Keyhole Superior Interhemispheric Transfalcine Approach for Tuberculum Sellae Meningioma: Technical Nuances and Visual Outcomes

Tuberculum sellae meningiomas are challenging tumors often compressing the optic apparatus and involving the optic canals. Traditional approaches provide wide exposure, but optic canal access can remain difficult. Endonasal approaches offer a less invasive option that allows access to the medial optic canals, but larger tumors can still be challenging along with a higher risk of postoperative spinal fluid leak. We present the use of a keyhole superior interhemispheric approach for tuberculum sellae meningioma resection. Five patients with tuberculum sellae meningioma who underwent a keyhole superior interhemispheric approach were retrospectively reviewed. Preoperative tumor volumes, visual outcomes, extent of resection, pathologic grading, perioperative complications, recurrence rates, operative times, and hospital length of stays were analyzed. The average age of the patients was 68.6 ± 7.7 years old (range 57–78). Average tumor volume was 8 ± 1.8 cm3. All patients had a gross total resection. Three out of 5 patients had World Health Organization grade 1 meningioma, and the other 2 had World Health Organization grade 2 meningioma. There were no recurrences over an average follow-up of 18.6 months (range 1–44). On preoperative visual assessment, 9 out of 10 eyes (90%) had a deficit. Postoperative visual assessment found 9 out of 9 eyes with preoperative deficits had improvement (100%). There were no perioperative or postoperative complications. The keyhole superior interhemispheric approach provides a transcranial alternative that allows excellent exposure of the vasculature and both optic canals, resulting in good extents of resection and recovery of vision.