Mumliev A. Surgical treatment of patients with tumors of the chiasmatic-sellar region using minimally-invasive technologies

The thesis is dedicated to the combined use of minimally-invasive technologies with the goal to improvement the results of surgical treatment of patients with tumors of the chiasmatic-sellar region (TCSR). The thesis is based on the analysis of the results of treatment provided to 59 patients with TCSR from 2012 to August, 2017. Tuberculum and diaphragma sellae meningiomas were found in 22 (37,3%) cases, craniopharyngiomas - in 15 (25,4%), pituitary adenomas - in 14 (23,7%), epidermoid and dermoid cysts - in 5 (8,5%), optic nerve gliomas - in 3 cases (5,1%). Mean age of patients was 48,2±2,4 years. The main symptoms were visual disturbances of different degree and duration. 56 patients underwent the surgical resection of the TCSR, in 3 cases tumor biopsywas performed. In 25 patients (42,4%) we used supraorbital approach, in 18 (30,5%) - minimized pterional approach and in 16 (27,1%) - modified orbitozygomatic approach. TCSR were totally removed in 42 patients (71,2%), "nearly totally " - in 3 (5,1%), subtotally - in 11 (18,6%) cases. Endoscopic techniques and three-dimensional preoperative modeling were used in all patients. Combined use of the minimized craniotomies, 3D-modeling and endoscopic assistance allowed to achieve the optimal cosmetic result, to decrease the duration of the in-patient treatment and to increase the radicalism of the TCSR removal. We have developed the algorithm of the preoperative planning using the 3D anatomic model highly concordant (89,8%) with the intraoperative findings. Together with intraoperative endoscopic assistance during different surgical steps the algoritm enables to increase the surgical safety operating on TCSR.