher rate of postoperative cerebrospinal fluid leaks (16 versus 0%; P = 0.3), 4 of 5 of which occurred in patients with meningioma.CONCLUSION: the endonasal route is preferred for removal of most retrochiasmal craniopharyngiomas, whereas the supraorbital route is recommended for meningiomas larger than 30 to 35 mm or with growth beyond the supraclinoid carotid arteries. for smaller midline tumors, either approach can be used, depending on surgeon experience and tumor anatomy. Compared with traditional craniotomies, the major limitation of both approaches is a narrow surgical corridor. the endonasal approach has the added challenges of restricted lateral suprasellar access, a greater need for endoscopy, and a more demanding cranial base repair.
Keywords Cerebrospinal fluid leak
Craniopharyngioma
Endoscopy
Extended transsphenoidal
Meningioma
Supraorbital craniotomy
Language English
Date 2009-05-01
Published in Neurosurgery. Philadelphia: Lippincott Williams & Wilkins, v. 64, n. 5, p. 269-284, 2009.
ISSN 0148-396X (Sherpa/Romeo, impact factor)
Publisher Lippincott Williams & Wilkins
Extent 269-284
Origin http://dx.doi.org/10.1227/01.NEU.0000327857.22221.53
Access rights Closed access
Type Article
Web of Science ID WOS:000265661300015
URI http://repositorio.unifesp.br/handle/11600/31515

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