Minipterional and supraorbital approaches in the surgical treatment for tuberculum sella meningiomas: a systematic literature review

INTRODUCTION. Chiasm-sellar meningiomas tend to grow into the optic canal along one or more of its walls, compressing the optic nerve. Therefore, decompression of the optic nerve is one of the main step of surgical treatment of patients with this pathology. In the structure of surgical treatment of patients with chiasm-sellar meningiomas, there are two main minimally invasive surgical approaches (supraorbital, SOA and minipterional, MPA), which have limitations in decompression of the optic nerve.
AIM. Comparison of the effectiveness of SOA and MPA in the structure of surgical treatment for patients with chiasm-sellar meningiomas spreading into the optic canal.
MATERIALS AND METHODS. The study carried out a systematic literature review of publications investigating surgical limitations of the SOA and MPA to the walls of the optic canal. The work was carried out in accordance with the recommendations of PRISMA 2020. Online databases such as Pubmed, Google Scholar and elibrary.ru were used to search for published works. For each publication evaluated the type of study and its result: limitations of surgical approaches for visualization of the optic canal. A total of 8 publications were analyzed.
RESULTS. In the analysis of publications, the “blind” zones of the optic canal were identified when performing each of the considered approaches. When performing MPA, direct visualization was mainly inaccessible to the medial wall of the ipsilateral optic canal. When performing SOA, the tangential viewing angle relative to the anterior cranial fossa limited the visualization of the lower wall and the lower region of the medial and lateral walls of the ipsilateral optic canal.
CONCLUSION. MPA provides a preferential access to chiasm-sellar region and is the method of choice for surgical treatment of the chasm-sellar meningiomas spreading into the optic canal. SOA provides a preferential access to anterior cranial fossa and is the method of choice for medially located chiasm-sellar meningiomas. Direct visualization of the largest number of walls of the optic canal, along which the meningioma spreads, makes it possible to remove the tumor with a lower risk of deterioration of visual functions in the postoperative period.

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