TITLE:
Tuberculum Sellae Meningiomas: Nuances in Treatment
AUTHORS:
Mohamed Khallaf
KEYWORDS:
Tuberculum Sellae, Meningiomas, Optic Nerve, Visual Outcome, Surgical Approaches
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.9 No.3,
May
20,
2019
ABSTRACT: Tuberculum sellae meningiomas (TSMs) represent special surgical challenge for neurosurgeons. In this review, we summarize the most common clinical manifestations, diagnostic images, surgical approaches and prognostic factors for outcome at single tertiary care teaching hospitals. Material and Methods: Prospective study was done between January 2010 and January 2017 (Minimum 24-month follow-up). Imaging and clinical data of 31 consecutive patients with TSMs were collected and analyzed. There were no exclusion criteria. Result: The majority of patients were >40 years old (22 patients; 71%). There was a female preponderance 74%: 23 cases (M/F ratio was 1:3). The most common clinical presentation was visual impairment (24; 77%). The mean tumor size was 3.3 cm. Thirty-one patients underwent surgical excision by different approaches. The overall visual improvement was 29% (9 of 31 patients) however visual deterioration occurred in 6.4% (2 of 31 patients). Favorable prognosis was found in patients with short preoperative visual affection (less than 6 months). This finding was statistically significant (P ≤ 0.05). Also, visual outcome had significant correlations with edema surrounded tumor: arterial encasement by the tumor and brain-tumor interface. Two patients died 3 weeks postoperatively from brain stem infarction (overall incidence of mortality 6%) while the overall incidence of morbidity was 19% (6 of 31 patients). Conclusion: The most common symptom of Tuberculum sellae meningioma is visual affection. The favorable prognosis was found in patients with short preoperative visual affection (less than 6 months). Also; visual prognosis had significant correlations with peritumoral edema, arterial encasement by the tumor, and brain-tumor interface.