Characteristic of Optic Canal Invasion in 31 Consecutive Cases with Tuberculum Sellae Meningioma

Background Optic canal invasion by tuberculum sellae meningiomas (TSMs) has been reported, but the characteristics of invasion remain unclear. This study was performed to clarify the incidence and characteristics of optic canal invasion by TSM and to determine whether optic canal invasion could be predicted preoperatively by magnetic resonance imaging (MRI).

Methods For the past 13 years, 31 patients with TSM underwent tumor resection in our institute. In all cases, the optic canal was explored to identify any tumor invasion. We classified the characteristics of optic canal invasion from intraoperative findings. Invasion was classified into four types: type 1, no invasion; type 2, secondary invasion; type 3, partial wall invasion (two subtypes); and type 4, invasion into the superomedial–inferior walls of the optic canal.

Results Thirty of 31 cases showed optic canal invasion. Of these 30 cases, 9 (30%) showed bilateral optic canal invasion. The most common finding was type 1 (23 sides). Among cases with optic canal invasion (39 sides), type 4 was the most common pattern (17 sides), followed by type 3-inferomedial (13 sides), type 2 (5 sides), and type 3-superomedial (4 sides). Blinded prediction of tumor invasion was accurate in 61% of cases, but characteristics of tumor invasion were undeterminable from preoperative MRI.

Conclusion Optic canal invasion was frequently seen in our consecutive series of TSM, characteristics of which were unpredictable preoperatively. Neurosurgeons should be aware of the high incidence and variety of optic canal invasion in planning strategies for TSM treatment.