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Page 4 of 18 Avery et al. Mini-invasive Surg 2021;5:17 https://dx.doi.org/10.20517/2574-1225.2021.05
Figure 1. Algorithm for approaching tuberculum sella meningiomas with 4 possible scenarios. In A the endonasal route is preferred; in B
the supraorbital is favored, and in C either approach may be reasonable based on tumor location, parasellar anatomy and presence or
absence of optic canal invasion. Overall, a slight majority of these tumors are now approached by the endonasal given a high propensity
of tuberculum meningiomas to invade one or both medial optic canals. ICAs: Internal carotid arteries.
Pre-operative management
Patients considered for surgery should undergo a detailed history and neurological exam. This evaluation
should include assessments of mental status, cranial nerve function, visual acuity, visual fields, dilated
fundoscopic evaluation, optical coherence tomography, comprehensive endocrinological evaluation (if the
tumor encroaches on the sella) and endoscopic nasal examination. Thin slice CT is recommended to
