Determinants of postoperative visual recovery in suprasellar meningiomas

Suprasellar meningiomas usually present with visual deterioration, including decreased visual acuity and/or visual field defects. Suprasellar meningiomas have a close relationship with the optic apparatus, arteries of the anterior circulation, pituitary stalk and hypothalamus, which makes safe surgical resection a challenge especially with dissection around an already compromised optic apparatus. In this report 21 patients operated on for a suprasellar meningioma over a 4-year period are reviewed. Postoperative outcome and visual recovery are evaluated, including analysis of its determinants. Over a 4-year period (2002-2006), patients surgically treated for suprasellar meningiomas were included in this retrospective study. All tumors were located at the tuberculum sellae and diaphragma sellae dura. Clinical and neuro-ophthalmological examinations, imaging studies, endocrinological evaluation and follow-up data were reviewed retrospectively. The influence of patient age, sex, duration of symptoms, extent of visual impairment, tumor size , extent into optic canal, consistency, operative respectability were analyzed as potential prognostic factors for postoperative visual outcome. Twenty-one patients were included in this retrospective study. Ages ranged from 25 to 65 years (mean: 43 years). All patients had visual acuity loss and visual field defects. Symptom duration ranged from 2 to 36 months (mean: 17 months). Tumor removal was complete in 17 patients, and subtotal resection was performed in four patients. There was one case of postoperative mortality. The follow-up duration ranged from 24 to 48 months (mean: 28 months). At the last follow-up 12 patients (60%) had achieved visual improvement, whereas vision was unchanged in eight patients (40%). None of the patients had visual deterioration during their follow-up. A univariate analysis of clinical and surgical parameters thought to be related to visual outcome showed that the duration of symptoms, preoperative visual status, tumor size and adherence to the internal carotid arteries and/or anterior cerebral artery had a significant impact on visual outcome. The extent and duration of visual symptoms, size of the tumor and vascular adherence were prognostic factors affecting visual recovery after microsurgical resection of suprasellar meningiomas.