Surgical Management Of Tuberculum Sellae Meningiomas

Abstract

Objectives: Tuberculum sellae meningiomas (TSM) account for 5-10% of intracranial meningiomas. TSM resection represents a great surgical challenge because of the proximity of vital neurovascular structures. We aim to share our surgical management experience of TSM, discuss different surgical approaches, and the functional results. Methods: We present a retrospective series of 32-patients operated in our department for a decade lasting from 01/01/2012 to 31/12/2021. Results: The mean age was 50 years-old with female/male ratio of 4.3. At diagnosis, all patients presented with impaired visual acuity and visual field, total bilateral blindness was present in 06 patients, and all patients underwent preoperative MRI. The mean tumor diameter was 36mm. All patients were operated transcranially. The frontolateral approach was mostly used. Total resection was achieved in 30 patients. In the remaining two patients, subtotal resection was performed due to the optic canal invasion. Postoperatively, transient diabetes insipidus was diagnosed in three patients; bacterial meningitis, and transient anterior pituitary deficiency in one case respectively. Visual outcome improvement was noticed in 75%, a stabilization in 21.8%, and visual worsening in one case. Zero death was recorded. MRI of control was performed in all cases at least twice in the follow up period. Conclusions: TSM often develop lateral, superior and inferior extensions, resulting in vascular encasement, optic canal invasion and occasionally cavernous sinus invasion. Although surgical treatment of these tumors evolved significantly over the last decades, the main problem remains the too long history of symptoms impacting negatively the surgical results.