• Julien Engelhardt, Houman Namaki, Olivier Mollier, Pascal Monteil, Guillaume Penchet, Emmanuel Cuny, and Hugues Loiseau.
• Department of Neurosurgery, CHU de Bordeaux, Bordeaux Cedex, France. Electronic address: julien.engelhardt@chu-bordeaux.fr.
• World Neurosurg. 2018 Aug 1; 116: e1066-e1074.

BackgroundOne of the most challenging aspects of the surgical treatment of tuberculum sellae meningioma is to control the involvement of the inferomedial side of the optic nerve, which is not directly visualized by an ipsilateral approach and thus requires optic nerve mobilization.MethodsBetween 2003 and 2017, 21 consecutive patients were operated on using this approach. The surgical technique is described and the visual outcomes, resection and recurrence rates, and complications are analyzed.ResultsTwenty patients were included, with a median follow-up of 5.6 years. Regarding visual outcomes, among the 19 patients who had a visual impairment before surgery, 14 (74%) improved, 2 were stabilized (10%), and 2 (10%) showed a worsening of the most-compromised optic nerve and 1 (5%) of the less-compromised optic nerve. Gross total resection was achieved in 18 patients (90%) and 1 patient experienced recurrence 10 years after the initial surgery.ConclusionsThis approach allowed lower mobilization of the compromised optic nerve, better preservation of the vascularization of the visual pathways, and direct access to the inferomedial side of the optic nerve.Copyright © 2018 Elsevier Inc. All rights reserved.

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