Surgical Management and Evaluation of Prognostic Factors Influencing Postoperative Visual Outcome of Suprasellar Meningiomas

OBJECTIVE: To study the microsurgical technique and the prognostic factors influencing postoperative visual outcome in patients with suprasellar meningiomas (SMs). METHOD: The clinical materials of 45 patients with SMs treated microsurgically between January 2002 and October 2008 were analyzed retrospectively. Patients received ophthalmologic and radiologic assessment before and after operation. Follow-up ranged from 12 to 93 months (median, 39 months). As far as monocular vision was concerned, univariate and multivariate statistical analysis was performed among factors that might influence postoperative visual outcome. RESULTS: In this group, the mean age of the patients was 51 years. Median tumor size was 3.5 cm. The duration of symptoms ranged from 10 days to 35 years (median, 18 months). Total tumor resection was achieved in 40 cases (88.9%) and subtotal in 5 cases (11.1%). With respect to visual outcome of the 90 eyes, 54 eyes (60%) improved, 24 (26.7%) remained unchanged, and 12 (13.3%) had worsened. It has been illustrated that the postoperative visual improvement was determined by various factors, including age, recurrence, duration and severity of visual disturbance, preoperative condition of optic disc, tumor size, location, peritumoral edema, involvement with optic canal, arachnoid membrane interface, and extent of tumor removal. However, the multivariate analysis showed that recurrence, preoperative condition of optic disc, duration of impaired vision, and peritumoral edema are the most influential factors. CONCLUSIONS: Skillful microsurgical techniques are key to resect SMs while getting the desired visual outcome. The recurrence, preoperative condition of optic disc, duration of impaired vision, and peritumoral edema might be the most important factors influencing postoperative visual outcome.