Suprasellar Meningiomas: Personal Experience in 37 Cases

• Main Author: Sbeih, Ibrahim
• Format: Conference Proceeding
• Language: English
• ISSN: 1531-5010; 1532-0065
• DOI: 10.1055/s-2007-983948

Introduction: Suprasellar meningiomas arising from dura mater around tuberculum sellae or diaphragma sellae are rare tumors constituting 2 to 6% of all intracranial meningiomas. Tumors of these regions can cause insidious visual loss unilaterally or bilaterally. They are challenging lesions because of their close proximity to major neurovascular structures. Methods: We present our experience with 37 suprasellar meningiomas (30 tuberculum sellae and 7 diaphragma sellae) in the period between 1990 and 2005. There were 27 females ages 35 to 70 years (mean age, 51 yrs) and 10 males ages 29 to 51 years (mean age, 43 yrs). Thirty-four patients were operated upon for the first time while 3 patients had previous surgery at other institutions. Results: The presenting symptoms were mostly visual deterioration (100%). The most common visual fields encountered were unilateral temporal hemianopia in 14/37 patients and bitemporal hemianopia in 9/37 patients. Other presenting symptoms include bitemporal headache, memory changes, epilepsy, and endocrine dysfunction. Surgical approaches utilized were interhemispheric transbasal in 32 patients, unilateral subfrontal in 3 patients, and unilateral pterional in 2 patients. We achieved gross total resection in 35 patients. Subtotal excision was achieved in 2 patients. Histopathological studies showed transitional and meningothelial types in most cases. Optic canal was involved in 6 patients where deroofing of optic canal was needed. Anterior clinoidectomy was needed in 2 patients only. Follow-up in our patients ranged from 24 to 149 months (mean follow-up, 78 mos). Three patients only were lost for follow-up. Results showed improved visual outcome in 20/34, patients' unchanged vision in 12/34, and worsening of vision in 2/34 patients. Other morbidity included anosmia, CSF leak, and temporary diabetes insipidus. There was no mortality encountered in this series. Recurrence occurred in one patient 4 years after his initial surgery. Conclusion: Tuberculum sellae and diaphragma sellae meningiomas are rare and challenging lesions. These tumors could and should be totally resected. Results of surgical excision depend on microsurgical techniques to preserve blood supply to visual apparatus and minimize surgical insult by delicate handling. This advantage is offered by the interhemispheric transbasal approach which puts the surgeon in total control of neurovascular structures and gives him/her the chance of achieving gross total resect