We report a case of tuberculum sellae meningioma with optic tract edema. Tuberculum sellae tuberculum sellae anatomical parts. However, vascular encasement of the anterior cerebral artery aca. May 19, 2015 university of pittsburgh center for skull base surgery associate director juan c. The tuberculum sellae meningioma tsm arises from the tuberculum sellae, chiasmatic sulcus, and limbus sphenoidale. Meningiomas are the most common primary tumor of the central nervous system, arising from the arachnoid cap cells of the arachnoid villi in the meninges. Illustrated anatomical parts with images from eanatomy and descriptions of anatomical structures. However, primary meningiomas of the paranasal sinuses are extremely rare. Tuberculum sellae meningiomas neurosurgery oxford academic. To retrospectively analyze patients withtsm who underwent surgery via an. In three patients, the meningioma was an incidental finding. The difficulty in surgically excising a tuberculum sellae meningioma comes from its anatomical relationship to the optic nerves and chiasm and to the anterior cerebral and internal carotid arteries and their perforators.
The surgeon approaching tumors in the parasellar region must contend with a highly congested neurovascular anatomy surrounding the pituitary gland and stalk. Although meningiomas are considered a type of primary brain tumor, they do not. C microscopic view of the dissection into the space between the optical nerve and the tumor using pterional access. All the chapters have been developed with high quality and including the most modern approaches for the different aspects they deal with. Symptoms depend on the location and occur as a result of the tumor pressing on nearby tissue. You will find some basic information about this disease and the parts of the body it may affect. A retrospective analysis was done on 53 patients 40 female with meningiomas originating from the tuberculum sellae who underwent surgery between 1991 and 2002. Surgical management of tuberculum sellae and planum. The tuberculum sellae or the tubercle of the sella turcica is a part of the sphenoid bone that is an elevation behind the chiasmatic groove. There were 16 women and 4 men ranging from 27 to 75 years. Modern surgical approaches to tuberculum sellae meningiomas coronal figure 1 skull base center clinical case report coronal contrastenhanced mri anterior a and more posterior b. The tumor may fill the sellar and suprasellar area with. The following are video recordings of surgical procedures from the department of neurosurgery of saint johns hospital of budapest.
We report a patient with a tuberculum sella meningioma with aca. Apr 05, 20 complete tumor resection with preservation or improvement of visual function is the goal of tuberculum sellae meningioma tsm treatment. Table 5 shows the histological subtypes of meningioma cases under study. Learn about uclas neurosurgeons who have extensive experience with all surgical techniques used for the removal of pituitary tumors. Diagnostic, prognostic, and therapeutic applications the harvard community has made this article openly available. The standard surgical approach consisted of pterional. Modern surgical approaches to tuberculum sellae meningiomas.
Sep 30, 2018 representing 5 to 10% of intracranial meningiomas, tuberculum and diaphragm sellae meningiomas are intimately involved with the critical suprasellar structures. Endonasal endoscopic transsphenoidal resection of tuberculum sella meningioma with anterior cerebral artery encasement. Posterior fossa meningioma surgical experiences 37. Tuberculum sellae ts meningiomas arise from the dura of the ts, chiasmatic sulcus, limbus sphenoidale, and diaphragma sellae. Think of that menu as a roadmap for this complete guide. Figure 2 a microsurgical vision of the frontotemporal approach of tuberculum sellae meningioma by subfrontal access through the transsylvian fissure. Use the menu below to choose the introduction section to get started. Most publications are available for download in spanish. From 1991 to 2001, 20 patients harboring a meningioma of the tuberculum sellae were operated on. Tuberculum meningioma ucla pituitary tumor program. Or, you can choose another section to learn more about a. Juxtasellar meningiomas frequently extend into the optic canal. Early central tumor decompression avoids retraction on the optic apparatus. Often this is eloquent cortex, making the approach very important.
The first successful removal of a tuberculum sellae meningioma was performed by cushing in 1916. Tuberculum sellae meningiomas are located not only on the limited surface between the prechiasmatic sulcus and and diaphragm sellae, but also on the limbus. They arise from the tuberculum sellae, chiasmatic sulcus, limbus sphenoidale, and diaphragma sellae and grow in a subchiasmal position. Almeftys meningiomas, second edition is the definitive guide to meningioma diagnosis, treatment, and surgery, and reflects over a decade of major advances in the diagnosis and management of both intracranial and spinal meningiomas since the first edition was published.
Anterior interhemispheric approach for tuberculum sellae. The videos were made to assist with the training of neurosurgery, residents. Contrary to a prior report on this topic, edema along the optic tract is not only seen in craniopharyngiomas but may be seen although rarely in other common parasellar tumors, as in our case of a tuberculum sellae meningioma. The optic nerves white arrow are seen lateral to the tumor t throughout their course. Treatment involves tumor removal and decompression of the optic chiasm via several operative approaches. It accounts for up to 10% of all intracranial meningiomas. This book is aimed at neurosurgeons with an interest in updating their knowledge on the latest state of meningiomas surgery and management. All patients underwent evaluation by ct scanning and mr imaging, with intravenous administration of a contrast agent. Cerebellopontine angle meningioma was the most common 40% followed by petroclival meningioma 25%, while the least meningioma location was the clival and foramen magnum meningioma 5% of cases each, figs. Tuberculum sellae meningioma tsm is a distinct group of meningiomas originating. B microsurgical vision, showing the tumor compressing the optic chiasm. Later, in 1929, cushing and eisenhardt classified the meningiomas of the tuberculum sellae in four stages, according to their size. Meningioma is a type of tumor that arises from the protective membranes, called meninges, which surround the brain and spinal cord.
We report our personal case series of 38 patients with tuberculum sellae meningiomas. Remote work advice from the largest allremote company. A total of 41 cases of tuberculum sellae meningiomas underwent surgery by the senior authors having an experience of more than 10 years during the period from january 2004 till june 2011. Tuberculum sellae meningiomas is a serious challenge for neurosurgeons. Figure 5 postoperative mri brain t1wi sagittal cut with contrast showed complete surgical removal of the dorsum sellae meningioma. This chapter addresses surgical selection, surgical technique, management of the sagittal sinus, recurrence and radiation therapy, and outcomes for parasagittal and falx meningiomas. We present detailed ophthalmic findings in a case of tuberculum sellae meningioma with acute visual symptoms due to optic canal involvement.
Planum sphenoidale meningiomas are located more anterior and in proximity of the olfactory groove location 4, 10. The text begins with important information on anatomy, pathology, and epidemiology, followed by clinical and preoperative. To present a large series of surgically treated tuberculum sellae meningiomas with particular regard to involvement of the optic canal and visual outcome. Data from 14 patients with tsms tuberculum sellae meningioma who underwent microsurgical treatment by a supraorbital keyhole eyebrow skin incision. Author links open overlay panel kohei ohta md f1 kensaku yasuo md. Surgical management of tuberculum sellae meningiomas. Dec 04, 2012 midline based meningioma arrised from the tuberculum sellae. Meningiomas arise from arachnoidal cells, most of which are near the vicinity of the venous sinuses, and this is the site of greatest prevalence for meningioma formation they most frequently are attached to the dura over the superior parasagittal surface of frontal and parietal lobes, along the sphenoid ridge, in the olfactory grooves, the sylvian region, superior cerebellum along the falx. Your story matters citation bi, wenya linda, michael zhang, winona w. Complete tumor resection with preservation or improvement of visual function is the goal of tuberculum sellae meningioma tsm treatment. In particular, the optic chiasm and nerves, carotid artery and branches, and upper cranial nerves merit meticulous attention, especially when meningiomas of. Midline based meningioma arrised from the tuberculum sellae. The tuberculum sellae forms the anterior wall of the sella turcica, which houses the pituitary gland.
Note that the diaphragma sellae is not pushed up as it would have been with a macroadenoma, but rather is depressed, indicating this mass is of suprasellar origin. Visual impairment was the most common initial complaint. Dengan insiden paling banyak pada usia pertengahan. Tuberculum sellae definition of tuberculum sellae by. Critical understanding of endoscopic technique for parasellar meningiomas is essential.
All patients underwent craniotomy, with an operating microscope being used in 62 cases. Meningiomas of the tuberculum sellae arise from the limbus sphenoidale, chiasmatic sulcus, and tuberculum. Technical nuances on the frontopterional approach authors. Hi, 6 tumors, two removed surgically, 2 cyberknife radiated because one is laying up against my brain stem and one laying on my optic nerve. Correct diagnosis and management require an appreciation of the unique clinical, neuroimaging, and surgeryrelated features that distinguish these meningiomas from others of the anterior skull base.
Changes in the size of the sella turcica are frequently related to pathologies and syndromes. In 17 patients, progressive asymmetrical visual loss from 3 to 48 months was the symptom leading to medical consultation. Occasionally seizures, dementia, trouble talking, vision problems, one sided weakness, or. Tuberculum sellae meningiomas tsms represent a distinct clinical entity among the intracranial meningiomas.
Pterional approach versus unilateral frontal approach on tuberculum. Sellar region tumors may origin from a various number of structures and each of them have a specific clinical and radiological appearance. Optic tract edema in a meningioma of the tuberculum sellae. Tumor yang tumbuh didalam rongga kepala atau tumor intra kranial, dapat berasal dari tulang tengkorak, selaput otak atau meninges, nervus cranialis, pembuluh darah, glandula pituitari atau parenkim otak itu sendiri.
Slowly progressing visual deterioration is the most common initial complaint, and prompt treatment is directed at preserving and improving vision. Join ronald warnick, md, as he presents a webinar discussing incidence rates, risk factors, tumor classification and presenting symptoms of meningioma. Meningiomas account for nearly 20% of all intracranial neoplasms and are the second most common tumors of the central nervous system following gliomas. L mavillamri of an unenhancing tuberculum sellae meningioma. Our patient was a 57yearold female with progressive visual deterioration and a complex sellarsuprasellar lesion. Case of acute optic nerve compression caused by tuberculum. Note the dural tail blue arrow, optic canal extension white arrowhead. Data from 14 patients with tsms tuberculum sellae meningioma who underwent microsurgical treatment by a supraorbital keyhole eyebrow skin incision between september 2006 and september 20 were. Full text pdf 945 kb 235 downloads abstract html 1108 views. A 62yearold japanese woman reported a 1week history. The locations of the meningiomas were olfactory groove and tuberculum. This study illustrates a number of important signs of how to distinguish a suprasellar mass from one arising from the pituitary.
Anterior interhemispheric approach for tuberculum sellae meningioma background. Tuberculum sellae and planum sphenoidale meningiomas represent 5% to 10% of intracranial meningiomas and represent a subgroup of anterior skull base meningiomas 10, 11, 19. Meningioma tumor yang tumbuh didalam rongga kepala atau tumor intra kranial, dapat berasal dari tulang tengkorak, selaput otak atau meninges, nervus cranialis, pembuluh darah, glandula pituitari atau parenkim otak itu sendiri. As they grow in the subchiasmal area compressing the optic nerves, ts meningiomas produce quite distinctive clinical, radiologic, and microsurgical features fig. Endonasal endoscopic transsphenoidal resection of tuberculum. Almeftys meningiomas ebook by 9781604063943 rakuten kobo. For these, the major issues are localization and resection without injury to the adjacent brain.
Meningioma, also known as meningeal tumor, is typically a slowgrowing tumor that forms from the meninges, the membranous layers surrounding the brain and spinal cord. The tuberculum sellae is the ridged process of the sphenoid bone which forms the anterior wall of the sella turcica gross anatomy relations. Tuberculum sellae meningiomas represent approximately 5 to 10% of intracranial meningiomas 2, 12, 25, 28, 29, 33. The pituitary tumor program at ucla is a multidisciplinary team of health care professionals dedicated to providing stateoftheart management of pituitary tumors. The clinical and radiological features of these tumors are nonspecific, and consequently an accurate diagnosis requires histologic evaluation. Case of acute optic nerve compression caused by tuberculum sellae meningioma with optic canal involvement chai y1, yamazaki h1, kondo a2, oshitari t3, yamamoto s31department of ophthalmology, kohnodai hospital, national center for global health and medicine, chiba, 2department of neurosurgery, juntendo university, school of medicine, tokyo, 3department of ophthalmology and visual science. University of pittsburgh center for skull base surgery associate director juan c. Tuberculum sella meningioma the neurosurgical atlas, by.
They arise from the tuberculum sellae, planum sphenoidale, and chiasmatic sulcus and account for 5 to 10% of all intracranial meningiomas. Conclusions ectopic intraosseous meningiomas remain a rare neoplasm with only a few cases reported. Microsurgery of tuberculum sellae meningiomas sciencedirect. Iracema araujo estevao i, bruno camporeze, giovanna matricardiii, pedro da silva junior iii, daniel a.
Tuberculum sellae meningiomas are a classic tumor of the anterior fossa that present in patients with gradual visual deterioration secondary to optic apparatus compression. Well defined suprasellar solid mass seen which shows homogenous enhancement and a broad dural attachment to the planum sphenoidale. They comprise approximately 3%10% of all intracranial meningiomas. Results sixtythree patients with either an optic nerve sheath n 16 or a sphenoid ridge or tuberculum sellae meningioma n 47 were seen mean age.
Fernandezmiranda, md, narrates surgery for a tuberculum sella meningioma using the endoscopic endonasal approach. The intimate relationship between tubercular sellae meningeomas and the optic apparatus characterizes their main clinical interaction. Jan 25, 2018 tuberculum sellae meningioma resection. Visual findings as primary manifestations in patients with intracranial.
The book is focused at performing a portrait of that what is state of the art in management of meningiomas. Harvey cushing conducted the autopsy of one of his patients who had suffered most likely from a tuberculum sella or medial sphenoid wing meningioma circa 19image courtesy of the cushing brain tumor registry at yale university. A variable slight to prominent median elevation forming the posterior boundary of the chiasmatic groove and the anterior boundary of the hypophysial fossa. Tuberculum sellae meningioma is one of the most challenging surgeries in neurosurgical field. Dunn the surgeon approaching tumors in the parasellar region must contend with a highly congested neurovascular anatomy surrounding the pituitary gland and stalk. Compromise of the optic apparatus is an important feature for decision making.
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