A Review Of Anterior Interhemispheric Subfrontal Approach In Management Of Suprasellar Meningiomas With Endoscopic Assistance

Abstract

Objective: The aim of this paper is to review the anterior interhemispheric subfrontal approach for resection of suprasellar meningiomas and to study the use of endoscope in achieving near complete resection. Methods: All cases of suprasellar meningiomas operated trans-cranially during last 13 years were analyzed retrospectively. Majority presented with visual complaints. The outcome was assessed after surgery and at follow up (ranging from 1-12 yrs) in terms of visual outcome, extent of resection and mortality & morbidity of the procedure. There were a total of 36 cases of which 15 were planum sphenoidale, 7 were tuberculum sellae, 4 were anterior clinoidal, 1 was a diaphragma sellae meningioma. In 9 cases there was a wider attachment to more than one place.25 patients underwent anterior interhemispheric subfrontal approach, 9 were operated from pterional approach and 2 were operated from unilateral sub-frontal approach. Endoscopy was used whenever required.Results: The meningiomas were excised completely in 33 cases (Simpson grade I and II) while subtotal excision was done in 3 cases. The visual recovery was observed in 60% of the patients while it was preserved in 40% cases. One patient died after 1 month of an uneventful discharge due to a seizure episode while bilateral anosmia was seen in 2 patients.Conclusions: Anterior interhemispheric subfrontal approach for suprasellar meningiomas is one of the key surgical approaches for management of larger midline lesions. The use of endoscope can further help in achieving near total resection. Although this approach has not been amongst the preferred ones off late, meticulous technique and adequate precautions can help in achieving optimal results with little morbidity.