Endoscopic supraorbital eyebrow approach for medium-size tuberculum sellae meningiomas; a cadaveric stepwise dissection, technical nuances and surgical outcomes.

BACKGROUND: Tuberculum sellae meningiomas (TSMs) have traditionally been removed using a transcranial approach. In recent years, endoscopic surgeries for TSMs have been reported with an expansion of indications.

OBJECTIVE: We have performed a fully endoscopic supraorbital keyhole approach for small to medium size TSMs, and performed radical tumor removal similar to conventional transcranial procedure. We report the details of this surgical procedure including cadaveric stepwise dissection and initial surgical results for small to medium size TSMs.

METHODS: We used an endoscopic supraorbital eyebrow approach for 6 patients with TSMs between September 2020 and September 2022. Mean tumor diameter was 16.0 mm (range, 10-20 mm). The surgical approach included an eyebrow skin incision ipsilateral to the lesion, a small frontal craniotomy, subfrontal exposure of the lesion, removal of the tuberculum sellae, unroofing of the optic canal and resection of the tumor. The extent of resection, pre- and postoperative visual function, complications, and operative time were evaluated.

RESULT: Optic canal involvement was observed in all patients. Two patients (33%) showed visual dysfunction before surgery. Simpson grade 1 tumor resection was achieved in all cases. Visual function was improved in 2 cases, and remained unchanged in 4 cases. Postoperative pituitary function was preserved in all cases, with no decreases in olfaction.

CONCLUSION: The endoscopic supraorbital eyebrow approach for TSMs allowed resection of the lesion, including tumor extending to the optic canal, with a good surgical view. This technique is minimally invasive for patients and may represent a good surgical option for medium size TSMs.