Characteristics of midline suprasellar meningiomas based on their origin and growth pattern

Abstract

BackgroundThe aim of the present study was to elucidate clinical and prognostic characteristics of the midline suprasellar meningiomas based on their origin and growth pattern. MethodsA retrospective review of the medical records was conducted for patients undergoing surgical resection of the midline suprasellar meningioma. The meningiomas were divided into group A – planum sphenoidale meningioma (PSM), group B – tuberculum sellae meningioma (TSM) and group C – diaphragma sellae meningioma (DSM), based on their growth pattern in relation to the optic pathway and pituitary stalk, group C was then divided into groups C1 and C2. ResultsThe mean age of 32 men and 74 women was 48.5±13.1 years (range, 20–78 years). The rate of visual impairment was highest in patients in group C2 and lowest in group A patients (P<0.001). The h–p axis impairment and MRI evidence of the pituitary stalk involvement was more frequent in patients with group C1 meningioma (P<0.001). The gross total resection (GTR) was achieved in 84/106 (79%) patients. The mean follow-up period was 70.4 months (median 86 months, range 64.5–76.3 months). The fronto-temporal approach was the only significant predictor of the postoperative visual acuity impairment (P=0.001, OR: 8.2, CI: 2.45–27.42) and visual field impairment (P=0.016, OR: 0.071, CI: 0.008–0.607). The meningiomas in groups B (P=0.024, OR: 0.198, CI: 0.049–0.812) and C1 (P=0.012, OR: 0.082, CI: 0.012–0.580) were significant predictors of the postoperative visual field deficits. The group C1 (P=0.036, OR: 0.244, CI: 0.065–0.912) and surgical approach employed (P=0.032, OR: 0.013, CI: 0.000–0.684) was significant predictors of the postoperative h–p function impairment. The mean recurrence free survival (RFS) time and rate were 102.9±3.2 months and 86%. The group C1 meningiomas had the lowest RFS rate and time (33.3% and 55.6±8.3 months). The subtotal resection and the group C1 meningioma (P=0.001, OR: 15.6, CI: 2.9–82.8) were the significant predictors of recurrence (P=0.008, OR: 0.08, CI: 0.014–0.529). ConclusionThe group A meningioma had the high rate of complete resection and favorable RFS. Groups B and C2 involve optic pathway and optic canal predominately. The group C1 DSM was an independent predictor of subtotal resection, postoperative visual field and h–p axis impairment. The subtotal resection was an independent predictor of the recurrence.