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The expanded endoscopic endonasal approach for suprasellar meningiomas: long-term outcomes in a single-center series of 27 patients

  • Original Article - Brain Tumors
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

The endoscopic endonasal approach (EEA) has become increasingly employed in the treatment of suprasellar meningiomas. These tumors often cause visual symptoms due to compression of the anterior visual pathway. We aimed to examine long-term visual outcomes after EEA for optic nerve decompression and resection of suprasellar meningioma at our center, and to identify preoperative factors predictive of postoperative visual improvement.

Methods

We performed a retrospective cohort study on 27 patients who underwent the EEA for resection of meningiomas extending into the suprasellar cistern and decompression of anterior visual pathway between January 1, 2005, and March 1, 2019.

Results

We treated 8 male and 19 female patients, with a mean follow-up of 7.6 years. The mean age of our patients at initial presentation was 60.1 years. Eighteen patients (66.7%) presented with visual acuity deficits, and 12 (44.4%) patients presented with visual field deficits. Postoperatively, 11 patients had improved visual acuity, 6 had stable visual acuity, and 1 patient had slow and progressive decline of visual acuity; 5 patients had improved visual field, 6 had stable visual field, and 1 patient had slow and progressive decline in visual field. Patients less likely to have postoperative improvement of visual acuity were those with longer than 6-month duration of visual symptoms (P = 0.024*) as well as patients with the presence of a relative afferent pupillary defect (RAPD) (P = 0.023*).

Conclusion

The EEA can achieve good visual outcomes in patients harboring suprasellar meningiomas. Symptom duration of less than 6 months and lack of a RAPD were positive predictors of postoperative visual acuity.

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Abbreviations

ACA:

Anterior cerebral artery

CHI:

Optic chiasm

CI:

Confidence interval

CSF:

Cerebrospinal fluid

DVT:

Deep vein thrombosis

EEA:

Endoscopic endonasal approach

GTR:

Gross total resection

ICA:

nternal carotid artery

INF:

Infundibulum

LP:

Light perception

MRI:

Magnetic resonance imaging

NLP:

No light perception

NTR:

Near total resection

OCT:

Ocular coherence test

ON:

Optic nerve

OR:

Odds ratio

PE:

Pulmonary embolism

RAPD:

Relative afferent pupillary defect

SHA:

Superior hypophyseal artery

STR:

Subtotal resection

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Acknowledgments

We acknowledge Glen Oomen for his help with our illustration and Sang Woo Park for his assistance with the statistical analysis.

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Authors and Affiliations

  1. Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada

    Kaiyun Yang, Almunder R Algird & Kesava Reddy

  2. Michael DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada

    Yosef Ellenbogen

  3. Department of Cell and System Biology, University of Toronto, Toronto, Ontario, Canada

    Shaowei Dong

  4. Division of Otolaryngology and Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada

    Jeehyun Kim & Doron D Sommer

  5. Division of Neuroradiology, McMaster University, Hamilton, Ontario, Canada

    Ramiro Larrazabal

  6. Division of Ophthalmology, McMaster University, Hamilton, Ontario, Canada

    Amadeo R Rodriguez

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  1. Kaiyun Yang
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  2. Yosef Ellenbogen
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  3. Shaowei Dong
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  4. Jeehyun Kim
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  5. Ramiro Larrazabal
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  6. Amadeo R Rodriguez
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  7. Almunder R Algird
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  8. Doron D Sommer
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  9. Kesava Reddy
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Correspondence to Kesava Reddy.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institution (Hamilton Integrated Research Ethics Board; McMaster University) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Presentation: This work was presented as a podium presentation on Feb 15, 2019 at the 29th Annual North American Skull Base Society Meeting in Orlando, USA. This work was also presented as a poster on June 19, 2019 at the 54th Annual Canadian Neurological Sciences Federation in Montreal, Canada.

This article is part of the Topical Collection on Brain Tumors

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Yang, K., Ellenbogen, Y., Dong, S. et al. The expanded endoscopic endonasal approach for suprasellar meningiomas: long-term outcomes in a single-center series of 27 patients. Acta Neurochir 162, 623–629 (2020). https://doi.org/10.1007/s00701-019-04113-x

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  • DOI: https://doi.org/10.1007/s00701-019-04113-x

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