Meningiomas of the Tuberculum and Diaphragma Sellae

Abstract

Introduction Although tuberculum sellae (TS) and diaphragma sellae (DS) meningiomas have different anatomical origins, they are frequently discussed as a single entity. Here we review the radiologic and intraoperative findings of TS and DS meningiomas and propose a radiologic classification.

Methods We retrospectively reviewed 10 consecutive TS and DS meningiomas. Data regarding clinical presentation, preoperative imaging, and intraoperative findings were analyzed. Three sellar dimensions were measured on magnetic resonance imaging (MRI): the tuberculum-sellar floor interval (TSFI), the planum-tuberculum interval (PTI), and the total height.

Results Three distinct anatomical patterns were recognized: exclusively tubercular meningiomas (type A) were accompanied by elongation of the TSFI and, more significantly, of the PTI; combined TS and DS meningiomas (type B) were associated with relative elongation of both the PTI and TSFI; and the sole exclusively DS meningioma (type C) was associated with elongation of neither PTI nor TSFI.

Conclusion Suprasellar meningiomas can be classified as tubercular, combined, or diaphragmatic based on preoperative MRI. Exclusively tubercular meningiomas (type A) require only a supradiaphragmatic approach. Tumor involvement of the sellar diaphragm (type B or C) requires resection of the diaphragm and thus a combined infra- and supradiaphragmatic approach.

Keywords

tuberculum sellae - diaphragma sellae - planum sphenoidale - meningioma - classification - endoscopic - endonasal

• References

• 1 Soni RS, Patel SK, Husain Q, Dahodwala MQ, Eloy JA, Liu JK. From above or below: the controversy and historical evolution of tuberculum sellae meningioma resection from open to endoscopic skull base approaches. J Clin Neurosci 2014; 21 (4) 559-568
• 2 Jallo GI, Benjamin V. Tuberculum sellae meningiomas: microsurgical anatomy and surgical technique. Neurosurgery 2002; 51 (6) 1432-1439 ; discussion 1439–1440
• 3 Al-Mefty O, Holoubi A, Rifai A, Fox JL. Microsurgical removal of suprasellar meningiomas. Neurosurgery 1985; 16 (3) 364-372
• 4 Chan RC, Thompson GB. Morbidity, mortality, and quality of life following surgery for intracranial meningiomas. A retrospective study in 257 cases. J Neurosurg 1984; 60 (1) 52-60
• 5 Rubin G, Ben David U, Gornish M, Rappaport ZH. Meningiomas of the anterior cranial fossa floor. Review of 67 cases. Acta Neurochir (Wien) 1994; 129 (1–2) 26-30
• 6 Nanda A, Ambekar S, Javalkar V, Sharma M. Technical nuances in the management of tuberculum sellae and diaphragma sellae meningiomas. Neurosurg Focus 2013; 35 (6) E7
• 7 de Divitiis E, Esposito F, Cappabianca P, Cavallo LM, de Divitiis O, Esposito I. Endoscopic transnasal resection of anterior cranial fossa meningiomas. Neurosurg Focus 2008; 25 (6) E8
• 8 Kwancharoen R, Blitz AM, Tavares F, Caturegli P, Gallia GL, Salvatori R. Clinical features of sellar and suprasellar meningiomas. Pituitary 2014; 17 (4) 342-348
• 9 Leu CH, Hu TL, Shen CC, Wang YC. Tuberculum sellae meningiomas: clinical manifestation, radiologic diagnosis, surgery and visual outcome. Zhonghua Yi Xue Za Zhi (Taipei) 1998; 61 (1) 1-7
• 10 Kinjo T, al-Mefty O, Ciric I. Diaphragma sellae meningiomas. Neurosurgery 1995; 36 (6) 1082-1092
• 11 Nakamura M, Roser F, Struck M, Vorkapic P, Samii M. Tuberculum sellae meningiomas: clinical outcome considering different surgical approaches. Neurosurgery 2006; 59 (5) 1019-1028 ; discussion 1028–1029
• 12 Fernandez-Miranda JC, Pinheiro-Nieto C, Gardner PA, Snyderman CH. Endoscopic endonasal approach for a tuberculum sellae meningioma. J Neurosurg 2012; 32 (Suppl): E8
• 13 Prosser JD, Vender JR, Alleyne CH, Solares CA. Expanded endoscopic endonasal approaches to skull base meningiomas. J Neurol Surg B Skull Base 2012; 73 (3) 147-156
• 14 Chowdhury FH, Haque MR, Goel AH, Kawsar KA. Endoscopic endonasal extended transsphenoidal removal of tuberculum sellae meningioma (TSM): an experience of six cases. Br J Neurosurg 2012; 26 (5) 692-699
• 15 Patterson Jr RH, Danylevich A. Surgical removal of craniopharyngiomas by the transcranial approach through the lamina terminalis and sphenoid sinus. Neurosurgery 1980; 7 (2) 111-117
• 16 Clark AJ, Jahangiri A, Garcia RM , et al. Endoscopic surgery for tuberculum sellae meningiomas: a systematic review and meta-analysis. Neurosurg Rev 2013; 36 (3) 349-359
• 17 Komotar RJ, Starke RM, Raper DM, Anand VK, Schwartz TH. Endoscopic endonasal versus open transcranial resection of anterior midline skull base meningiomas. World Neurosurg 2012; 77 (5–6) 713-724
• 18 Hayhurst C, Teo C. Tuberculum sella meningioma. Otolaryngol Clin North Am 2011; 44 (4) 953-963 , viii–ix
• 19 Chokyu I, Goto T, Ishibashi K, Nagata T, Ohata K. Bilateral subfrontal approach for tuberculum sellae meningiomas in long-term postoperative visual outcome. J Neurosurg 2011; 115 (4) 802-810
• 20 Zada G, Agarwalla PK, Mukundan Jr S, Dunn I, Golby AJ, Laws Jr ER. The neurosurgical anatomy of the sphenoid sinus and sellar floor in endoscopic transsphenoidal surgery. J Neurosurg 2011; 114 (5) 1319-1330
• 21 Renn WH, Rhoton Jr AL. Microsurgical anatomy of the sellar region. J Neurosurg 1975; 43 (3) 288-298
• 22 Peris-Celda M, Kucukyuruk B, Monroy-Sosa A, Funaki T, Valentine R, Rhoton Jr AL. The recesses of the sellar wall of the sphenoid sinus and their intracranial relationships. Neurosurgery 2013; 73 (2, Suppl Operative): 117-131 ; discussion 131