Tuberculum Sellae Meningiomas: Surgical Technique, Visual Outcome, and Prognostic Factors in 51 Cases

Abstract

Complete tumor resection with preservation or improvement of visual function is the goal of tuberculum sellae meningioma (TSM) treatment. The authors retrospectively reviewed 51 patients treated surgically for TSM between 2003 and 2010, with special attention to surgical technique, visual outcomes, and prognostic factors for treatment outcome.

All patients were operated via the lateral subfrontal approach. The cohort mean age and Karnofsky performance status (KPS) on admission was 57.1 ± 13.6 and 84.3 ± 11.7, respectively. The most common presenting sign was visual impairment. The mean tumor size was 29.4 ± 10.7 mm. In 45 of the patients (88.2%), gross total resection was achieved. Improvement and/or preservation of visual acuity and visual field were achieved in 95.9% and 85.3%, respectively. Visual functions on admission were found to be the strongest predictors for postoperative improvement in visual outcome, followed by better KPS on admission, smaller tumor size, and young age. Postoperative neurological complications included cerebrospinal fluid (CSF) leak, meningitis, and postoperative seizures.

TSM can be safely operated on through the lateral subfrontal approach. A high percentage of complete tumor resection and excellent visual outcomes are achieved using this technique. Surgical treatment in the early stage of the disease may result in a better visual outcome.

Keywords

meningioma - optic nerve - surgical technique - visual outcome

Note

Nevo Margalit and Tal Shahar authors are contributed equally to this work.

• References

• 1 Yaşargil MG. Microsurgery of CNS Tumors. Vol IVB. New York: Thieme; 1996
• 2 Gökalp HZ, Arasil E, Kanpolat Y, Balim T. Meningiomas of the tuberculum sella. Neurosurg Rev 1993; 16 (2) 111-114
• 3 Schulze-Bonsel K, Feltgen N, Burau H, Hansen L, Bach M. Visual acuities “hand motion” and “counting fingers” can be quantified with the freiburg visual acuity test. Invest Ophthalmol Vis. Sci Mar 2006; 47 (3) 1236-1240
• 4 Simpson D. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 1957; 20 (1) 22-39
• 5 Margalit N, Kesler A, Ezer H, Freedman S, Ram Z. Tuberculum and diaphragma sella meningioma—surgical technique and visual outcome in a series of 20 cases operated over a 2.5-year period. Acta Neurochir (Wien) 2007; 149 (12) 1199-1204 , discussion 204
• 6 Margalit NS, Lesser JB, Moche J, Sen C. Meningiomas involving the optic nerve: technical aspects and outcomes for a series of 50 patients. Neurosurgery 2003; 53 (3) 523-532 , discussion 532–533
• 7 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): ons108-118 ; discussion ons118–119
• 8 Sade B, Lee JH. High incidence of optic canal involvement in clinoidal meningiomas: rationale for aggressive skull base approach. Acta Neurochir (Wien) 2008; 150 (11) 1127-1132 , discussion 1132
• 9 Nakamura M, Roser F, Struck M, Vorkapic P, Samii M. Tuberculum sellae meningiomas: clinical outcome considering different surgical approaches. Neurosurgery 2006; 59 (5) 1019-1028 , discussion 1028–1029
• 10 Goel A, Muzumdar D, Desai KI. Tuberculum sellae meningioma: a report on management on the basis of a surgical experience with 70 patients. Neurosurgery 2002; 51 (6) 1358-1363 , discussion 1363–1364
• 11 Schick U, Hassler W. Surgical management of tuberculum sellae meningiomas: involvement of the optic canal and visual outcome. J Neurol Neurosurg Psychiatry 2005; 76 (7) 977-983
• 12 Mathiesen T, Kihlström L. Visual outcome of tuberculum sellae meningiomas after extradural optic nerve decompression. Neurosurgery 2006; 59 (3) 570-576 , discussion 570–576
• 13 Jallo GI, Benjamin V. Tuberculum sellae meningiomas: microsurgical anatomy and surgical technique. Neurosurgery 2002; 51 (6) 1432-1439 , discussion 1439–1440
• 14 Ganna A, Dehdashti AR, Karabatsou K, Gentili F. Fronto-basal interhemispheric approach for tuberculum sellae meningiomas; long-term visual outcome. Br J Neurosurg 2009; 23 (4) 422-430
• 15 Fahlbusch R, Schott W. Pterional surgery of meningiomas of the tuberculum sellae and planum sphenoidale: surgical results with special consideration of ophthalmological and endocrinological outcomes. J Neurosurg 2002; 96 (2) 235-243
• 16 de Divitiis E, Esposito F, Cappabianca P, Cavallo LM, de Divitiis O. Tuberculum sellae meningiomas: high route or low route? A series of 51 consecutive cases. Neurosurgery 2008; 62 (3) 556-563 , discussion 556–563
• 17 Laufer I, Anand VK, Schwartz TH. Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions. J Neurosurg 2007; 106 (3) 400-406
• 18 Gardner PA, Kassam AB, Thomas A , et al. Endoscopic endonasal resection of anterior cranial base meningiomas. Neurosurgery 2008; 63 (1) 36-52 , discussion 52–54