{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T13:34:28Z","timestamp":1788356068623,"version":"build-2803163510"},"reference-count":92,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2013,12]]},"abstract":"<jats:sec>\n                    <jats:title>Object<\/jats:title>\n                    <jats:p>Tuberculum sellae meningiomas (TSMs) and diaphragma sellae meningiomas (DSMs) are challenging lesions to treat due to their proximity to neurovascular structures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The authors reviewed the medical records of patients who underwent surgical excision of TSMs and DSMs from 1990 to 2013. They also describe the technical strategies used to minimize injury to the optic apparatus, vascular structures, and pituitary stalk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-four patients with TSM and 6 patients with DSM were included in the study. Seventy percent of the tumors were large (\u2265 5 cm). The pterional approach was employed in most cases. Optic canal involvement was observed in 4 patients. Twenty-one patients (70%) had visual dysfunction before surgery. At follow-up (median 18 months), visual improvement was noted in 10 (47.6%) of 21 patients. Gross-total excision was achieved in 22 patients (91.6%) with TSM and 5 (83.3%) with DSM. At last follow-up, 28 patients (93.3%) had a Glasgow Outcome Scale score of 5. There were no deaths in this series.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Tuberculum and diaphragma sellae meningiomas present a unique subset of tumors due to their location. They can be safely excised with minimal morbidity and mortality using microsurgical techniques. Attention to technical details during surgery leads to greater respectability and superior visual outcome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2013.10.focus13350","type":"journal-article","created":{"date-parts":[[2013,12,1]],"date-time":"2013-12-01T03:33:23Z","timestamp":1385868803000},"page":"E7","source":"Crossref","is-referenced-by-count":33,"title":["Technical nuances in the management of tuberculum sellae and diaphragma sellae meningiomas"],"prefix":"10.3171","volume":"35","author":[{"given":"Anil","family":"Nanda","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudheer","family":"Ambekar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijayakumar","family":"Javalkar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayur","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0350007","series-title":"Acta Neurochir (Wien)","first-page":"751","article-title":"Transcranial transsphenoidal approach for tuberculum sellae meningiomas","volume":"142","author":"Arai","year":"2000"},{"key":"b2-0350007","series-title":"J Anat","first-page":"486","article-title":"The blood supply of the optic nerve and chiasma in man","volume":"90","author":"Blunt","year":"1956"},{"issue":"5","key":"b3-0350007","series-title":"Neurosurg Focus","first-page":"E1","article-title":"Surgical decision-making strategies in tuberculum sellae meningioma resection","volume":"30","author":"Bowers","year":"2011"},{"key":"b4-0350007","series-title":"Surg Neurol","first-page":"28","article-title":"Fractionated stereotactic radiotherapy in the treatment of exclusive cavernous sinus meningioma: functional outcome, local control, and tolerance","volume":"65","author":"Brell","year":"2006"},{"issue":"66 Suppl","key":"b5-0350007","series-title":"Int Radiat Oncol Biol Phys","first-page":"S3","article-title":"Stereotactic fractionated radiotherapy for the treatment of benign meningiomas","author":"Candish","year":"2006"},{"key":"b6-0350007","series-title":"Neurosurgery","first-page":"1372","article-title":"Suprasellar meningiomas","volume":"49","author":"Ciric","year":"2001"},{"key":"b7-0350007","series-title":"Neurosurgery","first-page":"539","article-title":"Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases","volume":"55","author":"Couldwell","year":"2004"},{"key":"b8-0350007","series-title":"Meningiomas: Their Classification, Regional Behaviour, Life History, and Surgical End Results","first-page":"224","article-title":"Suprasellar meningiomas","author":"Cushing","year":"1938"},{"issue":"6","key":"b9-0350007","series-title":"Neurosurg Focus","first-page":"E8","article-title":"Endoscopic transnasal resection of anterior cranial fossa meningiomas","volume":"25","author":"de Divitiis","year":"2008"},{"key":"b10-0350007","series-title":"J Clin Oncol","first-page":"3547","article-title":"High efficacy of fractionated stereotactic radiotherapy of large base-of-skull meningiomas: long-term results","volume":"19","author":"Debus","year":"2001"},{"key":"b11-0350007","series-title":"J Neurooncol","first-page":"239","article-title":"Surgical treatment of anterior basal meningiomas","volume":"29","author":"DeMonte","year":"1996"},{"key":"b12-0350007","series-title":"J Neurosurg","first-page":"832","article-title":"The extended direct endonasal transsphenoidal approach for nonadenomatous suprasellar tumors","volume":"102","author":"Dusick","year":"2005"},{"issue":"4","key":"b13-0350007","series-title":"Neurosurg Focus","first-page":"E5","article-title":"Stereotactic radiation treatment for benign meningiomas","volume":"23","author":"Elia","year":"2007"},{"key":"b14-0350007","series-title":"Laryngoscope","first-page":"1219","article-title":"Nasoseptal flap repair after endoscopic transsellar versus expanded endonasal approaches: is there an increased risk of postoperative cerebrospinal fluid 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Suppl","article-title":"Endoscopic endonasal approach for a tuberculum sellae meningioma","volume":"32","author":"Fernandez-Miranda","year":"2012"},{"key":"b19-0350007","series-title":"Neurosurgery","first-page":"36","article-title":"Endoscopic endonasal resection of anterior cranial base meningiomas","volume":"63","author":"Gardner","year":"2008"},{"key":"b20-0350007","series-title":"Neurochirurgie","first-page":"273","article-title":"[Retrochiasmatic suprasellar meningiomas.]","volume":"16","author":"Guiot","year":"1970"},{"key":"b21-0350007","series-title":"Neurochirurgie","first-page":"329","article-title":"[Frontal sinus approach to olfactory groove meningiomas.]","volume":"45","author":"Hallacq","year":"1999"},{"key":"b22-0350007","series-title":"Neurochirurgie","first-page":"535","article-title":"[A meningioma of the sella turcica, subdiaphragmatic variety. 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surgery","volume":"54","author":"Jho","year":"2001"},{"key":"b28-0350007","series-title":"Minim Invasive Neurosurg","first-page":"91","article-title":"Orbital roof craniotomy via an eyebrow incision: a simplified anterior skull base approach","volume":"40","author":"Jho","year":"1997"},{"key":"b29-0350007","series-title":"J Craniofac Surg","first-page":"1070","article-title":"Application of the supraorbital endoscopic approach to tumors of the anterior cranial base","volume":"16","author":"Kabil","year":"2005"},{"key":"b30-0350007","series-title":"Br J Neurosurg","first-page":"231","article-title":"Prognostic factors of postoperative visual outcomes in tuberculum sellae meningioma","volume":"22","author":"Kim","year":"2008"},{"key":"b31-0350007","series-title":"Neurosurgery","first-page":"1082","article-title":"Diaphragma sellae meningiomas","volume":"36","author":"Kinjo","year":"1995"},{"key":"b32-0350007","series-title":"World Neurosurg","first-page":"713","article-title":"Endoscopic endonasal versus open transcranial resection of anterior midline skull base meningiomas","volume":"77","author":"Komotar","year":"2012"},{"key":"b33-0350007","series-title":"J Neurosurg","first-page":"400","article-title":"Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions","volume":"106","author":"Laufer","year":"2007"},{"key":"b34-0350007","series-title":"Acta Neurochir (Wien)","first-page":"1293","article-title":"Impact of anterior clinoidectomy on visual function after resection of meningiomas in and around the optic canal","volume":"155","author":"Lehmberg","year":"2013"},{"key":"b35-0350007","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1012","article-title":"Fractionated stereotactic radiotherapy treatment of cavernous sinus meningiomas: a study of 100 cases","volume":"74","author":"Litr\u00e9","year":"2009"},{"issue":"5","key":"b36-0350007","series-title":"Neurosurg Focus","first-page":"E2","article-title":"Surgical nuances for removal of tuberculum sellae meningiomas with optic canal involvement using the endoscopic endonasal extended transsphenoidal transplanum transtuberculum approach","volume":"30","author":"Liu","year":"2011"},{"key":"b37-0350007","series-title":"Clin Neurosurg","first-page":"99","article-title":"Stereotactic radiosurgery of anterior skull base tumors","volume":"42","author":"Lunsford","year":"1995"},{"key":"b38-0350007","series-title":"Neurosurgery","first-page":"873","article-title":"Evaluation of fractionated radiotherapy and gamma knife radiosurgery in cavernous sinus meningiomas: treatment strategy","volume":"57","author":"Metellus","year":"2005"},{"key":"b39-0350007","series-title":"J Neurooncol","first-page":"419","article-title":"Fractionated stereotactic radiation therapy in the management of primary optic nerve sheath meningiomas","volume":"94","author":"Milker-Zabel","year":"2009"},{"key":"b40-0350007","series-title":"Int J Radiat Oncol Biol Phys","first-page":"809","article-title":"Fractionated stereotactic radiotherapy in patients with benign or atypical intracranial meningioma: long-term experience and prognostic factors","volume":"61","author":"Milker-Zabel","year":"2005"},{"key":"b41-0350007","series-title":"Br J Neurosurg","first-page":"129","article-title":"Surgical management of tuberculum sellae meningioma: role of selective extradural anterior clinoidectomy","volume":"20","author":"Otani","year":"2006"},{"key":"b42-0350007","series-title":"Neurosurgery","first-page":"219","article-title":"Meningiomas: an update","volume":"3","author":"Quest","year":"1978"},{"key":"b43-0350007","series-title":"J Neurosurg","first-page":"198","article-title":"The extended frontal approach to tumors of the anterior, middle, and posterior skull base","volume":"76","author":"Sekhar","year":"1992"},{"key":"b44-0350007","series-title":"Int J Radiat Oncol Biol Phys","first-page":"101","article-title":"Stereotactic radiotherapy for treatment of cavernous sinus meningiomas","volume":"59","author":"Selch","year":"2004"},{"issue":"5","key":"b45-0350007","series-title":"Neurosurg Focus","first-page":"E5","article-title":"Radiosurgery and stereotactic radiotherapy for intracranial meningiomas","volume":"14","author":"Torres","year":"2003"},{"key":"b46-0350007","series-title":"J Neurosurg Sci","first-page":"7","article-title":"Hypofractionated stereotactic radiotherapy for intracranial meningiomas: preliminary results of a feasible trial","volume":"53","author":"Trippa","year":"2009"},{"key":"b1-0350007","series-title":"Acta Neurochir (Wien)","first-page":"751","article-title":"Transcranial transsphenoidal approach for tuberculum sellae meningiomas","volume":"142","author":"Arai","year":"2000"},{"key":"b2-0350007","series-title":"J Anat","first-page":"486","article-title":"The blood supply of the optic nerve and chiasma in man","volume":"90","author":"Blunt","year":"1956"},{"issue":"5","key":"b3-0350007","series-title":"Neurosurg Focus","first-page":"E1","article-title":"Surgical decision-making strategies in tuberculum sellae meningioma resection","volume":"30","author":"Bowers","year":"2011"},{"key":"b4-0350007","series-title":"Surg Neurol","first-page":"28","article-title":"Fractionated stereotactic radiotherapy in the treatment of exclusive cavernous sinus meningioma: functional outcome, local control, and tolerance","volume":"65","author":"Brell","year":"2006"},{"issue":"66 Suppl","key":"b5-0350007","series-title":"Int Radiat Oncol Biol Phys","first-page":"S3","article-title":"Stereotactic fractionated radiotherapy for the treatment of benign meningiomas","author":"Candish","year":"2006"},{"key":"b6-0350007","series-title":"Neurosurgery","first-page":"1372","article-title":"Suprasellar meningiomas","volume":"49","author":"Ciric","year":"2001"},{"key":"b7-0350007","series-title":"Neurosurgery","first-page":"539","article-title":"Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases","volume":"55","author":"Couldwell","year":"2004"},{"key":"b8-0350007","series-title":"Meningiomas: Their Classification, Regional Behaviour, Life History, and Surgical End Results","first-page":"224","article-title":"Suprasellar meningiomas","author":"Cushing","year":"1938"},{"issue":"6","key":"b9-0350007","series-title":"Neurosurg Focus","first-page":"E8","article-title":"Endoscopic transnasal resection of anterior cranial fossa meningiomas","volume":"25","author":"de Divitiis","year":"2008"},{"key":"b10-0350007","series-title":"J Clin Oncol","first-page":"3547","article-title":"High efficacy of fractionated stereotactic radiotherapy of large base-of-skull meningiomas: long-term results","volume":"19","author":"Debus","year":"2001"},{"key":"b11-0350007","series-title":"J Neurooncol","first-page":"239","article-title":"Surgical treatment of anterior basal meningiomas","volume":"29","author":"DeMonte","year":"1996"},{"key":"b12-0350007","series-title":"J Neurosurg","first-page":"832","article-title":"The extended direct endonasal transsphenoidal approach for nonadenomatous suprasellar tumors","volume":"102","author":"Dusick","year":"2005"},{"issue":"4","key":"b13-0350007","series-title":"Neurosurg Focus","first-page":"E5","article-title":"Stereotactic radiation treatment for benign meningiomas","volume":"23","author":"Elia","year":"2007"},{"key":"b14-0350007","series-title":"Laryngoscope","first-page":"1219","article-title":"Nasoseptal flap repair after endoscopic transsellar versus expanded endonasal approaches: is there an increased risk of postoperative cerebrospinal fluid leak?","volume":"122","author":"Eloy","year":"2012"},{"key":"b15-0350007","series-title":"Int Forum Allergy Rhinol","first-page":"397","article-title":"Efficacy of the pedicled nasoseptal flap without cerebrospinal fluid (CSF) diversion for repair of skull base defects: incidence of postoperative CSF leaks","volume":"2","author":"Eloy","year":"2012"},{"key":"b16-0350007","series-title":"J Neurosurg","first-page":"235","article-title":"Pterional surgery of meningiomas of the tuberculum sellae and planum sphenoidale: surgical results with special consideration of ophthalmological and endocrinological outcomes","volume":"96","author":"Fahlbusch","year":"2002"},{"issue":"5 Suppl 2","key":"b17-0350007","series-title":"Neurosurgery","first-page":"269","article-title":"Endonasal versus supraorbital keyhole removal of craniopharyngiomas and tuberculum sellae meningiomas","volume":"64","author":"Fatemi","year":"2009"},{"issue":"1","key":"b18-0350007","series-title":"Neurosurg Focus Suppl","article-title":"Endoscopic endonasal approach for a tuberculum sellae meningioma","volume":"32","author":"Fernandez-Miranda","year":"2012"},{"key":"b19-0350007","series-title":"Neurosurgery","first-page":"36","article-title":"Endoscopic endonasal resection of anterior cranial base meningiomas","volume":"63","author":"Gardner","year":"2008"},{"key":"b20-0350007","series-title":"Neurochirurgie","first-page":"273","article-title":"[Retrochiasmatic suprasellar meningiomas.]","volume":"16","author":"Guiot","year":"1970"},{"key":"b21-0350007","series-title":"Neurochirurgie","first-page":"329","article-title":"[Frontal sinus approach to olfactory groove meningiomas.]","volume":"45","author":"Hallacq","year":"1999"},{"key":"b22-0350007","series-title":"Neurochirurgie","first-page":"535","article-title":"[A meningioma of the sella turcica, subdiaphragmatic variety. 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surgery","volume":"54","author":"Jho","year":"2001"},{"key":"b28-0350007","series-title":"Minim Invasive Neurosurg","first-page":"91","article-title":"Orbital roof craniotomy via an eyebrow incision: a simplified anterior skull base approach","volume":"40","author":"Jho","year":"1997"},{"key":"b29-0350007","series-title":"J Craniofac Surg","first-page":"1070","article-title":"Application of the supraorbital endoscopic approach to tumors of the anterior cranial base","volume":"16","author":"Kabil","year":"2005"},{"key":"b30-0350007","series-title":"Br J Neurosurg","first-page":"231","article-title":"Prognostic factors of postoperative visual outcomes in tuberculum sellae meningioma","volume":"22","author":"Kim","year":"2008"},{"key":"b31-0350007","series-title":"Neurosurgery","first-page":"1082","article-title":"Diaphragma sellae meningiomas","volume":"36","author":"Kinjo","year":"1995"},{"key":"b32-0350007","series-title":"World Neurosurg","first-page":"713","article-title":"Endoscopic 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