Surgery for diaphragma sellae meningioma: how I do it
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HOW I DO IT - TUMOR - MENINGIOMA
Surgery for diaphragma sellae meningioma: how I do it Amani Belouaer 1 & Daniele Starnoni 1 & Roy Thomas Daniel 1,2 Received: 5 June 2020 / Accepted: 8 September 2020 # The Author(s) 2020
Abstract Background Surgery for diaphragma sellae meningiomas (DSM) remains challenging due to the intimate neurovascular relationships of the tumor. Excision of DSM along with a decompression of the optic apparatus requires a good knowledge of the skull base anatomy and a precise preoperative evaluation of the tumor extensions. Method We describe the key steps of transcranial approach for DSM with a video illustration. The surgical anatomy is described along with the advantages and limitations of this approach. Conclusions The transcranial approach allows a safe tumor excision with an early and adequate control of the neurovascular structures, while minimizing postoperative CSF rhinorrhea. Keywords Diaphragma sellae meningioma . Transcranial approach
Relevant surgical anatomy The diaphragma sellae (DS) forms the roof of the sella turcica and is continuous with the dura mater covering the tuberculum sellae, the dorsum sellae, and laterally the roof of the cavernous sinus (Figs. 1b and 2) [1]. The pituitary stalk (PS) passes through a defect within the DS (Fig. 1b) [1]. The two optic nerves (ON) converge onto the optic chiasm, overlying the DS. At the level of the optic canal (OC), the ON is covered by the falciform ligament, which extends from the anterior clinoid process (ACP) to the planum sphenoidale (Fig. 1). The roof of the OC is formed by the medial root of the ACP, and the inferolateral wall is formed by the optic strut, which separates the OC from the superior orbital fissure (SOF). The internal carotid artery (ICA) pierces the dura at the distal dural ring inferomedial to the ACP and Submission statement: All the authors confirm that the abstract and video are original and have not been submitted elsewhere in part or whole. This article is part of the Topical Collection on Tumor - Meningioma Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00701-020-04581-6) contains supplementary material, which is available to authorized users. * Roy Thomas Daniel [email protected] 1
Department of Neurosurgery, University Hospital of Lausanne (CHUV), rue du Bugnon 46, 1011 Lausanne, Switzerland
2
University of Lausanne, Lausanne, Switzerland
courses in a posterolateral direction. There are often (70%) two groups of superior hypophyseal arteries (SHAs), arising from ICA, which run in the preinfundibular and retroinfundibular spaces [10].
Description of the surgical technique (video) The patient is placed in the supine position, and the head turned 20°–30° to the opposite side, extended to allow easier frontal lobe retraction. A frontotemporal skin incision is carried down sharply to the pericranium. A subfascial dissection is performed, and the temporalis muscle is retracted inferolaterally. Fat is harvested from the infratemporal fossa for skull base
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