Comparison of supraorbital keyhole approach and extended transsphenoidal approach in endoscopic surgery for tuberculum sellae meningioma: A case series

The endoscope-assisted supraorbital keyhole approach and extended transsphenoidal approach have been widely used in the treatment of tuberculum sellae meningiomas (TSMs). The purpose of the present study was to retrospectively analyze and compare the characteristics and efficacy of the two surgical approaches under the endoscope in the resection of TSMs. In the present study, 36 patients with TSMs who underwent surgical resection are presented, including one group of 17 cases with an endoscopic supraorbital keyhole approach and the other group of 19 cases with an endoscopic extended transsphenoidal approach. The clinical characteristics, diagnosis, treatment process and treatment effect of the two groups were analyzed retrospectively, and the two surgical approaches were also compared. The gross total resection rates of the two groups were similar, reaching 94.5 and 94.7%, respectively. The postoperative visual acuity recovery showed that in the endoscopic supraorbital keyhole approach group, 23 eyes were improved, 8 eyes were maintained and 3 eyes deteriorated, and the visual recovery was 67.6%. In the endoscopic extended transsphenoidal approach group, 32 eyes were improved, 4 eyes were maintained and 2 eyes deteriorated, and the visual recovery was 84.2%. In the supraorbital keyhole approach group, there was no cerebrospinal fluid leakage, while in the extended transsphenoidal approach group, cerebrospinal fluid leakage occurred in 3 cases (15.8%). In these two groups, no tumor recurrence was revealed during the follow-up of ~5 years. Both the endoscope-assisted supraorbital keyhole approach and the extended transsphenoidal approach were effective and safe. The endoscopic supraorbital keyhole approach treated TSMs with lateral extension, but it was not enough to protect the optic nerve. The endoscopic extended transsphenoidal approach protected the optic nerve, but the risk of cerebrospinal fluid leakage was increased. In conclusion, these two surgical methods have their own advantages and limitations.