From above or below: the controversy and historical evolution of tuberculum sellae meningioma resection from open to endoscopic skull base approaches.
In the early 20th century, the first successful surgical removal of a tuberculum sellae meningioma (TSM) was performed and described by Harvey Cushing. It soon became recognized that TSM pose a formidable challenge for skull base surgeons because of their deep and sensitive location, proximity to critical neurovascular elements, and often dense and fibrous nature. Because of this, over the next several decades controversy transpired regarding their optimal method of resection. Early attempts involved utilization of open transcranial routes. This included classic bilateral and unilateral frontal approaches, followed by pterional or frontotemporal approaches, which have evolved to incorporate skull base modifications, such as the supraorbital, orbitozygomatic, and orbitopterional approaches. Minimally invasive supraorbital keyhole approaches through eyebrow incisions have also been adopted. Over the past 25 years, the microsurgical transsphenoidal approach, classically used for pituitary and parasellar tumors, was modified to resect suprasesllar TSM via the extended transsphenoidal approach. More recently, with the evolution of endoscopic techniques, resection of TSM has been achieved using purely endoscopic endonasal transplanum transtuberculum approaches. Although each of these techniques has been successfully described for the treatment of TSM, the question still remains: is it better to access and operate on these lesions via a traditional, transcranial avenue, or are they better treated via endoscopic endonasal techniques? We outline the surgical management of TSM through history, from early transcranial and transsphenoidal approaches to modern extended endoscopic endonasal procedures. We briefly explore the arguments favoring each of the methods and the advancements which have emerged to further optimize surgical resection.
Department of Otolaryngology - Head & Neck Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA.
Resha S
RS
Soni
Department of Neurological Surgery, Rutgers University, New Jersey Medical School, 90 Bergen St, Suite 8100, Newark, NJ 07101, USA.
Smruti K
SK
Patel
Department of Otolaryngology - Head & Neck Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA.
Qasim
Q
Husain
Department of Otolaryngology - Head & Neck Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA.
Mufaddal Q
MQ
Dahodwala
Department of Otolaryngology - Head & Neck Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA; Department of Neurological Surgery, Rutgers University, New Jersey Medical School, 90 Bergen St, Suite 8100, Newark, NJ 07101, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, Newark, NJ, USA.
Jean Anderson
JA
Eloy
Department of Otolaryngology - Head & Neck Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA; Department of Neurological Surgery, Rutgers University, New Jersey Medical School, 90 Bergen St, Suite 8100, Newark, NJ 07101, USA; Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers University, New Jersey Medical School, Newark, NJ, USA. Electronic address: james.liu.md@rutgers.edu.
James K
JK
Liu
D004724:Endoscopy / Q000266:history* / Q000379:methods*; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D008579:Meningioma / Q000601:surgery*; D008866:Microsurgery / Q000266:history / Q000379:methods; D019292:Skull Base Neoplasms / Q000601:surgery*; D013100:Sphenoid Bone
Anterior skull base; Endoscopic endonasal; Skull base surgery; Suprasellar tumor; Transcranial; Transsphenoidal; Tuberculum sellae meningioma