High Incidence of Optic Canal Involvement by Tuberculum Sellae Meningiomas: Rationale for Aggressive Skull Base Approach

Purpose: Current literature on tuberculum sellae meningiomas (TSM) underemphasizes the significance of optic canal involvement (OCI) by the tumor. In this study, we aimed to document the incidence of OCI, its management using a skull base technique (SBT), and its significance with relation to the visual outcome.

Methods: Thirty-one patients with TSM were retrospectively analyzed. In 28 patients, SBT consisting of extradural anterior clinoidectomy, with falciform ligament and optic nerve sheath opening, was performed. Preoperative visual status and postoperative outcome were analyzed with respect to OCI.

Results: Overall incidence of OCI was 77.4%. Incidence of preoperative visual deficit (VD) was 83.8%. With regard to preoperative visual status, OCI incidence was 84.6% in 26 patients with VD, and 40% in 5 patients without (p = 0.016). Among the 23 patients with VD and detailed postoperative evaluation, vision improved in 18 patients (78.3%) and remained stable in 5 (21.7%) on the operated side. In 1 patient (3.2%), vision deteriorated on the side contralateral to the side of surgery. In the presence of OCI, vision improved in 17 patients (80%) and remained unchanged in 3 (20%). In the absence of OCI, 1 of the 3 patients improved, and the other 2 remained unchanged. Simpson grade 1 or 2 resection was achieved in 83.8%.

Conclusion: OCI is common in TSM (77.4%), and it correlates well with preoperative visual status. With the use of SBT, without which the tumor in the optic canal could not have been removed completely and safely, an overall visual improvement of 78.3% and stability of 21.7% was achieved on the operated side.