Suprasellar Meningioma Classification: Endoscopic Transnasal Perspective

Abdulrazag Ajlan; Basim Noor Elahi; Saif Almeshari; Sarah Basindwah; Fatimah Abdulrahim Alghabban; Saud Alromaih; Ahmad Alroqi; Abdulaziz S. Alrasheed; Ashwag Alqurashi; Saad Alsaleh

doi:10.1055/a-2070-8496

Journal of Neurological Surgery Part B: Skull Base, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2024; 85(04): 397-405
DOI: 10.1055/a-2070-8496

Original Article

Suprasellar Meningioma Classification: Endoscopic Transnasal Perspective

Abdulrazag Ajlan

¹Division of Neurosurgery, Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia

,

Basim Noor Elahi

¹Division of Neurosurgery, Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia

²Division of Neurosurgery, Surgery Department, Security Forces Hospital, Riyadh, Saudi Arabia

,

Saif Almeshari

¹Division of Neurosurgery, Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia

,

Sarah Basindwah

¹Division of Neurosurgery, Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia

,

Fatimah Abdulrahim Alghabban

³Department of Neurosurgery, King Abdulaziz Specialist Hospital, Taif, Saudi Arabia

,

Saud Alromaih

⁴Department of Otorhinolaryngology – Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia

,

Ahmad Alroqi

⁴Department of Otorhinolaryngology – Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia

,

Abdulaziz S. Alrasheed

⁴Department of Otorhinolaryngology – Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia

⁵Department of Otorhinolaryngology – Head & Neck Surgery, The James Cancer Hospital, Wexner Medical Center, The Ohio State University, Columbus, Ohio, United States

,

Ashwag Alqurashi

¹Division of Neurosurgery, Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia

,

Saad Alsaleh

⁴Department of Otorhinolaryngology – Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia

› Institutsangaben

Abstract

Objectives Midline suprasellar meningiomas include planum sphenoidale, tuberculum sellae, and diaphragma sellae meningiomas. Multiple classifications have been previously documented; however, they come with controversies and limitations, including those with surgical implications. The aim of this study was to classify suprasellar meningiomas based on their behavior toward the underlying bone and neurovascular structures.

Methods Patients with newly diagnosed suprasellar meningiomas that underwent extended endoscopic transnasal approach between 2015 and 2021 were included in this study. The following parameters were evaluated: chiasmatic sulcus length, location of the optic chiasm and nerves, optic canal involvement, and vascular displacement.

Results We identified 40 cases of midline suprasellar meningiomas, 1 diaphragma sellae meningioma (type A), 10 tuberculum sellae meningiomas (type B), 9 chiasmatic sulcus meningiomas (type C), and 10 planum sphenoidale meningiomas (type D). Asymmetrical visual complaints were most common in chiasmatic sulcus meningiomas, followed by tuberculum sellae meningiomas (66 and 50%, respectively). Chiasmatic sulcus meningiomas showed increased separation between the optic chiasm and the A1/A2 complex (8.9 mm) compared with tuberculum sellae (2.7 mm) and planum sphenoidale (1.9 mm) meningiomas. Compared with other types, increased chiasmatic sulcus length was observed in chiasmatic sulcus meningiomas.

Conclusion Preoperative evaluation of bone involvement and tumor relation to neurovascular structures can be used to classify suprasellar meningiomas. Chiasmatic sulcus meningioma is a distinct subtype of suprasellar meningiomas. Its unique behavior toward nearby neurovascular structures could be of surgical value during tumor resection.

Keywords

meningioma - suprasellar - chiasmatic sulcus

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Referenzen

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