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.

Surgical management of meningiomas involving the optic nerve sheath

2004 ◽  
Vol 101 (6) ◽  
pp. 951-959 ◽  
Author(s):  
Uta Schick ◽  
Uwe Dott ◽  
Werner Hassler
Keyword(s):  
Optic Nerve ◽  
Postoperative Radiotherapy ◽  
Visual Outcome ◽  
Tumor Location ◽  
Optic Nerve Sheath ◽  
Optic Canal ◽  
Content Type ◽  
Nerve Sheath ◽  
Fine Print

Object. The management of optic nerve sheath meningiomas (ONSMs) remains controversial but includes surgery, radiotherapy, and plain observation. Surgery is often thought to result in postoperative blindness. The authors report on a large series of patients surgically treated for ONSM, with an emphasis on the visual outcome. Methods. Seventy-three patients with ONSMs who had undergone surgery between 1991 and 2002 were retrospectively analyzed. The standard surgical approach consisted of pterional craniotomy, intradural (54 patients) or extradural (10 patients) unroofing of the optic canal, or a combined procedure (seven patients). Thirty-two tumors demonstrated extension through the optic canal. Twenty-nine tumors reached the chiasm or contralateral side. Patients with intraorbital flat tumors should undergo radiotherapy instead of surgery. Those with a large intraorbital mass and no useful vision should undergo surgery. Tumors extending intracranially through the optic canal are amenable to decompression of the optic canal and resection of the intracranial portion. The follow-up period was a mean 45.4 months (range 6–144 months). Ten patients underwent postoperative radiotherapy. Visual acuity was not significantly influenced by surgery but did become worse with a longer duration of preoperative symptoms and a longer follow-up period. A tumor location in the optic canal was another negative factor. Radiotherapy preserved vision in five of 10 cases. Conclusions. The loss of vision in patients with ONSM is only a matter of time. In patients with good vision the role of radiotherapy becomes more important. Surgery is recommended for intracranial tumors to prevent contralateral extension.

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.

Bilateral Optic Canal Meningiomas

Neurosurgery ◽  
1978 ◽  
Vol 3 (1) ◽  
pp. 9-15 ◽  
Author(s):  
Jonathan D. Trobe ◽  
Joel S. Glaser ◽  
Judith D. Post ◽  
Larry K. Page
Keyword(s):  
Surgical Treatment ◽  
Visual Loss ◽  
Correct Diagnosis ◽  
Clinical Suspicion ◽  
Optic Canal ◽  
The Future ◽  
Planum Sphenoidale ◽  
Radiological Studies

Abstract In the case presented, bilateral optic canal meningiomas produced binocular visual loss. Correct diagnosis was delayed because of inadequate and misinterpreted radiological studies. Careful radiological and surgical examination of the planum sphenoidale later suggested this as the source of both canalicular masses. The pertinent aspects of this case are reviewed in relation to information from similar cases reported previously. In the future, increased clinical suspicion and more accurate neuroradiological studies should improve the detection and afford earlier surgical treatment of meningiomas of the optic canal.

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.

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.

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

Transsphenoidal chiasmapexy for correction of posthypophysectomy traction syndrome of optic chiasm

1977 ◽  
Vol 46 (4) ◽  
pp. 527-529 ◽  
Author(s):  
Robert E. Decker ◽  
Robert Carras
Keyword(s):  
Visual Loss ◽  
Optic Chiasm ◽  
Content Type ◽  
Traction Injury ◽  
Diaphragma Sellae ◽  
Postoperative Improvement ◽  
Fine Print

✓ Postoperative improvement occurred as a result of transsphenoidal chiasmapexy in a patient with posthypophysectomy visual loss. Traction injury of the optic chiasm may have been caused by a deficient diaphragma sellae and inadequate packing and repair of the sella floor. A cartilaginous seal is recommended.

Surgical management of suprasellar meningioma

1984 ◽  
Vol 61 (4) ◽  
pp. 642-648 ◽  
Author(s):  
Jacob Rosenstein ◽  
Lindsay Symon
Keyword(s):  
Tumor Size ◽  
Visual Loss ◽  
Visual Fields ◽  
Visual Outcome ◽  
Duration Of Symptoms ◽  
Content Type ◽  
Before And After ◽  
Funduscopic Examination ◽  
Optic Discs ◽  
Fine Print

✓ Visual outcome in 101 consecutive cases of suprasellar meningioma treated over a 35-year period has been examined. Preoperative visual loss was evaluated using a scoring system that takes both visual acuity and visual fields into account. In this way a percentage visual loss was calculated for each patient before and after surgery. The effects on visual outcome of age, preoperative visual loss, duration of visual symptoms, tumor size, status of the optic disc, and binocular versus monocular involvement was examined. For the group as a whole, vision improved in 63 patients, was unchanged in 12 patients, and was worse in 24 patients. Prognosis was favorably affected by a mean duration of symptoms of less than 2 years, a tumor size of less than 3 cm, a preoperative visual loss of less than 50%, and the presence of normal optic discs on funduscopic examination. Age had some effect on prognosis, but the presence of binocular or monocular involvement had no effect.

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.

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