title: Endonasal Endoscopic Transsphenoidal Resection of Tuberculum Sella Meningioma with Anterior Cerebral Artery Encasement.
abstract: Anterior cerebral artery (ACA) encasement is often considered a contraindication for an endonasal endoscopic transsphenoidal approach. We report a patient with a tuberculum sella meningioma with ACA encasement, in whom a gross total excision was achieved through an endonasal endoscopic transsphenoidal transtuberculum, transplanum approach. The tumor was sharply dissected along the left ACA using meticulous bimanual sharp dissection after internal decompression. Moreover, the medial optic canals were opened and the optic nerves decompressed. A gasket seal closure with a nasoseptal flap was performed, and the patient was discharged on postoperative day four with improved vision. This case highlights the ability to remove planum and tuberculum meningiomas with vascular encasement through an endonasal endoscopic approach with the potential for safe vascular dissection. The absence of luminal narrowing can be used to assure the likelihood of a safe arachnoid plane.
authors.affiliation: Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh.
authors.forename: Sivashanmugam
authors.initials: S
authors.lastname: Dhandapani
authors.affiliation: Department of Neurosurgery, Menoufia University.
authors.forename: Hazem M
authors.initials: HM
authors.lastname: Negm
authors.affiliation: Department of Neurosurgery, National Institute of Neurology and Neurosurgery, Manuel Velasco Suárez.
authors.forename: Salomon
authors.initials: S
authors.lastname: Cohen
authors.affiliation: Department of Otorhinolaryngology, New York-Presbyterian/Weill Cornell Medical Center.
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Anand
authors.affiliation: Weill Cornell Brain and Spine Center, New York-Presbyterian/Weill Cornell Medical Center.
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Schwartz
keywords: anterior cerebral artery encasement; arachnoid plane; endonasal endoscopy; transtuberculum/transplanum approach; tuberculum sella meningioma