Introduction: Suprasellar meningioma account for 10% of all meningiomas. They usually present with
visual deterioration of one eye more than the other due to extension and compression
of optic nerve within the optic canal. Meningiomas of suprasellar area arise from
different sites including the most anterior planum sphenoidale, followed by limbus
sphenoidal, chiasmatic sulcus, tuberculum sellae and finally diaphragma sellae. Meningiomas
of suprasellar area arise from different sites including the most anterior planum
sphenoidale, followed by limbus sphenoidal, chiasmatic sulcus, tuberculum sellae and
finally diaphragma sellae. Suprasellar meningiomas approached transcranially or transnasally.
We reviewed the radiological and intraoperative finding of suprasellar meningioma
to propose new anatomical classification with possible standardize one approach over
the other
Methodology: We reviewed 40 cases retrospectively of suprasellar meningioma. Data of clinical
presentation, preoperative imaging to identify the visual apparatus displacement and
vascular structure, as well as patency of diaphragma sellae, and intraoperative finding
of arachnoid separation between the tumor and visual apparatus, patency of diaphragma
sellae, tumor extension into optic canals, and direction of displacement of neurovascular
structure were analyzed.
Result: Four subtypes of suprasellar meningiomas identified: planum sphenoidale (10), chiasmatic
sulcus (9), tuberculum sellae (10), and diaphragma sellae (1). Canal extension was
located inferiorly to optic nerve in diaphragma sellae meningioma, medial in tuberculum
sellae and chiasmatic sulcus meningioma, and superomedial in planum sphenoidale. Optic
chiasm was displaced posteriorly and displaced from A1/A2 complex in all cases corresponded
to new subtype chiasmatic sulcus meningioma.
Conclusion: Chiasmatic sulcus meningioma is distinct subtype, its behavior toward neurovascular
structure and bone reaction is different from other subtype. The location of the arachnoid
layer and its protection to the visual apparatus is distinct and can be appreciated
in different location based on the type during endoscopic transnasal approach.
