Tuberculum Sellae Meningiomas: Surgical Outcomes and Technical Considerations

• Main Authors: Minamida, Yoshihiro, Akiyama, Yukinori, Houkin, Kiyohiro
• Format: Conference Proceeding
• Language: English
• ISSN: 1531-5010; 1532-0065
• DOI: 10.1055/s-2007-984268

Objective: Tuberculum sellae meningiomas involving the optic nerve can cause visual impairment by optic nerve compression. Difficulties in surgical management arise due to the delicate nature of the optic nerve and optic chiasma. We reviewed 16 cases of tuberculum sellae meningiomas, with special consideration to surgical techniques and outcomes. Methods: Retrospective analysis was performed on 15 consecutive patients with tuberculum sellae meningiomas, who underwent surgical resection at our institution between January 1994 and December 2006. Fourteen patients had various degrees of visual deficits preoperatively. In most patients, pterional approach with a modification in the cranial base techniques was employed. Meticulous microsurgical techniques, which included keeping the arachnoid membrane, avoiding direct manipulations to the nerve (no-touch technique), and no coagulation around the nerve, were performed in all patients. Preoperative and postoperative ophthalmological evaluations were performed in all patients. The mean follow-up period was 75 months. Results: Total resection was achieved in 15 (94%) of the 16 patients. There were no cases of mortality, and the rate of visual improvement was 88%. Visual deterioration had never occurred in our series. The visual outcome was more favorable in patients in whom the duration of symptoms was less than 6 months and the preoperative visual acuity was greater than 0.1. One of the patients recurred or progressed during the follow-up period (6.7%). There were 2 patients in whom visual symptoms could not be improved. One patient had a recurrent tumor invading the internal carotid artery, and another patient was blind in both eyes for 3 years. One patient (6.7%) suffered the surgical complications of anosmia. Conclusion: In this study, total resection with minimal complications could be achieved in a majority of the patients. Surgical approach with a modification in the cranial base techniques and meticulous microsurgical techniques such as “no-touch technique” enable appropriate access to these cranial base tumors and may lead to an improvement in the visual and overall outcomes.