Tailored Microsurgical Approach to Tuberculum Sella Meningioma

Evolution in skull base surgery has witnessed significant progress in recent years, with a wide range of surgical approaches leading to a vital shift away from gross conventional interventions toward more functional exposure. There has been a recent trend toward reverting to simple tailored approaches for most cases and reserving complex, signature interventions only for a select indications. This trend has been inspired by microsurgical strategies, which have been made possible by the availability of high-definition microscopes, advanced neuronavigation, and the resurgence of endoscopy. When selecting a surgical approach for tuberculum sella meningiomas (TSMs) or other central skull base meningiomas, several factors are taken into account, including tumor size, direction of growth, vascular anatomy and involvement, as well as the surgeon’s experience, and the patient’s age, clinical condition, and reported comorbidities. The tailored pterional approach and modified FOZ approach are both suitable options for optimal approach selection. Recently, the endonasal endoscopic extended transsphenoidal approach (EETSS) has emerged as a promising and innovative treatment option for selected cases of TSMs, with several endoscopic surgeons advocating for its use. However, further scrutiny, validation, and long-term outcome studies are necessary before this approach can be widely accepted in the neurosurgical community.