Surgical Treatment of Tuberculum Sellae Meningiomas

Introduction: Tuberculum sellae meningiomas (TSM) represent 5 to 10% of all intracranial meningiomas. Their main treatment is surgical resection, especially in patients presenting with visual impairment. Different surgical approaches have been described, including the transcranial and the neuroendoscopic endonasal transsphenoidal approaches. The objective of this study is to evaluate ophthalmological results and surgical complications after TSM resection using two different surgical approaches (transcranial and endonasal).

Materials and Methods: A total of 41 patients with TSM were treated at our institution between March 2009 and July 2022. Clinical files were retrospectively analyzed for demographic data, symptoms, neuroradiological findings, surgical approaches and postoperative complications. An ophthalmological evaluation was performed pre and postoperatively. Mean patient follow-up was 42 months.

Results: Out of the 40 patients who underwent surgical resection, the average age was 50 (±11) years. Female preponderance was observed. Loss of vision was the most frequent symptom (80%) followed by headaches (25%). The mean lesion volume was 5.12 cc. A transcranial approach was performed in 27 patients (mostly through a subfrontal approach), and an extended endonasal endoscopic approach in 14 patients. Postoperative magnetic resonance imaging showed Simpson A resection in 42.5% of the cases, Simpson B in 35%, Simpson C in 15%, and Simpson D in 7.5% of the patients. Two patients underwent stereotactic radiosurgery as adjuvant therapy. Ophthalmological results showed visual deficit improvement in 62.5% of the patients, stabilization in 32.5%, and worsening in 5%. Surgical complications included cerebrospinal leak in 3 patients, diabetes insipidus in 2, hyposmia in 1, and one patient died of postoperative meningitis and vasospasm ([Figs. 1] and [2]).

Conclusion: Complete tumor resection with preservation of visual function is the main objective of TSM surgery. These tumors can be safely operated through a lateral subfrontal approach. In addition, the extended endoscopic endonasal approach is an excellent alternative to the classic transcranial procedure in selected patients without anterior cerebral artery encasement or lateral extension over the optic nerves. Satisfactory visual outcomes can be achieved with both techniques.

Fig. 1 Female patient operated on trough endoscopic approach. A: MRI sagittal T1 after contrast sequence showing tuberculum sellae meningioma. B: Intraoperative picture during tumor resection. C: Intraoperative picture after tumor resection of the surgical lodge. D: Postoperative MRI shoving total resection of the lesion.

Fig. 2 Female patient operated through right frontolateral approach. A: Preoperative MRI T1 axial sequence after contrast. B: Intraoperative picture showing tumor resection near right optic nerve. C: Postoperative MRI revealing near-total resection (small remnant near left optic nerve)

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
01 February 2023