Supraorbital Craniotomy for Sellar Solitary Fibrous Tumor: Operative Technique and Literature Review

World Neurosurg. 2020 Sep:141:395-401. doi: 10.1016/j.wneu.2020.06.108. Epub 2020 Jul 5.

Abstract

Objective: Solitary fibrous tumors (SFT) are rare, locally aggressive, mesenchymal neoplasms that pose both diagnostic and operative challenges. In this review of the literature, data were collected from all previously described sellar and suprasellar SFTs to date, with special attention paid to presenting symptoms, surgical technique performed, recurrence status, and adjuvant radiotherapy or chemotherapy, among others.

Methods: A review of prior sellar and suprasellar SFTs was performed. Eleven cases of SFTs in the sellar and suprasellar regions were identified. We considered age and sex, along with case-specific information, such as presenting symptoms, surgical approach taken, number of resections, recurrence information, and adjuvant therapy.

Results: All cases including ours presented with visual deficits, ranging from blurry vision to complete bilateral visual loss. Endocrine hormonal abnormalities occurred in nearly all patients (90%.) Craniotomy was performed more often than endonasal transsphenoidal resection of tumors, 42% versus 33%, respectively.

Conclusions: SFTs are slow-growing fibroblastic mesenchymal neoplasms that comprise <2% of all intracranial tumors. They are even more infrequently found in the sellar/suprasellar region, with our case being the 12th reported case of such and the first only to use supraorbital craniotomy as a resection strategy. Multimodal therapy consisting of safe gross total resection, radiosurgery, and/or chemotherapy provides the best possible results for these rare and locally aggressive entities.

Keywords: Eyebrow craniotomy; Hemangiopericytoma; Sellar; Solitary fibrous tumor; Suprasellar.

Publication types

  • Review

MeSH terms

  • Brain Neoplasms / surgery*
  • Craniopharyngioma / surgery
  • Craniotomy* / methods
  • Humans
  • Neoplasm Recurrence, Local / surgery*
  • Pituitary Neoplasms / surgery*
  • Solitary Fibrous Tumors / surgery*