title: The transplanum transtuberculum approaches for suprasellar and sellar-suprasellar lesions: avoidance of cerebrospinal fluid leak and lessons learned.
abstract: OBJECTIVE
  To present a large series of patients and examine the learning curve of the endonasal endoscopic transplanum, transtuberculum approach for primarily suprasellar or sellar-suprasellar tumors.
  
  
  METHODS
  We identified 122 patients who underwent 126 surgeries using the transplanum, transtuberculum approach. Extent of resection was determined with volumetric analysis of magnetic resonance imagings. Results concerning vision, endocrine function, and complications were noted.
  
  
  RESULTS
  Average tumor volume was 14 cm(3). The most frequent pathologies were pituitary macroadenoma (51.6%), craniopharyngioma (20.6%), and meningioma (15.9%). A total of 73% patients presented with visual compromise. Rates of gross total resection (GTR) and near total resection for the group as a whole were 58.1% and 13.7%, and for the patients in whom GTR was intended (n = 90), rates of GTR and near total resection were 77.5% and 12.5% for a total of 90%. Extent of resection in this group was 97.6%. Vision improved in 52.4% and deteriorated in 4.8%. Favorable endocrine outcome occurred in 63.5%. The cerebrospinal fluid leak rate was 3.1% for the series as a whole. It improved from 6.3% in the first half of the series to 0 in the second half. Leak rates varied with technique from 11% (fat graft only) to 4.2% (gasket seal only) to 1.8% (fat plus nasoseptal flap) to 0 (gasket plus nasoseptal flap). The rate of other complications was 14.3% in the first half of the series and 1.6% in the second half. There was one infection (0.8%).
  
  
  CONCLUSIONS
  The endonasal endoscopic transtuberculum transplanum approach is a safe and effective minimal access approach to midline pathology in the suprasellar cistern.
authors: Department of Neurosurgery, Brain and Spine Center, Brain and Mind Research Institute, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
authors: Lino
authors: L
authors: Mascarenhas
authors: Department of Neurosurgery, Brain and Spine Center, Brain and Mind Research Institute, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
authors: Yaron A
authors: YA
authors: Moshel
authors: Department of Neurosurgery, Brain and Spine Center, Brain and Mind Research Institute, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
authors: Fatema
authors: F
authors: Bayad
authors: Department of Neurosurgery, Brain and Spine Center, Brain and Mind Research Institute, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
authors: Oszkar
authors: O
authors: Szentirmai
authors: Department of Neurosurgery, Brain and Spine Center, Brain and Mind Research Institute, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
authors: Al Amin
authors: AA
authors: Salek
authors: Department of Neurosurgery, Brain and Spine Center, Brain and Mind Research Institute, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
authors: Lewis Z
authors: LZ
authors: Leng
authors: Department of Neurosurgery, Brain and Spine Center, Brain and Mind Research Institute, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
authors: Christoph P
authors: CP
authors: Hofstetter
authors: Department of Neurosurgery, Brain and Spine Center, Brain and Mind Research Institute, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
authors: Dimitris G
authors: DG
authors: Placantonakis
authors: Department of Radiology, Brain and Spine Center, Brain and Mind Research Institute, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
authors: Apostolos J
authors: AJ
authors: Tsiouris
authors: Department of Otolaryngology, Brain and Spine Center, Brain and Mind Research Institute, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
authors: Vijay K
authors: VK
authors: Anand
authors: Department of Neurosurgery, Brain and Spine Center, Brain and Mind Research Institute, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA; Department of Neurology and Neuroscience, Brain and Spine Center, Brain and Mind Research Institute, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA; Department of Otolaryngology, Brain and Spine Center, Brain and Mind Research Institute, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA. Electronic address: schwarh@med.cornell.edu.
authors: Theodore H
authors: TH
authors: Schwartz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065634:Cerebrospinal Fluid Leak; D002559:Cerebrospinal Fluid Rhinorrhea / Q000517:prevention & control*; D002648:Child; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D059032:Learning Curve; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D009296:Nasal Cavity / Q000601:surgery*; D018365:Neoplasm, Residual / Q000473:pathology; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D010901:Pituitary Function Tests; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery; D016896:Treatment Outcome; D014786:Vision Disorders / Q000628:therapy; D055815:Young Adult
keywords: Craniopharyngioma; Endonasal transsphenoidal approach; Meningioma; Planum sphenoidale; Rathke cleft cyst; Skull base; Tuberculum sellae