Endoscopic endonasal removal of Tuberculum Sellae Meningioma

Tuberculum sellae meningiomas are a challenging tumor of the suprasellar area, having dural attachments to the tuberculum sellae, chiasmatic sulcus, limbus sphenoidale, and diaphragma sellae . Often,  visual impairment is  first and the most common symptom of onset. The goals of surgery are vision preservation or improvement with maximal safe resection.  A variety of transcranial approaches (TCAs) have been proposed over the time. However, with the advancement of anatomical knowledge and instrumental innovation, extended endoscopic endonasal approaches (EEEAs) have gained wider acceptance. In contrast to the various transcranial approaches, EEA allows  the devascularization of  the skull base blood supply before tumor resection , avoids brain and optic nerve manipulation, allows the intervening arachnoid plane to protect the vascular supply of the optic apparatus since the tumor is approached from below,  allows early bilateral optic nerve decompression at the level of the optic canal.  Nasoseptal flap, and recent reconstruction techniques, i.e. “3F technique”, made possible to reduce the rate of postoperative CSF leak, the major disadvantage of this route