Image guided minimally invasive surgical approaches to tumors around sella

Abstract

Background: Previously, conventional craniotomy techniques have been employed to reach lesions that affect the sellar and parasellar regions. In recent times, there has been a growing preference for minimally invasive methods, such as supraorbital and endonasal endoscopic approaches. Objective: This study aimed to assess the efficacy, advantages, and limitation of minimally invasive approaches to tumors around sella with using of image guided system. Methods: 25 patients with tumors around sella who underwent minimally invasive approaches were identified: 7 supraorbital keyhole and 18 endoscopic endonasal. Radiographic images, presenting complaints and outcomes, were analyzed. The safety of each approach was evaluated concerning lesions diameter, extension, encasement of neurovascular structures, and brain invasion especially malignant lesions are considered some contraindications for the transnasal approach and suitable for the supraorbital approach. Results: According to surgical approaches used transnasal (16%), transclival (20%), and transsphenoidal (36%), which was the most common approach in this study. Gross total tumor removal, as assessed by postoperative magnetic resonance imaging, was possible in most patients (72%). Clinical improvement from 13 (52%) of patients post-operative increased up to 80% of patients after 6 months. Complications included cerebrospinal fluid leak in 6 patients (24%), meningitis in 1 patient (4%) and transient diabetes insipidus in (68%). There was one operative mortality, and two patients showed tumor regrowth after 6 months follow up. Conclusion: meticulous planning and coordination with multiple specialists is necessary to provide the patient with optimal therapy while minimizing potential consequences.