title: Extended endoscopic transphenoidal approach for tuberculum sellae meningiomas.
abstract: OBJECTIVE
  Removal of tuberculum sella (TS) meningiomas is traditionally performed through transcranial approaches. Wide use of the endoscope in transphenoidal pituitary surgery is recently accessible through the tuberculum sellae with an endoscope-assisted or purely endoscopic technique. Extended endoscopic approach is an important and alternative route for meningiomas, which are located on the midline originating from the tuberculum sella. However, cerebrospinal fluid (CSF) leakage is an important problem in extended endoscopic approaches. In this report, we discuss surgical limitations and nuances of endoscopic transphenoidal approach from a retrospective analysis of nine patients with TS meningiomas.
  
  
  METHODS
  Endoscopic transphenoidal approach was performed for seven women and two men (mean age, 51.1 years; age range, 32-78 years) with TS meningiomas between July 2007 and March 2010 in the Department of Neurosurgery, Kocaeli, Turkey.
  
  
  RESULTS
  Total removal was achieved in six of nine patients. An improvement of the preoperative visual deficits was observed in six of the nine patients. Multilayer closure was performed for reconstruction, and lumbar external drainage was used for all patients for 3-5 days. CSF leakage was not seen in any of the patients after the operation and removal of the drainage.
  
  
  CONCLUSIONS
  Endoscopic extended transphenoidal approach is still not a standardized procedure for TS meningiomas, but it may be considered as an alternative procedure in selected cases.
authors.affiliation: School of Medicine, Department of Neurosurgery, Kocaeli University, Eski İstanbul Yolu 10.Km, Izmit, Kocaeli, Turkey. ssceylan@yahoo.com
authors.forename: Savas
authors.initials: S
authors.lastname: Ceylan
authors.forename: Kenan
authors.initials: K
authors.lastname: Koc
authors.forename: Ihsan
authors.initials: I
authors.lastname: Anık
mesh_terms: D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D011859:Radiography; D012189:Retrospective Studies; D012658:Sella Turcica / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013100:Sphenoid Bone / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery