Minimal Invasive Neurosurgery of Infiltrative Tumours Extending Around the Sellar Region: Advantage of Combined Methods

Abstract

Most of the infiltrative tumoural lesions located around the sellar region compromise the cavernous sinus, cranial nerves, vascular neighboured structures and the hypothalamus. Minimal invasive neurosurgery (MIN) employing microsurgery, neuroendoscopy, neuronavigation and intraoperative radioscopy are reported to increase gross total tumour resection reducing the operative trauma. We combined at least 3 of these techniques in 32 patients with solid and 8 patients with cystic tumours of this region. Thirty tumours were approached in a transphenoidal manner, ten were via a single burr hole craniotomy in a transcortico-ventricular approach. In 36 cases the tumours were adequately removed with only six cases suffering a transitory and one with a permanent deterioration of a preoperatively diagnosed neurological deficit. In our experience, the use of combined techniques, particularly in these patients, reduces the operative trauma and improves the accuracy in planning the access, angle and extension of tumour removal. It also protects the patient from secondary damage to neighboured structures.

Key words

Neuronavigation - neuroendoscopy - microsurgery - sellar region

References

• 1 Shirane R, Ching-Chan S, Kusaka Y, Jokura H, Yoshimoto T. Surgical outcomes in 31 patients with craniopharyngiomas extending outside the suprasellar cistern: an evaluation of the frontobasal interhemispheric appoach.  J Neurosurg. 2002;  96 704-712
• 2 Suzuki J, Katakura R, Kayama T, Yoshimoto T. Interhemispheric trans-lamina terminalis approach by bifrontal craniotomy to tumor of the anterior part of third ventricle. In: Samii M (ed). Surgery in and around the brain stem and the third ventricle. Berlin, Heidelberg: Springer-Verlag 1986: 334-338
• 3 Yasui N, Suzuki A, Ohta H, Kamiyama H, Watanabe K, Shindo K MH. Microneurosurgical anterior and basal interhemispheric approaches for lesions in and around the anterior third ventricle. In: Samii M (ed). Surgery in and around the brain stem and the third ventricle. Berlin, Heidelberg: Springer-Verlag 1986: 339-345
• 4 Melmed S. Acromegaly.  N Engl J Med. 1990;  322 966-977
• 5 Wilson C. Neurosurgical management of large and invasive pituitary tumors: Clinical management of pituitary disorders. Tindall GT, Collins WF (eds). New York: Raven Press 1979: 335-342
• 6 Ebersold M J, Quast L M, Laws Jr E R, Scheithauer B, Randall R V. Long-term results in transsphenoidal removal of nonfunctioning pituitary adenomas.  J Neurosurg. 1986;  64 713-719
• 7 Klibasnski A, Zervas N. Diagnosis and management of hormonesecreting pituitary adenomas.  N Engl J Med. 1991;  324 822-831
• 8 Duff J M, Meyer F B, Ilstrup D M, Laws Jr E R, Schleck C D, Scheithauer B W. Long-term outcomes for surgically resected craniopharyngiomas.  Neurosurgery. 2000;  46 291-302
• 9 Spetzger U, Laborde G, Gilsbach J M. Frameless neuronavigation in modern neurosurgery.  Minim Invas Neurosurg. 1995;  38 163-166
• 10 Kaus M, Steinmeier R, Sporer T, Ganslandt O, Falbusch R. Technical accuracy of a neuronavigation system measured with a high-precision mechanical micromanipulator.  Neurosurgery. 1997;  41 1431-1437
• 11 Kaptain G J, Vincent D A, Sheehan J P, Laws E R. Transsphenoidal approaches for the extracapsular resection of midline suprasellar and anterior cranial base lesions.  Neurosurgery. 2001;  49 94-100
• 12 Carvi y Nievas M N, Bronst J, Höllerhage H-G. Benefit of neuronavigation in transphenoidal tumor microsurgery. In: European Association of Neurosurgical Societies: 11th European Congress of Neurosurgery Bologna: Monduzzi Editore 1999: 873-879
• 13 Wirtz R, Kunze S. Neuronavigation Computerassistierte Neurochirurgie.  Dt Ärztebl. 1998;  95 (39) A-2384-2390
• 14 Moreland D B, Diaz-Ordaz E, Czajka G A. Endoscopic endonasal hemisphenoidotomy for resection of pituitary lesions confined to the sella: report of 3 cases and technical note.  Minim Invasive Neurosurg. 2000;  43 57-61
• 15 Cappabianca P, Alfieri A, Colao A, Cavallo L M, Fusco M, Peca C, Lombardi G, Divitiis E de. Endoscopic endonasal transsphenoidal surgery in recurrent and residual pituitary adenomas: technical note.  Minim Invasive Neurosurg. 2000;  43 38-43
• 16 Laws E R, Vance M L. Radiosurgery for pituitary tumors and craniopharyngiomas.  Neurosurg Clin N Am. 1999;  10 327-336
• 17 Nakagawa T, Asada M, Tadashima T, Tomiyama K. Staged endoscopic operation for large pituitary adenomas.  J Laryngol Otol. 2002;  116 57-60
• 18 Perneczky A, Fries G. Endoscope-assisted brain surgery: Part 1 - Evolution, Basic concept, and current technique.  Neurosurgery. 1998;  42 219-225
• 19 Jarrahy R, Berci G, Shahinian H K. Assessment of the efficacy of endoscopy in pituitary adenoma resection.  Arch Otolaryngol Head Neck Surg. 2000;  126 1487-1490
• 20 Gumprecht H, Trost H A, Lumenta C B. Neuroendoscopy combined with framless neuronavigation.  Br J Neurosurg. 2000;  14 129-131
• 21 Dulou R, Soultrait F de, Blondet E, Dutertre G, Pernot P, Desgeorges M. Neuronavigation in third ventricle tumors.  Neurochirurgie. 2000;  46 282-285