Download PDF
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
1   Division of Neurosurgery, Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Basim Noor Elahi
1   Division of Neurosurgery, Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
2   Division of Neurosurgery, Surgery Department, Security Forces Hospital, Riyadh, Saudi Arabia
,
Saif Almeshari
1   Division of Neurosurgery, Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Sarah Basindwah
1   Division of Neurosurgery, Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Fatimah Abdulrahim Alghabban
3   Department of Neurosurgery, King Abdulaziz Specialist Hospital, Taif, Saudi Arabia
,
Saud Alromaih
4   Department of Otorhinolaryngology – Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Ahmad Alroqi
4   Department of Otorhinolaryngology – Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Abdulaziz S. Alrasheed
4   Department of Otorhinolaryngology – Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
5   Department of Otorhinolaryngology – Head & Neck Surgery, The James Cancer Hospital, Wexner Medical Center, The Ohio State University, Columbus, Ohio, United States
,
Ashwag Alqurashi
1   Division of Neurosurgery, Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
,
Saad Alsaleh
4   Department of Otorhinolaryngology – Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

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


Publication History

Received: 11 November 2022

Accepted: 27 March 2023

Accepted Manuscript online:
11 April 2023

Article published online:
24 May 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 DeMonte F. Surgical treatment of anterior basal meningiomas. J Neurooncol 1996; 29 (03) 239-248
    CrossrefPubMedSearch in Google Scholar
  • 2 Al-Mefty O, Holoubi A, Rifai A, Fox JL. Microsurgical removal of suprasellar meningiomas. Neurosurgery 1985; 16 (03) 364-372
    CrossrefPubMedSearch in Google Scholar
  • 3 Kwancharoen R, Blitz AM, Tavares F, Caturegli P, Gallia GL, Salvatori R. Clinical features of sellar and suprasellar meningiomas. Pituitary 2014; 17 (04) 342-348
    CrossrefPubMedSearch in Google Scholar
  • 4 Ajlan AM, Choudhri O, Hwang P, Harsh G. Meningiomas of the tuberculum and diaphragma sellae. J Neurol Surg B Skull Base 2015; 76 (01) 74-79
    PubMedSearch in Google Scholar
  • 5 Henderson F, Youngerman BE, Niogi SN. et al. Endonasal transsphenoidal surgery for planum sphenoidale versus tuberculum sellae meningiomas. J Neurosurg 2022; 138 (05) 1338-1346
    PubMedSearch in Google Scholar
  • 6 Guthikonda B, Tobler Jr WD, Froelich SC. et al. Anatomic study of the prechiasmatic sulcus and its surgical implications. Clin Anat 2010; 23 (06) 622-628
    CrossrefPubMedSearch in Google Scholar
  • 7 Kurucz P, Baksa G, Patonay L, Hopf NJ. Endoscopic anatomical study of the arachnoid architecture on the base of the skull. Part I: The anterior and middle cranial fossa. Innov Neurosurg 2013; 1: 55-66
    CrossrefPubMedSearch in Google Scholar
  • 8 Yasargil MG. Microneurosurgery. Vol. 1. Stuttgart: George Thieme Verlag; 1996
    Search in Google Scholar
  • 9 Mahmoud M, Nader R, Al-Mefty O. Optic canal involvement in tuberculum sellae meningiomas: influence on approach, recurrence, and visual recovery. Neurosurgery 2010; 67 (3, Suppl Operative): discussion ons118–ons119 ons108-ons118
    PubMedSearch in Google Scholar
  • 10 Fernandez-Miranda JC, Gardner PA, Snyderman CH. Endoscopic endonasal approach for tuberculum sellae meningiomas. Neurosurgery 2011; 69 (01) E260-E261
    CrossrefPubMedSearch in Google Scholar
  • 11 Fernandez-Miranda JC, Pinheiro-Nieto C, Gardner PA, Snyderman CH. Endoscopic endonasal approach for a tuberculum sellae meningioma. J Neurosurg 2012; 32 (Suppl): E8
    PubMedSearch in Google Scholar
  • 12 Ditzel Filho LFS, Prevedello DM, Jamshidi AO. et al. Endoscopic endonasal approach for removal of tuberculum sellae meningiomas. Neurosurg Clin N Am 2015; 26 (03) 349-361
    CrossrefPubMedSearch in Google Scholar
  • 13 Chowdhury FH, Haque MR, Goel AH, Kawsar KA. Endoscopic endonasal extended transsphenoidal removal of tuberculum sellae meningioma (TSM): an experience of six cases. Br J Neurosurg 2012; 26 (05) 692-699
    CrossrefPubMedSearch in Google Scholar
  • 14 Khan OH, Anand VK, Schwartz TH. Endoscopic endonasal resection of skull base meningiomas: the significance of a “cortical cuff” and brain edema compared with careful case selection and surgical experience in predicting morbidity and extent of resection. Neurosurg Focus 2014; 37 (04) E7
    CrossrefPubMedSearch in Google Scholar