Pros And Cons Of Endoscopic Approach

Tuberculum sellae meningioma usually displace the optic nerves superolaterally and optic chiasm posteriorly, resulting in visual impairment, the most common symptom on presentation (11). Preservation of visual function is the most important indication for surgery (12). The pure endoscopic endonasal approach have a number of advantages including: 1- elimination of brain retraction and a lack of optic nerve manipulation with the wide removal of cranial base bone; 2- devascularization by early control of vascular supply by of the tumor ,3- preservation of the supply to the optic nerves and chiasm from the hypophyseal vessels; 4- Early identification and coagulation of the dural attachment of the tumor is also allowed , so debulking and resection can occur in a near-bloodless field ; 5 - No facial/scalp incision for improved cosmesis.( 13)
Reconstruction is a challenging and critical step of the procedure with the optimal solution not yet found (14-16). The use of a vascularized septal flap, however, has been a significant advance in reducing CSF leak rates. Specific nasal morbidity may be a problem, with nasal crusting and discharge being the most commonly reported symptoms. Tumor characteristics less suitable for endoscopic resection: Significant optic canal tumor extension, and extension lateral to a major neurovascular structure. If the surgical goal is complete removal, limitations may include encasement of either internal carotid or anterior communicating arteries. Relative factors such as tumor size over 4 cm and significant peritumoral edema on MRI may make the approach less favourable. (14, 17,