title: Planum Sphenoidale and Tuberculum Sellae Meningiomas: Operative Nuances of a Modern Surgical Technique with Outcome and Proposal of a New Classification System.
abstract: BACKGROUND
  The resection of planum sphenoidale and tuberculum sellae meningiomas is challenging. A universally accepted classification system predicting surgical risk and outcome is still lacking.
  
  
  OBJECTIVE
  We report a modern surgical technique specific for planum sphenoidale and tuberculum sellae meningiomas with associated outcome. A new classification system that can guide the surgical approach and may predict surgical risk is proposed.
  
  
  METHODS
  We conducted a retrospective review of the patients who between 2005 and March 2015 underwent a craniotomy or endoscopic surgery for the resection of meningiomas involving the suprasellar region. Operative nuances of a modified frontotemporal craniotomy and orbital osteotomy technique for meningioma removal and reconstruction are described.
  
  
  RESULTS
  Twenty-seven patients were found to have tumors arising mainly from the planum sphenoidale or the tuberculum sellae; 25 underwent frontotemporal craniotomy and tumor removal with orbital osteotomy and bilateral optic canal decompression, and 2 patients underwent endonasal transphenoidal resection. The most common presenting symptom was visual disturbance (77%). Vision improved in 90% of those who presented with visual decline, and there was no permanent visual deterioration. Cerebrospinal fluid leak occurred in one of the 25 cranial cases (4%) and in 1 of 2 transphenoidal cases (50%), and in both cases it resolved with treatment. There was no surgical mortality.
  
  
  CONCLUSIONS
  An orbitotomy and early decompression of the involved optic canal are important for achieving gross total resection, maximizing visual improvement, and avoiding recurrence. The visual outcomes were excellent. A new classification system that can allow the comparison of different series and approaches and indicate cases that are more suitable for an endoscopic transsphenoidal approach is presented.
authors.affiliation: Department of Neurological Surgery, University of Washington, Harborview Medical Center, Seattle, Washington, USA.
authors.forename: Martin M
authors.initials: MM
authors.lastname: Mortazavi
authors.affiliation: Department of Neurological Surgery, University of Washington, Harborview Medical Center, Seattle, Washington, USA.
authors.forename: Harley
authors.initials: H
authors.lastname: Brito da Silva
authors.affiliation: Department of Neurological Surgery, University of Washington, Harborview Medical Center, Seattle, Washington, USA.
authors.forename: Manuel
authors.initials: M
authors.lastname: Ferreira
authors.affiliation: Department of Neurological Surgery, University of Washington, Harborview Medical Center, Seattle, Washington, USA.
authors.forename: Jason K
authors.initials: JK
authors.lastname: Barber
authors.affiliation: Department of Neurological Surgery, University of Washington, Harborview Medical Center, Seattle, Washington, USA.
authors.forename: James S
authors.initials: JS
authors.lastname: Pridgeon
authors.affiliation: Department of Neurological Surgery, University of Washington, Harborview Medical Center, Seattle, Washington, USA; Department of Radiology, University of Washington, Harborview Medical Center, Seattle, Washington, USA. Electronic address: lsekhar@u.washington.edu.
authors.forename: Laligam N
authors.initials: LN
authors.lastname: Sekhar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065634:Cerebrospinal Fluid Leak / Q000209:etiology / Q000628:therapy; D003399:Craniotomy / Q000379:methods; D019299:Decompression, Surgical; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008579:Meningioma / Q000145:classification / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D019635:Neurosurgical Procedures / Q000379:methods*; D009915:Orbit / Q000033:anatomy & histology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012658:Sella Turcica / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000145:classification / Q000601:surgery*; D013100:Sphenoid Bone / Q000601:surgery*; D025321:Surgery, Computer-Assisted; D013701:Temporal Bone / Q000033:anatomy & histology / Q000601:surgery; D016896:Treatment Outcome
keywords: Classification; Meningioma; Olfactory groove; Planum sphenoidale; Suprasellar; Surgical technique; Tuberculum sellae