Tuberculum Sellar Meningioma: Is There an Ideal Approach?

Background: Tuberculum sellae meningiomas (TSM) is surely a challenge for neurosurgeons. It accounts for up to 10% of all intracranial meningiomas. The difficulty in surgically excising a TSM stems comes from its relationship to the optic nerves and chiasma and to the anterior cerebral and internal carotid arteries and their perforators. The authors discuss the main approaches and the complications based on literature review and their experience.

Methods: We report our personal case series of 38 patients with TSMs. 36 patients underwent craniotomy for tumor resection (12 bifrontal, 12 pterional, 6 supraciliary, 4 unilateral frontal, and 2 fronto-orbito-zygomatic), and 2 received an endoscopic endonasal approach. Simpson grade as well as morbidity and mortality rates were analyzed by this study accordingly to different approaches.

Results: 31 patients had Simpson grades 1 and 2 excisions, while the rest underwent Simpson grade 4 excisions. The overall rate of nonvisual morbidity was 13.15% (5 of 38 patients) and mortality was 5.2%.

Conclusion: The primary symptom leading to the diagnosis of a TSM was visual compromise and the main goal of surgery is to achieve improvement of vision. Favorable outcomes were achieved with appropriate selection of surgical approach. More studies are necessary to define the prognostic factors for patients with TSM after surgical intervention.