Surgical Management of Tuberculum Sellae Meningioma

Abstract

Background: Tuberculum sellae (TS) meningiomas are benign lesions that produce neurological deficits through a mass effect on vital neurovascular structures. The treatment of choice is surgical removal with the ultimate goal to improve vision and achieve total tumor removal. Objective: We analyzed clinical features, tumor characteristics, and surgical approaches in 62 consecutive patients with TS meningiomas to identify factors influencing the postoperative outcome. Methods: The authors reviewed the medical records of all patients of TS meningiomas who underwent surgery at our institute between 2005 and 2018. Pre- and postoperative clinical data, including the operative findings, of these patients were analyzed. Results: Sixty-two patients who underwent surgery for removal of TSM, transcranial (TCA) in 38, and endoscopic endonasal (EEA) in 24, were identified. Gross total resection was performed in 84% and 87.5% patients in the TCA and EEA groups, respectively. A significantly higher rate of visual improvement was observed in the EEA group as compared to TCA (96% versus 79%). Visual worsening after surgery was greater with TCA than EEA (21% versus 4%). Fourteen (37%) patients in the TCA group experienced different postoperative complications, and CSF leak was the main complication in the EEA group. Conclusions: TCA and EEA are both associated with higher rates of GTR and visual improvement without compromising the safety of the procedure. An optimal outcome, however, depends on the careful selection of cases based on the tumor location and morphology, and the surgeon's familiarity with the surgical approach.

Surgical management of tuberculum sellae meningioma: Transcranial approach or endoscopic endonasal approach?

“…The GTR rate of TSM is about 60%–100% in literatures reviewed ( 5 – 7 , 20 ). However, it is difficult to compare the surgical outcomes between different studies directly, due to the lack of uniform criteria ( 6 ). In the current study, we use standard criteria to evaluate the degree of tumor resection in 112 patients, with a result of GTR rate 85.9% in TCA group and 91.2% in EEA group.…”

“…Vision impairment is the most common clinical manifestation in the patients harboring TSM ( 6 , 7 , 9 ). Generally, surgical management remains to be the most effective treatment for TSM and contributes to restoring the vision ( 6 ). In the current study, there were 92 (82.1%) patients of TSM suffering from vision impairment.…”

“…Moreover, it is necessary to perform continuous lumbar drainage and apply antibiotics, if CSF leakage occurs ( 36 ). Recently, with the surgical technique progressing, the occurrence of CSF leakage keeps decreasing ( 6 ).…”

“…Therefore, the most common clinical manifestation of TSM patients is progressive vision impairment. Other clinical manifestations of TSM patient comprise headache, anosmia, seizures, and pituitary dysfunction ( 6 ).…”

“…Traditional transcranial approaches (TCAs), including pterional, subfrontal, interhemispheric, and supraorbital craniotomy, are familiar to most neurosurgeons. Nevertheless, in the past decade, endoscopic endonasal approach (EEA) emerged as an effective option for neurosurgeons in skull base surgery ( 6 , 8 ). Both TCA and EEA have been described in literatures with successful surgical outcome and minimum complication in TSM surgery ( 9 , 10 ).…”