Comparison of Extended Transsphenoidal Approach and Transcranial Approach for Tuberculum Sellae Meningiomas

Tuberculum sellae meningiomas are usually removed using various transcranial approaches. The extended transsphenoidal approach also indicates for some lesions around the sella turcica. The author primarily approaches supradiaphragmatic tumors through the tuberculum sellae using the extended transsphenoidal approach, termed the “transsphenoidal-transtuberculum sellae approach” even for the tuberculum sellae meningiomas. When a patient complains of visual problems and MRI shows the presence of a tuberculum sellae meningioma, a decision is made as to whether surgical treatment requires using the transcranial or the transsphenoidal-transtuberculum sellae approach. To make the correct choice, 3 radiological factors on MRI are always investigated: (1) degree of sphenoid sinus pneumatization, (2) anterior and/or lateral extension of the tumor, (3) tumor extension into the optic canals. This paper describes personal experience of the transsphenoidal-transtuberculum sellae approach for 3 meningiomas compared to the frontobasal interhemispheric approach for 3 meningiomas.