title: Preoperative Evaluation of the Interface Between Tuberculum Sellae Meningioma and the Optic Nerves on Fast Imaging with Steady-State Acquisition for Extended Endoscopic Endonasal Transsphenoidal Surgery.
abstract: BACKGROUND
  Endoscopic endonasal transsphenoidal surgery (EETS) is increasingly applied to treat tuberculum sellae meningiomas. However, if the tumor adheres firmly to the optic nerve, dissection of the interface between both structures should be prudent to preserve visual function. The purpose of this study was to investigate whether tumor adhesion to the optic nerve can be predicted preoperatively by fast imaging with steady-state acquisition (FIESTA).
  
  
  METHODS
  Twenty-two patients with tuberculum sellae meningioma treated with EETS were retrospectively identified. Clinical characteristics, radiologic studies, intraoperative findings, and outcomes were reviewed from their clinical charts.
  
  
  RESULTS
  Patients' symptoms included visual function impairment in 18 patients and headaches in 4 patients. Symptoms were resolved in 19 patients after operation. Preoperative radiologic evaluation was performed in 44 sides (22 patients) of the interface between tumors and the optic nerves and showed absence of peritumoral hyperintensity on FIESTA in 7 sides in 7 patients. In 5 of the 7 sides, tumor dissection was complicated by firm adhesion to the optic nerves. Among these cases, visual functions were unchanged in 1 patient after complete removal of the adhesion but substantially improved in 3 patients after partial resection. In the remaining 37 sides with preoperative peritumoral hyperintensity, no adhesion was found between both structures intraoperatively.
  
  
  CONCLUSIONS
  Absence of peritumoral hyperintensity between tuberculum sellae meningioma and the optic nerve on FIESTA may indicate firm adhesion at the interface, severely complicating complete removal. Preoperative recognition of this adhesion is important for safe tumor removal and preservation of visual functions.
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan. Electronic address: yahayashi@med.kanazawa-u.ac.jp.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Hayashi
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kita
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Issei
authors.initials: I
authors.lastname: Fukui
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Sasagawa
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Oishi
authors.affiliation: Department of Neurosurgery, Kanazawa Medical University, Kanazawa, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Tachibana
authors.affiliation: Department of Radiology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Ueda
authors.affiliation: Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Nakada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004210:Dissection; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D008579:Meningioma / Q000000981:diagnostic imaging* / Q000601:surgery; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery; D044583:Neuroendoscopy / Q000379:methods*; D009900:Optic Nerve / Q000000981:diagnostic imaging*; D011300:Preoperative Care; D012189:Retrospective Studies; D012658:Sella Turcica / Q000000981:diagnostic imaging*
keywords: Endoscopic endonasal transsphenoidal surgery; Interface; Magnetic resonance imaging; Optic nerve; Tuberculum sellae meningioma