Preserving of the sphenoid sinus mucosa at endoscopic supraorbital eyebrow approach for tuberculum sellae meningioma effectively prevents cerebrospinal fluid leakage: a case report

Tuberculum sellae meningiomas (TSMs) have generally been removed by a transcranial microscopic approach or a transsphenoidal endoscopic approach. A small craniotomy endoscopic tumor resection for TSMs has been reported in recent years, but prevention of cerebrospinal fluid leakage is still an issue of controversy in any surgical method. Herein, the authors describe the nuances and efficacy of preservation of the sphenoid sinus mucosa for preventing cerebrospinal fluid leakage after small craniotomy endoscopic tumor removal for tuberculum sellae meningioma.

A 64-year-old female presented with left optic nerve dysfunction. Imaging findings showed a tumor at the tuberculum sellae that extended to the left optic canal. The preoperative diagnosis was TSM. Tumor resection was performed by a small craniotomy endoscopic approach. Tumor was successfully observed and resected. Postoperative imaging findings showed the sphenoid sinus mucosa was fall down. Two weeks after surgery, however, the sphenoid sinus mucosa returned to its original position. Cerebrospinal fluid leakage or infection was not observed. We advocate that preservation of the sphenoid sinus mucosa was quite useful in preventing cerebrospinal fluid leakage during small craniotomy endoscopic tumor removal for TSM.