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 ORIGINAL ARTICLE
Year : 2013  |  Volume : 61  |  Issue : 6  |  Page : 581--586

Bifrontal basal interhemispheric approach for midline suprasellar tumors: Our experience with forty-eight patients


Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Bhawani S Sharma
Department of Neurosurgery, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.125247

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Introduction: Suprasellar lesions present a surgical challenge due to their complex relationship with surrounding neurovascular structures. Of the approaches for these lesions, bifrontal basal interhemispheric approach (BBIA) gives a midline perspective of suprasellar anatomy and has certain advantages over lateral approaches. Materials and Methods: We retrospectively reviewed 48 patients with suprasellar lesions operated over 7 years via BBIA. Patient records, operation notes, radiology, and outpatient files were scrutinized to collect data. Results: During the study period 48 patients (mean age 33 years, M:F 1.5:1) were operated by this approach. The clinical features included: Visual field deficits in 33 (69%) patients, with 6 of them being blind, diabetes insipidus in 7, growth retardation in 5, and subarachnoid hemorrhage in three patients. Cranopharyngiomas (52%) and meningiomas (16.7%) were the most common pathologies. Dyselectrolytemia (18, 40%) and diabetes insipidus (15, 33%) were the most common complications. Postoperative seizures, meningitis, subdural effusion, and retraction site contusion were seen in 12 (27%), 5 (11%), 4 (9%), and 1 (2.2%) patient, respectively. Three patients died postoperatively and 19 (40%) patients required hormone replacement therapy. Amongst the patients with preoperative visual deficits, 23 (70%) had improvement in visual functions, in six (20%), there was no change and four (8.3%) patients had visual deterioration. Conclusion: BBIA provides a true midline perspective and orientation, and permits complete and safe removal of midline suprasellar lesions in majority of cases. This approach is especially useful in retrochiasmatic tumors and in residual/recurrent tumors providing virgin plane of dissection.






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