Intrasellar Meningiomas: A Case Series and Systematic Review of Literature

Introduction: Meningiomas constitute ~35% of all intracranial neoplasms. Intrasellar meningiomas represent an exceedingly rare subset, frequently misdiagnosed as pituitary adenomas due to overlapping clinical manifestations, hormonal assays, and radiological appearances. Definite diagnosis of intrasellar meningiomas typically necessitates magnetic resonance imaging (MRI) and visually demarcating the pituitary gland and the meningioma. However, histopathological evaluation remains essential for a conclusive diagnosis.

Materials and Methods: A retrospective analysis was conducted for all patients diagnosed with intracranial meningiomas between 2006 and 2020 at Massachusetts General Hospital and Brigham and Women’s Hospital, Boston, was performed to identify the patients of intrasellar meningioma. Additionally, a systematic review of literature from inception to the present was conducted using the search terms “sellar meningioma” and “intrasellar meningioma” aiming to compile the previously documented intrasellar meningiomas in literature.

Results: Two female patients aged 58 and 71 years at the time of surgery were identified at the participating institutions. An extensive literature review identified 37 patients (age range = 27–82 years; female:male = 22:15) across 18 studies from an initial pool of 468 abstracts and 60 full texts. Visual field defects were the most prevalent symptoms, observed in twenty-seven patients (69.2%), followed by headaches in 13 patients (33.3%). Hormonal assessments revealed panhypopituitarism in 9 patients (23%), with 5 additional patients (12.8%) displaying reduced hormonal levels. Conversely, hyperprolactinemia was documented in a total of 10 patients (25.6%). Computed tomography (CT) scan and magnetic resonance imaging (MRI) were used for preoperative radiological assessment, identifying 5 cases (12.8%) of pure intrasellar meningiomas and the rest exhibiting suprasellar extension. The maximum tumor diameter ranged from 1.1 to 7 cm. Transsphenoidal surgery was the predominant surgical approach (56.4%), with four patients requiring revision surgeries and one patient undergoing a tumor biopsy. Three cases in the previous literature described diagnosing intrasellar meningioma via radiological evaluation. Histopathological assessment confirmed the diagnosis of intrasellar meningioma, categorizing 27 tumors WHO Grade I and two each for WHO Grade II and Grade III. Among the Grade I tumors, meningothelial meningiomas were the most frequently observed (n = 19, 48.7%). Additionally, a significant association was observed between the pathological grade of tumor and tumor recurrence, with higher risk of recurrence observed in WHO Grade II meningiomas (p = 0.018). Postoperative radiation therapy was administered to six patients, with six cases of recurrence reported during follow-up (range: 4 months to 13 years).

Conclusion: Intrasellar meningiomas are infrequently reported and often underdiagnosed during initial clinical evaluation. To highlight the importance of radiological diagnosis in identifying intrasellar meningiomas, it is essential to emphasize the role of imaging in the diagnostic process for cases at the participating hospitals. Neurosurgeons and neurologists should consider intrasellar meningiomas as a differential diagnosis when assessing a sellar or intrasellar lesion to ensure appropriate management and improve clinical outcomes.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
07 February 2025