Abstract Recent publications and studies propose using decision-making algorithms in choosing the optimal approach for each individual case of tuberculum sellae meningioma (TSM). Minimally invasive endoscopic approaches offer the possibility of early devascularization, reduced brain and nerve retraction and speedy patient recovery. We used the decision-making algorithm proposed in the literature to choose between the extended endoscopic endonasal approach (EEA) or the classic transcranial approaches for resection of tuberculum sella/planum sphenoidale meningiomas, based on anatomical landmarks and lateral extension. We describe rates of gross-total resection, visual outcomes, as well as complications in four cases of TSMs, where EEA was used based on the proposed algorithm. Over a period of 15 months, we used the algorithm in nine patients with tuberculum sella/planum sphenoidale meningiomas, in four of whom we used the extended EEA. The mean follow-up duration was 3 months. Gross-total resection was achieved in three out of the four cases, the fourth being a second operation a long period of time after the classical transcranial approach had been used. Visual improvement was achieved in three out of the four cases. One patient had stable vision. There were no cerebrospinal fluid leaks or any kind of neurological postoperative deterioration, although a patient developed pulmonary embolism, but recovered successfully and was discharged. The algorithm proposed in the literature that was explored here is simple, minimally invasive and can produce excellent outcomes in the surgical resection of TSMs in carefully selected cases.

中文翻译：

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基于文献中提出的决策算法的内镜手术切除鞍结节脑膜瘤

摘要 最近的出版物和研究建议使用决策算法为每个鞍结节脑膜瘤 (TSM) 病例选择最佳方法。微创内窥镜方法提供了早期断血管、减少大脑和神经牵拉以及患者快速康复的可能性。我们使用文献中提出的决策算法，根据解剖标志和横向扩展，在扩展的内窥镜鼻内入路 (EEA) 或经典经颅入路之间进行选择，以切除鞍结节/蝶骨平面脑膜瘤。我们描述了四例 TSM 的总切除率、视觉结果以及并发症，其中基于所提出的算法使用 EEA。在 15 个月的时间里，我们在 9 名蝶鞍结节脑膜瘤患者中使用了该算法，其中 4 名我们使用了扩展 EEA。平均随访时间为 3 个月。四个病例中的三个实现了大体切除，第四个是在使用经典经颅手术后很长一段时间内进行的第二次手术。在四个案例中的三个中实现了视觉改善。一名患者视力稳定。术后无脑脊液漏或任何神经功能恶化，患者虽出现肺栓塞，但痊愈出院。此处探讨的文献中提出的算法简单、微创，并且可以在精心挑选的病例中手术切除 TSM 时产生出色的结果。