Visual outcome of planum sphenoidale and tuberculum sellae meningiomas

1997 ◽  
Vol 99 ◽  
pp. S236 ◽  
Author(s):  
Teiji Uede ◽  
Masafumi Ohtaki ◽  
Sumiyoshi Tanabe ◽  
Kazuo Hashi
Keyword(s):  
Visual Outcome ◽  
Tuberculum Sellae ◽  
Planum Sphenoidale

Suprasellar meningiomas: the effect of tumor location on postoperative visual outcome

1988 ◽  
Vol 69 (4) ◽  
pp. 523-528 ◽  
Author(s):  
Brian T. Andrews ◽  
Charles B. Wilson
Keyword(s):  
Visual Loss ◽  
Visual Outcome ◽  
Tumor Location ◽  
Postoperative Recovery ◽  
Optic Canal ◽  
Visual Disability ◽  
Content Type ◽  
Tuberculum Sellae ◽  
Diaphragma Sellae ◽  
Planum Sphenoidale

✓ The authors reviewed 38 cases of suprasellar meningioma to determine the correlation between tumor site and postoperative visual outcome. Progressive visual loss, the most frequent initial complaint (94.7%), occurred over a mean of 24½ months, was most often unilateral (18 patients) or bilateral but asymmetrical (14 patients), and was severe (20/200 vision or worse) in 23 patients; 24 patients had visual field abnormalities. Computerized tomography or magnetic resonance studies clearly delineated the lesions but did not appear to permit earlier diagnosis. Eleven patients had tumors limited to the tuberculum sellae; the tumor extended from the tuberculum sellae onto the planum sphenoidale in nine patients, into one optic canal in eight, onto the diaphragma sellae in seven, and onto the medial sphenoid wing in three. Patients with tumors affecting the optic canal had severe unilateral visual loss more often than those with tumors at other sites. Tumors limited to the tuberculum sellae were most often completely resected; postoperative recovery of vision was also most frequent in patients with tumors at this site. Tumors involving the diaphragma sellae or the medial sphenoid wing were least often completely removed and most likely to be associated with postoperative visual deterioration. Overall, 42% of patients had improved vision postoperatively, 30% remained unchanged, and 28% were worse. After a mean follow-up period of 38 months, 24 patients are doing well, four have significant visual disability, and three are blind or doing poorly. Two patients died of causes unrelated to their tumor. Three patients have had tumor recurrence.

Endoscopic endonasal versus transcranial approach to tuberculum sellae and planum sphenoidale meningiomas in a similar cohort of patients

2018 ◽  
Vol 128 (1) ◽  
pp. 40-48 ◽  
Author(s):  
Evan D. Bander ◽  
Harminder Singh ◽  
Colin B. Ogilvie ◽  
Ryan C. Cusic ◽  
David J. Pisapia ◽  
...  
Keyword(s):  
Tumor Size ◽  
Visual Outcome ◽  
Optic Chiasm ◽  
Extent Of Resection ◽  
Surgical Removal ◽  
Endoscopic Endonasal ◽  
Csf Leakage ◽  
Transcranial Approach ◽  
Tuberculum Sellae ◽  
Planum Sphenoidale

OBJECTIVEPlanum sphenoidale (PS) and tuberculum sellae (TS) meningiomas cause visual symptoms due to compression of the optic chiasm. The treatment of choice is surgical removal with the goal of improving vision and achieving complete tumor removal. Two options exist to remove these tumors: the transcranial approach (TCA) and the endonasal endoscopic approach (EEA). Significant controversy exists regarding which approach provides the best results and whether there is a subset of patients for whom an EEA may be more suitable. Comparisons using a similar cohort of patients, namely, those suitable for gross-total resection with EEA, are lacking from the literature.METHODSThe authors reviewed all cases of PS and TS meningiomas that were surgically removed at Weill Cornell Medical College between 2000 and 2015 (TCA) and 2008 and 2015 (EEA). All cases were shown to a panel of 3 neurosurgeons to find only those tumors that could be removed equally well either through an EEA or TCA to standardize both groups. Volumetric measurements of preoperative and postoperative tumor size, FLAIR images, and apparent diffusion coefficient maps were assessed by 2 independent reviewers and compared to assess extent of resection and trauma to the surrounding brain. Visual outcome and complications were also compared.RESULTSThirty-two patients were identified who underwent either EEA (n = 17) or TCA (n = 15). The preoperative tumor size was comparable (mean 5.58 ± 3.42 vs 5.04 ± 3.38 cm3 [± SD], p = 0.661). The average extent of resection achieved was not significantly different between the 2 groups (98.80% ± 3.32% vs 95.13% ± 11.69%, p = 0.206). Postoperatively, the TCA group demonstrated a significant increase in the FLAIR/edema signal compared with EEA patients (4.15 ± 7.10 vs −0.69 ± 2.73 cm3, p = 0.014). In addition, the postoperative diffusion-weighted imaging signal of cytotoxic ischemic damage was significantly higher in the TCA group than in the EEA group (1.88 ± 1.96 vs 0.40 ± 0.55 cm3, p =0.008). Overall, significantly more EEA patients experienced improved or stable visual outcomes compared with TCA patients (93% vs 56%, p = 0.049). Visual deterioration was greater after TCA than EEA (44% vs 0%, p = 0.012). While more patients experienced postoperative seizures after TCA than after EEA (27% vs 0%, p = 0.038), there was a trend toward more CSF leakage and anosmia after EEA than after TCA (11.8% vs 0%, p = 0.486 and 11.8% vs 0%, p = 0.118, respectively).CONCLUSIONSIn this small single-institution study of similarly sized and located PS and TS meningiomas, EEA provided equivalent rates of resection with better visual results, less trauma to the brain, and fewer seizures. These preliminary results merit further investigation in a larger multiinstitutional study and may support EEA resection by experienced surgeons in a subset of carefully selected PS and TS meningiomas.

Optic Canal Involvement in Tuberculum Sellae Meningiomas: Influence on Approach, Recurrence, and Visual Recovery

2010 ◽  
Vol 67 (3) ◽  
pp. ons108-ons119 ◽  
Author(s):  
Mohamed Mahmoud ◽  
Remi Nader ◽  
Ossama Al-Mefty
Keyword(s):  
Tumor Resection ◽  
Visual Outcome ◽  
Senior Author ◽  
Optic Canal ◽  
Recurrence Rates ◽  
Simpson Grade ◽  
Tuberculum Sellae ◽  
Tuberculum Sella ◽  
Planum Sphenoidale ◽  
The Impact

Abstract BACKGROUND: Tuberculum sellae meningiomas frequently extend into the optic canals. OBJECTIVE: To emphasize the high frequency of optic canal (OC) involvement in tuberculum sellae meningiomas; the importance of opening the OC and of removing tumor within the canal; and the effect of this maneuver on visual outcome, recurrence rates, and surgical approach selection. METHODS: A retrospective review of 58 patients with tuberculum sellae meningiomas treated surgically by the senior author (O.A.M) between 1993 and 2009 was performed. The frequency of involvement of the OC was documented, as well as the impact of removal of this part of the tumor on visual outcome and recurrence. RESULTS: Total resection (Simpson grade 1) was achieved in 51 of 58 patients (87.9%). The tumor invaded the optic canal in 67%. Tumor resection from the optic nerve was achieved in all cases, and most (92%) underwent deroofing of the OC for this purpose. The dura over the tuberculum sella and/or planum sphenoidale was removed in all patients. Eighty-three percent required removal of affected hyperostotic bone. Vision was improved and/or spared in 88%. The average follow-up period was 23 months with 1 recurrence detected. CONCLUSION: In the majority of cases, tuberculum sellae meningiomas extend into 1 or both OCs. Opening the OC for resection of the intracanalicular portion of the tumor enabled us to achieve excellent visual outcome. The supraorbital craniotomy remains the favored approach for removal of such tumors because it allows unroofing of both OCs, wide excision of the dura, and drilling of the affected bone.

Visual Outcome of Tuberculum Sellae Meningiomas after Extradural Optic Nerve Decompression

Neurosurgery ◽  
2006 ◽  
Vol 59 (3) ◽  
pp. 570-576 ◽  
Author(s):  
Tiit Mathiesen ◽  
Lars Kihlström
Keyword(s):  
Cerebrospinal Fluid ◽  
Optic Nerve ◽  
Diabetes Insipidus ◽  
Visual Outcome ◽  
Optic Canal ◽  
Visual Deterioration ◽  
Nerve Decompression ◽  
Visual Outcomes ◽  
Tuberculum Sellae

Abstract OBJECTIVE: Meningiomas of the tuberculum sellae have a close relationship with the optic apparatus. Even modern series show a 10 to 20% risk of visual deterioration after surgery. We have attempted to improve visual outcome by extradural decompression of the optic canal and anterior clinoid process, followed by intradural release of the optic nerve; this study provides an analysis of visual outcomes with this approach. METHODS: Treatment, histopathology, and follow-up data of 29 consecutive patients undergoing surgery for tuberculum sellae meningiomas with initial release of the optic nerve were prospectively collected. RESULTS: Radical tumor removal was possible in all 23 patients with primary tumors and in three out of six patients with recurrent tumors. All patients but two of the worst affected with preoperative visual compromise improved from surgery; there were no instances of visual deterioration. Five patients with normal preoperative vision remained intact and visual improvement was 22 (91%) out of 24 patients in the remaining patients. In total, 13 patients (42%) had completely normal vision at follow-up. Mainly patients younger than 60 years experienced complete normalization after surgery. Two patients underwent transsphenoidal surgery for cerebrospinal fluid leaks. Postoperative endocrinological symptoms were temporary diabetes insipidus in one patient and permanent diabetes insipidus in another patient undergoing elective sectioning of the pituitary stalk because of a recurrent tumor with invasive growth into the stalk. CONCLUSION: Adding early optic nerve decompression by extradural clinoidectomy and optic canal unroofing to a frontopterional approach seemed to improve visual outcomes because there were no instances of visual deterioration. Simpson Grade 1 to 2 removal was possible in all patients with primary surgery, whereas recurrent cases could only be treated with lower grades of radicality. Radical removal, however, required readiness to reoperate for cerebrospinal fluid leakage at the site of the drilled tumor origin in bone.

scholarly journals Tuberculum sellae meningiomas: A series of 41 cases; surgical and ophthalmological outcomes with proposal of a new prognostic scoring system

2012 ◽  
Vol 03 (03) ◽  
pp. 286-293 ◽  
Author(s):  
Arun Palani ◽  
Manas K Panigrahi ◽  
Anirudh K Purohit
Keyword(s):  
Prognostic Factors ◽  
Scoring System ◽  
Visual Outcome ◽  
Categorical Variables ◽  
P Value ◽  
Visual Recovery ◽  
Chi Square ◽  
Factors Affecting ◽  
Chi Square Test ◽  
Tuberculum Sellae

ABSTRACT Context: Tuberculum sellae meningiomas have proved difficult to treat, partly because of their intimate association with the optic nerves and chiasma, hypothalamus, and internal carotid arteries. Aims: The aim of this study is to analyze the degree of influence of various prognostic factors affecting visual outcome; the pattern of visual recovery and develop a scoring system for prognostication. Settings and Design: This is a retrospective study carried out from January 2004 till June 2011. Materials and Methods: Patients were analyzed on the basis of clinical, radiological, and surgical factors that appeared to affect the outcome. A special scoring system (according to the guidelines of the German Ophthalmological Society) was adopted to quantify the extent of ophthalmological disturbances. Statistical Analysis Used: Comparison of categorical variables between the two was performed using chi-square test and a P value of ≤ 0.05 was considered significant. Logistic regression was used when multivariate analysis was required. Results: Vision improved in 27% and deteriorated in 7.3%. A prognostic scoring system (score 4–13) was developed depending on the degree of influence of significant prognostic factors. The patients with a score of ≤6 had improved vision postoperatively (44%), whereas none of those with a score > 6 improved. Completeness of visual recovery was perceived in 100% of patients within 3 months. Complete resectability was achieved in 73% of patients. Conclusions: The proposed scoring system is very useful in prognosticating the visual outcome of these patients. The patients with a score of ≤6 have the best visual outcome postoperatively. Complete resectability is better achieved with extended bifrontal and unilateral frontal approaches. Short-term postoperative visual outcome is a strong indicator of permanent visual outcome after surgery.

Visual Outcome After Extended Endoscopic Endonasal Transsphenoidal Surgery for Tuberculum Sellae Meningiomas

2010 ◽  
Vol 73 (6) ◽  
pp. 694-700 ◽  
Author(s):  
Qing Wang ◽  
Xiao-Jie Lu ◽  
Wei-Ying Ji ◽  
Zheng-Cun Yan ◽  
Jia Xu ◽  
...  
Keyword(s):  
Transsphenoidal Surgery ◽  
Visual Outcome ◽  
Endoscopic Endonasal ◽  
Endoscopic Endonasal Transsphenoidal Surgery ◽  
Tuberculum Sellae

TUBERCULUM SELLAE MENINGIOMAS

Neurosurgery ◽  
2008 ◽  
Vol 62 (3) ◽  
pp. 556-563 ◽  
Author(s):  
Enrico de Divitiis ◽  
Felice Esposito ◽  
Paolo Cappabianca ◽  
Luigi M. Cavallo ◽  
Oreste de Divitiis
Keyword(s):  
Visual Outcome ◽  
Transsphenoidal Approach ◽  
Cerebrospinal Fluid Leakage ◽  
Total Removal ◽  
Extended Transsphenoidal Approach ◽  
Significant Difference ◽  
Major Vessel ◽  
Transcranial Approach ◽  
Tuberculum Sellae ◽  
Postoperative Improvement

Abstract OBJECTIVE Tuberculum sellae meningiomas represent 5 to 10% of all intracranial meningiomas. Such lesions are classically removed through a variety of well-standardized transcranial approaches. The extended endonasal transsphenoidal route, under either microscopic or endoscopic visualization, has only recently been proposed as a viable surgical technique for the management of such tumors. MATERIAL AND METHODS A total of 51 consecutive patients with tuberculum sellae meningiomas were treated at our institution during a 21-year period. Forty-four patients had transcranial surgery, and the last seven were treated via the extended endoscopic transsphenoidal approach. We also compared our data with those reported in the pertinent literature related to the surgical, ophthalmological, and endocrinological outcome. RESULTS The significant difference among the transcranial and transsphenoidal series, both in our experience and in the reviewed literature, did not allow us to draw statistically significant results but rather a reporting of the outcomes. In the transcranial group, 86.4% had a gross total removal of the lesion, whereas the percentage was 83.3% in the transsphenoidal group. Concerning the visual outcome, we experienced postoperative improvement in 61.4% of the transcranial patients and a worsening of 13.6%, whereas improvement was reported in 71.4% of the patients in the transsphenoidal group; in the last group, we did not observe any postoperative worsening. The main drawback of the transsphenoidal approach still remains the difficulty in reconstructing the cranial base dural and bone defects, which expose patients to a greater risk of postoperative cerebrospinal fluid leakage (28.6% in our series) and related complications. CONCLUSION When treating a patient with a diagnosis of tuberculum sellae meningioma, a neurosurgeon should know that, aside from the classical transcranial approach, the possibility of an extended transsphenoidal approach exists. Although it is still not a standardized procedure, in carefully selected cases (i.e., small midline lesions, without major vessel encasement, or parasellar extension) and in experienced hands, it could be considered a viable alternative, especially in overcoming the reconstruction-related problems.

Surgical anatomy of the juxta—dural ring area

1998 ◽  
Vol 89 (2) ◽  
pp. 250-254 ◽  
Author(s):  
Susumu Oikawa ◽  
Kazuhiko Kyoshima ◽  
Shigeaki Kobayashi
Keyword(s):  
Surgical Anatomy ◽  
Lateral View ◽  
Horizontal Line ◽  
Anterior Clinoid Process ◽  
Lateral Projection ◽  
Content Type ◽  
Medial Side ◽  
Tuberculum Sellae ◽  
Planum Sphenoidale ◽  
Fine Print

Object. The authors report on the surgical anatomy of the juxta—dural ring area of the internal carotid artery to add to the information available about this important structure. Methods. Twenty sides of cadaver specimens were used in this study. The plane of the dural ring was found to incline in the posteromedial direction. Medial inclination was measured at 21.8° on average against the horizontal line in the anteroposterior view on radiographic studies. Posterior inclination was measured at 20.3° against the planum sphenoidale in the lateral projection, and the medial edge of the dural ring was located 0.4 mm above the tuberculum sellae in the same projection. The lateral edge of the dural ring was located 1.4 mm below the superior border of the anterior clinoid process. The carotid cave was situated at the medial or posteromedial aspect of the dural ring; however, two of the 20 specimens showed no cave formation. The carotid cave contained the subarachnoid space in 13 sides, the arachnoid membrane only in three sides, and the extraarachnoid space in two sides. The authors propose that the marker of the medial side of the dural ring, which is more proximal than the lateral, is the tuberculum sellae in the lateral view on radiographic studies. In the medial aspect of the dural ring the intradural space can be situated below the level of the tuberculum sellae because of the existence of the carotid cave. Conclusions. An aneurysm arising from the medial side of the juxta—dural ring area even below the tuberculum sellae is a potential cause of subarachnoid hemorrhage.

scholarly journals Technical nuances in the management of tuberculum sellae and diaphragma sellae meningiomas

2013 ◽  
Vol 35 (6) ◽  
pp. E7 ◽  
Author(s):  
Anil Nanda ◽  
Sudheer Ambekar ◽  
Vijayakumar Javalkar ◽  
Mayur Sharma
Keyword(s):  
Visual Outcome ◽  
Surgical Excision ◽  
Visual Improvement ◽  
Microsurgical Techniques ◽  
Technical Details ◽  
Tuberculum Sellae ◽  
Vascular Structures ◽  
Diaphragma Sellae ◽  
Neurovascular Structures

Object Tuberculum sellae meningiomas (TSMs) and diaphragma sellae meningiomas (DSMs) are challenging lesions to treat due to their proximity to neurovascular structures. Methods The authors reviewed the medical records of patients who underwent surgical excision of TSMs and DSMs from 1990 to 2013. They also describe the technical strategies used to minimize injury to the optic apparatus, vascular structures, and pituitary stalk. Results Twenty-four patients with TSM and 6 patients with DSM were included in the study. Seventy percent of the tumors were large (≥ 5 cm). The pterional approach was employed in most cases. Optic canal involvement was observed in 4 patients. Twenty-one patients (70%) had visual dysfunction before surgery. At follow-up (median 18 months), visual improvement was noted in 10 (47.6%) of 21 patients. Gross-total excision was achieved in 22 patients (91.6%) with TSM and 5 (83.3%) with DSM. At last follow-up, 28 patients (93.3%) had a Glasgow Outcome Scale score of 5. There were no deaths in this series. Conclusions Tuberculum and diaphragma sellae meningiomas present a unique subset of tumors due to their location. They can be safely excised with minimal morbidity and mortality using microsurgical techniques. Attention to technical details during surgery leads to greater respectability and superior visual outcome.

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