• Michel Roethlisberger, Ronie Romelean Jayapalan, Isabel Charlotte Hostettler, Bin Abd Kadir Khairul Azmi KA Department of Biomedical Imaging, University Malaya Specialist Centre, University of Malaya, Kuala Lumpur, Malaysia., Kein Seong Mun, Yves Brand, Luigi Mariani, Narayanan Prepageran, and Vicknes Waran.
• Department of Neurosurgery, University Hospital Basel, University of Basel, Basel, Switzerland; Department of Neurosurgery, University Malaya Specialist Centre, University of Malaya, Kuala Lumpur, Malaysia; Department of Otorhinolaryngology, University Malaya Specialist Centre, University of Malaya, Kuala Lumpur, Malaysia. Electronic address: Michel.Roethlisberger@usb.ch.
• World Neurosurg. 2020 Jan 1; 133: 381-391.e2.

BackgroundData on the endonasal endoscopic approach (EEA) to treat sellar/parasellar synchronous tumors remain sparse. This work aims to describe a minimally invasive approach with intraoperative magnetic resonance imaging (MRI) to remove a large sellar/parasellar synchronous tumor, and presents a systematic literature review.MethodsThe preoperative MRI of a 54-year-old woman revealed a sellar lesion (28 × 19 × 16 mm), presumably a pituitary macroadenoma, and a second extra-axial lesion (22 × 36 × 20 mm) expanding from the tuberculum sellae to the planum sphenoidale with encasement of the anterior communicating complex, presumably a meningioma. We used intraoperative MRI to assess the extent of the resection before reconstructing the large skull base defect. Furthermore, we systematically reviewed pertinent articles retrieved by a PubMed/Embase database search between 1961 and December 2018.ResultsOut of 63 patients with synchronous tumors reported in 43 publications, we found 3 patients in which the tumor was removed by EEA. In these 3 patients and the presented case, the resection of both lesions was successful, without major approach-related morbidity or mortality. More extensive removal of endonasal structures to gain an adequate tumor exposure was not necessary. We did not find any previous reports describing the benefits of intraoperative MRI in the presented setting.ConclusionsIn the rare case of a synchronous meningioma and pituitary adenoma of the sellar region, intraoperative MRI might be beneficial in confirming residual disease before skull base reconstruction, and therefore radiologic follow-up.Copyright © 2019 Elsevier Inc. All rights reserved.

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