title: Lateral supraorbital approach applied to tuberculum sellae meningiomas:  experience with 52 consecutive patients.
abstract: BACKGROUND
  Various surgical approaches for the removal of tuberculum sellae meningiomas (TSMs) have previously been described.
  
  
  OBJECTIVE
  To assess the reliability and safety of the lateral supraorbital (LSO) approach to remove TSMs.
  
  
  METHODS
  We identified all TSM patients operated on at the Department of Neurosurgery at Helsinki University Central Hospital, Finland, by the senior author (J.H.) using the LSO approach between September 1997 and August 2010. We retrospectively analyzed the clinical data, radiological findings, surgical treatment, histology, and outcome of patients and discuss the operative technique.
  
  
  RESULTS
  Apparent complete tumor removal was achieved in 45 patients (87%). Of 42 patients, preexisting visual deficit improved in 22, remained the same in 13, and worsened in 7, and de novo visual deficit occurred in 1 patient. At 3 months post-discharge, 47 patients (90%) had a good recovery, 4 (8%) were moderately disabled, and 1 (2%) died 40 days after surgery of unexplained cardiac arrest. Seven patients (13%) had minimal residual tumors, 2 of which required reoperation. During the median follow-up of 59 months (range, 1-133 months), tumor recurred in 1 of the patients who had undergone a second operation.
  
  
  CONCLUSIONS
  TSMs of all sizes can be removed via the LSO approach with minimal morbidity and mortality. Low-power or no coagulation is recommended near the optic nerves and the optic chiasm to preserve their vascular support from the internal carotid artery perforators. Our results are comparable to those obtained using more extensive and time-consuming approaches. We recommend the LSO approach to remove TSMs.
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland. rossana.romani@hus.fi
authors.forename: Rossana
authors.initials: R
authors.lastname: Romani
authors.forename: Aki
authors.initials: A
authors.lastname: Laakso
authors.forename: Marko
authors.initials: M
authors.lastname: Kangasniemi
authors.forename: Mika
authors.initials: M
authors.lastname: Niemelä
authors.forename: Juha
authors.initials: J
authors.lastname: Hernesniemi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery*; D008579:Meningioma / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D012658:Sella Turcica / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult