Evolving strategies for resection of sellar/parasellar synchronous tumors via endoscopic endonasal approach: A technical case report and systematic review of the literature
Document Type
Article
Publication Date
1-1-2020
Abstract
Background: Data on the endonasal endoscopic approach (EEA) to treat sellar/parasellar synchronous tumors remain sparse. This work aims to describe a minimally invasive approach with intraoperative magnetic resonance imaging (MRI) to remove a large sellar/parasellar synchronous tumor, and presents a systematic literature review. Methods: The preoperative MRI of a 54-year-old woman revealed a sellar lesion (28 x 19 x 16 mm), presumably a pituitary macroadenoma, and a second extra-axial lesion (22 x 36 x 20 mm) expanding from the tuberculum sellae to the planum sphenoidale with encasement of the anterior communicating complex, presumably a meningioma. We used intraoperative MRI to assess the extent of the resection before reconstructing the large skull base defect. Furthermore, we systematically reviewed pertinent articles retrieved by a PubMed/Embase database search between 1961 and December 2018. Results: Out of 63 patients with synchronous tumors reported in 43 publications, we found 3 patients in which the tumor was removed by EEA. In these 3 patients and the presented case, the resection of both lesions was successful, without major approach-related morbidity or mortality. More extensive removal of endonasal structures to gain an adequate tumor exposure was not necessary. We did not find any previous reports describing the benefits of intraoperative MRI in the presented setting. Conclusions: In the rare case of a synchronous meningioma and pituitary adenoma of the sellar region, intraoperative MRI might be beneficial in confirming residual disease before skull base reconstruction, and therefore radiologic follow-up.
Keywords
Endoscopic endonasal transsphenoidal surgery, Intraoperative magnetic resonance imaging, Pituitary adenoma, Sella, Synchronous tumor, Tuberculum sellae meningioma
Divisions
ummc
Funders
Department of Surgery of the University Hospital of Basel (Basel, Switzerland),Gottfried and Julia Bangerter-Rhyner Foundation (Bern, Switzerland),Department of Neurosurgery of the University Hospital of Basel (Basel, Switzerland),University of Malaya Specialist Centre (Kuala Lumpur, Malaysia)
Publication Title
World Neurosurgery
Volume
133
Publisher
Elsevier
Publisher Location
STE 800, 230 PARK AVE, NEW YORK, NY 10169 USA