Extended endoscopic transphenoidal approach for tuberculum sellae meningiomas

Removal of tuberculum sella (TS) meningiomas is traditionally performed through transcranial approaches. Wide use of the endoscope in transphenoidal pituitary surgery is recently accessible through the tuberculum sellae with an endoscope-assisted or purely endoscopic technique. Extended endoscopic approach is an important and alternative route for meningiomas, which are located on the midline originating from the tuberculum sella. However, cerebrospinal fluid (CSF) leakage is an important problem in extended endoscopic approaches. In this report, we discuss surgical limitations and nuances of endoscopic transphenoidal approach from a retrospective analysis of nine patients with TS meningiomas. Endoscopic transphenoidal approach was performed for seven women and two men (mean age, 51.1 years; age range, 32-78 years) with TS meningiomas between July 2007 and March 2010 in the Department of Neurosurgery, Kocaeli, Turkey. Total removal was achieved in six of nine patients. An improvement of the preoperative visual deficits was observed in six of the nine patients. Multilayer closure was performed for reconstruction, and lumbar external drainage was used for all patients for 3-5 days. CSF leakage was not seen in any of the patients after the operation and removal of the drainage. Endoscopic extended transphenoidal approach is still not a standardized procedure for TS meningiomas, but it may be considered as an alternative procedure in selected cases.