Diagnosis and surgical management of the tuberculum sellae meningiomas

Meningiomas of tuberculum sellae, together with those from the olfactory groove, are the most frequent anterior skull base meningiomas. The most frequent symptoms in order of frequency are visual loss, mental disorders, epilepsy, anosmia and motor deficits. We stress the still unacceptably long period between the onset of symptoms and the correct diagnosis (in the majority of patients it exceeds two years). When the size of tumor exceeds 4 cm and the compression on adjacent important neurovascular structures is evident, possibilities of total removal are limited and the chance for visual improvement is low. The ideal treatment of the tuberculum sellae meningiomas is the resection of the tumor, with decompression of the vascular and of the nervous structures. Due to lack of highly specialized and experimented surgical groups, many cases of tubercullum sellae meningiomas are treated by some neurosurgical centers with non-optimal alternative procedures, presenting worse results than recently published surgical series. In this article, the authors provide a general overview of diagnostic methods for detection and correct pre-operative evaluation of tubercullum sellae meningiomas. We also emphasize the benefits of the surgical treatment, which, if managed by experts in skull base neurosurgery, may be curative and present less co-morbidities than other treatment modalities.