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.

Prognostic factors of microsurgical treatment of intracranial meningiomas – A multivariate analysis

“…Considering the results of similar studies, a change in a patient’s mean age at the time of surgery could be observed over the last decades. While the average age a few decades ago was just over 50 years [ 20 , 22 ], meningioma patients who undergo surgery today are approximately 60 years old, similar to this study [ 9 , 21 , 23 , 24 ]. This is not surprising, since the ongoing advances in medicine mean that people are living longer and, consequently, also in the case of patients undergoing surgery.…”

“…This might seem contradictory at first glance, but those who are in very poor health have a greater potential of getting better compared to those with only slight restrictions on health and everyday life. The considerable influence of K1 for the patient has been verified by different authors [ 20 , 21 ]. Based on a study determining and assessing prognostic indicators among elderly patients, the KPS on hospital admission affected outcome parameters some years after surgery [ 6 ].…”

Quality of life and olfactory function after suprasellar craniopharyngioma surgery—a single-center experience comparing transcranial and endoscopic endonasal approaches

“…The outcome was divided into improved, stable, or deteriorated compared with the preoperative status. Furthermore, a quantitative analysis of visual acuity and visual field was done as previously described [ 19 , 21 ]. To assess the visual acuity, the modified logMAR scale was used.…”

“…To assess the visual acuity, the modified logMAR scale was used. To assess visual field deficits, an ordinal scale was used with the following score: 6 indicates normal visual field; 5, slight constriction; 4, loss of a single quadrant; 3, loss of 2 quadrants; 2, loss of 3 quadrants; 1, severe constriction; and 0, blindness [ 19 , 21 ].…”

Tuberculum sellae meningioma: Is there an ideal approach?

“…Prognosis is also better in younger patients with a short history of symptoms and good preoperative visual function. 3,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Regarding the surgical act, independently of technique, the initial debulking of the tumor should start from its center, where no vital structures are present. The arachnoid plane is then delineated, starting at the contralateral optic nerve and working toward the undersurface of the optic chiasma and then along the ipsilateral nerve.…”