Microsurgical Treatment of Tuberculum Sellae Meningiomas

Introduction: To inquire and assess the clinical and imaging features, microsurgical techniques, and operative effect in cases of tuberculum sellae meningiomas. Methods: A retrospective analysis of clinical and imaging manifestations was made on 41 cases of tuberculum sellae meningioma from 1985 to 2002. The tumors operated on with four different operative approaches were classified into large, middle, and small types, depending upon their size on CT or MRI, with a comparison of total resection rate, operative results, and complications among the types. Results: The clinical features of tuberculum sellae meningioma include early occurring visual dysfunction in one or both eyes and atypical visual field defects. There is a relationship between total resection rate and size and site of tumors, with a higher rate in middle and small types and anterior tumors. Total removal rate is related to the size of tumor with higher rate of total removal in the middle and small types. The supraorbital keyhole approach, pterional approach, and frontotemporal orbitozygomatic approach are superior to the unilateral subfrontal approach, with a list of advantages including satisfactory exposure, little retraction of the frontal lobe, higher resection rate, fewer postoperative complications, and better operative results. Conclusions: Tuberculum sellae meningiomas cause visual deficits early and the majority of the tumors are the middle and small types. These tumors can be removed completely and safely in many cases. The more appropriate approaches are the supraorbital keyhole approach in the small and middle types, the pterional approach in the middle and large types, and the frontotemporal orbitozygomatic approach in the large type.