Surgical decision-making strategies in tuberculum sellae meningioma resection.

OBJECT Although the transcranial route (TCR) has been the traditional approach for removing tuberculum sellae meningiomas (TSMs), the use of the microscopic and/or more recently the endoscopic transsphenoidal approach (ETSA) has gained acceptance for selected cases. In this study, the authors present their experience with the ETSA and the TCR and examine the criteria most important for deciding the optimal approach in a particular case. METHODS The authors retrospectively reviewed recent cases of TSMs treated surgically by the senior author via either the TCR or the ETSA or both. Demographic information, clinical presentation, and clinical and radiological outcomes of the patients were evaluated. RESULTS Twenty-seven patients underwent removal of a TSM during a recent period. Gross-total or near-total resection was achieved in 20 (91%) of 22 patients who underwent resection via the TCR and in 3 (60%) of 5 patients who underwent the ETSA. Among the patients in whom gross- or near-total resection was achieved, recurrence was observed in only 1 patient, whose tumor was removed via the ETSA. CONCLUSIONS In the majority of patients, the TCR provided complete resection of the tumor without compromising the safety of the procedure. In select cases of tumors with a reasonable size and location (midline and/or extending into the sphenoid sinus) as well as no involvement of inaccessible neurovascular and bony elements via this approach, the ETSA could also be a viable option.