Anatomical origin of tuberculum sellae meningioma: off-midline location and its clinical implications

• Published in: World neurosurgery 2016-05, Vol.89, p.552-561
• Main Authors: Lee, Seungjoo, M.D., Ph.D, Hong, Seok Ho, M.D., Ph.D, Cho, Young Hyun, M.D., Ph.D, Kim, Jeong Hoon, M.D., Ph.D, Kim, Chang Jin, M.D., Ph.D
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anatomical origin; Brain - blood supply; Brain - diagnostic imaging; Cerebral Angiography; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Meningeal Neoplasms - diagnostic imaging; Meningeal Neoplasms - pathology; Meningeal Neoplasms - physiopathology; Meningeal Neoplasms - surgery; Meningioma - diagnostic imaging; Meningioma - pathology; Meningioma - physiopathology; Meningioma - surgery; Microsurgery; Middle Aged; Neurosurgery; Neurosurgical Procedures; Treatment Outcome; Tuberculum sellae meningioma; Visual Field Tests; Visual outcomes
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.02.016

Abstract Objective Tuberculum sellae meningiomas (TSM) arise from the dura mater of tuberculum sellae, limbus sphenoidale, chiasmatic sulcus and cause asymmetric visual disturbances. In this study, we analyzed the laterality of the origin of TSM and discussed its clinical implications on immediate and long term visual outcomes. Methods Between 1994 and 2013, TSM was diagnosed in 100 patients after microsurgical resection. The medical records, radiological features, and operative findings were retrospectively reviewed and analyzed in these patients. Results Visual disturbances were evident in 95 patients (95.0 %) in neuro-ophthalmologic test. Among them, 89 patients (89.0 %) showed marked asymmetric visual field defect, and 6 patients (6.0 %) had relatively symmetric visual field defect. On intraoperative inspection, the origin of TSM was at the one lateral end portion of the tuberculum sellae in 85 patients (85.0 %). In 15 patients (15.0 %), the TSM originated from the midline region, including the central portion of the tuberculum sellae (n=13) and diaphragm sellae (n=2). Optic canal involvement was observed in 73 patients (73.0 %). Preexisted visual field defects were improved in 70 patients (70.0 %) and were stationary in 25 patients (25.0 %) and aggravated in 5 patients (5 %) during postoperative follow-up (mean 58 months, 24∼122 months). The preoperative symptom duration, the laterality of the origin of TSM, and optic disc atrophy were associated with long term poor visual outcomes. Conclusions Majority of the TSM originated from the dura of one lateral end portion of the tuberculum sellae, correlated with asymmetric visual symptoms and poor visual outcomes. This microsurgical features should be considered to plan optimal surgical strategy to achieve favorable outcomes.