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The first 25 slides, exactly as they appear. The full deck has 57 content slides.
Neurosurgery
Surgical Management of Tuberculum Sellae Meningiomas
Built from Feldman — Neurosurgical Operative Atlas: Neuro-Oncology
What’s inside
8 sections · 57 slides
Overview
- What this deck teaches you
The tumor and why it is special
Meningiomas, the tuberculum sellae, and the optic apparatus
- What is a meningioma?
- Where tuberculum sellae meningiomas arise
- Why TSMs behave differently from other meningiomas
- TSMs by the numbers (from the chapter)
Presentation and patient selection
Symptoms, differential diagnosis, and the decision to operate
- How TSMs usually announce themselves
- What else the tumor can press on
- Not everything here is a meningioma
- The problem of the incidental meningioma
- Operate or watch? An individualized decision
Getting ready for surgery
The team and the pre-operative workup
- A tumor best treated by a whole team
- Mapping the vision before you touch the tumor
- Checking the hormones
- Imaging and navigation
Choosing the route
Two keyhole options, and how to pick between them
- From big craniotomies to two keyhole options
- Which route for which tumor?
- MRI of tuberculum sellae meningiomas by chosen approach
- Microscope versus endoscope: complementary tools
- Endoscopic blind spots the microscope cannot reach
The supraorbital eyebrow craniotomy
A small window hidden in the eyebrow, above the orbit
- Positioning the patient
- Steps of the supraorbital eyebrow craniotomy
- Skin incision and pericranial flap
- Making the bone window
- Reaching the tumor: releasing brain-cushioning fluid
- Microsurgical removal of the tumor
- The final view and the endoscope
- A hidden recurrence under the optic nerve
- Closing the eyebrow craniotomy
The endonasal endoscopic approach
Reaching the tumor from below, straight up through the nose
- The endonasal route in overview
- Operating room setup for endonasal endoscopic surgery
- Building the nasoseptal flap
- Nasal septal anatomy and flap
- Opening the sphenoid sinus safely
- Exposing the sella, tuberculum, and planum
- Opening the dura
- Dissecting the arteries and removing the tumor
- Rebuilding the skull base to keep fluid in
- Before and after endonasal endoscopic resection
- Finishing the nasal case
After surgery, and the bottom line
Postoperative care, recovery, and take-home messages
- The first hours and days after surgery
- Recovery and follow-up timeline
- Protecting the nasal repair during recovery
- Three things to remember
- Key takeaways
- Why does the surgeon expose the medial opticocarotid recess during the endonasal approach, and what does it mark?
- References (1/3)
- References (2/3)
- References (3/3)
- Neurosurgical Operative Atlas: Neuro-Oncology