Endoscopic Extended Transsphenoidal Surgery for Transbasal Tuberculum Sellae Meningioma: 2-Dimensional Operative Video

Transbasal meningiomas1are a rare group of tumors that grow intracranially, invade the skull base, and propagateextracranially; they are usually located at the level of the olfactory cribra and sphenoid wing.1-4Transbasal tuberculumsellae meningiomas are a subset of these tumors, which extend into the suprasellar and sphenoid regions. The traditionaltranscranial approach for some transbasal meningiomas has recently evolved toward the transnasal endoscopic ap-proach, which allows the removal of both the intranasal and intracranial components, reducing the manipulation of theoptic nerves and neurovascular structures. Nevertheless, specific anatomical criteria must be present; the knowledge ofspecific anatomy5,6and the surgeon's experience are fundamental for reaching the most favorable outcome.7-11In thisvideo, we present the case of a 50-year-old woman with a history of progressive visual impairment and scotoma in theleft inferotemporal quadrant. Radiological examinations suggested a transbasal tuberculum meningioma that extendedinto the suprasellar region, sphenoid sinus, and optic canals. An endoscopic transtuberculum approach with intra-operative visual-evoked potentials12was performed, allowing an early devascularization with the preservation of thesuperior hypophyseal arteries and the removal of the component extending in the medial portion of both optic canals.The postoperative MRI documented a gross total resection without complications. The patient reported an immediateimprovement of the visual symptoms. Histopathology documented a meningioma (CNS World Health Organizationgrade 1) with bone invasion. The patient consented to the procedure and to the publication of her image; InstitutionalReview Board approval was not required for this single case report.