Surgical strategy for tuberculum sellae meningiomas

The surgical strategies and outcomes for 85 patients operated on for tuberculum sellae meningioma were analyzed retrospectively The analysis was based on factors that probably determined the difficulties encountered during surgery, assisted in predicting the extent of resectability, and helped in predicting the surgical outcome. Eighty-five patients with tuberculum sellae meningiomas were operated on in the Neurosurgery Department at King Edward VII Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Bombay, India, between January 1989 and December 2003. The patients were analyzed retrospectively on the basis of clinical and radiologic factors that seemed to affect the outcome. Each factor was given points, and for each tumor, the points were added to obtain a score. On the basis of the score, the tumors were then divided into 3 grades. The grades determined the difficulties that could be anticipated during surgery. Most patients were operated on by means of a unifrontal cramotomy on the side of worse vision using standard dissection techniques. Total tumor resection was achieved in 72 patients, and subtotal tumor resection with less than 7% of tumor left behind was achieved in 13 patients. All patients with subtotal resection had higher grade tumors. Preoperative visual status had a bearing on the visual outcome after surgery. Four patients were misdiagnosed as having a pituitary tumor. Two patients died in the immediate postoperative period. The average follow-up was 48 months (range: 6 months to 9 years). There was symptomatic recurrence in 1 patient in whom subtotal resection had been performed. The extent and duration of visual symptoms, encasement of the anterior cerebral artery complex, and size of the tumor were the most important factors affecting surgery. The grading system provided a reasonable assessment concerning the possible surgical problems.