Influence of origin site and growth pattern in prognosis of midline suprasellar meningiomas tumors

Abstract

Objective To elucidate the clinical and prognostic characteristics of the midline suprasellar meningiomas based on their origin site and growth pattern. Methods One hundred and six patients with midline suprasellar meningiomas, admitted to and underwent surgery in our hospital from January 2000 to December 2008, were chosen in our study; according to the origin and growth pattern of the tumors, they were divided into planum sphenoidal meningioma (PSM) group (n=22), tuberculum sellae meningioma (TSM) group (n=27), prefixed optic chiasm diaphragma sellae meningioma (DSM) group (n=11) and postfixed optic chiasm DSM group (n=46). A retrospective analysis of clinical symptoms, tumor diameters, optic pathways, anterior communicating artery complexes and pituitary stalk involvements, surgical approaches, optic nerve involvements and total resection rates was performed; multiple linear regression analysis of deterioration of visual acuity, visual field defect deteriorated hypothalamic-pituitary axis damage, tumor resection, risk factors of tumor recurrence was performed. Results Patients from postfixed optic chiasm DSM group had the highest rate of visual impairment (98%), headache (76%), optic pathway involvement (98%), and anterior communicating artery complex involvement (76.1%); patients from the DSM group had the highest rate of visual field defects (91%); patients from prefixed optic chiasm DSM group had highest incidence of hypothalamic-pituitary axis dysfunction (100%) and pituitary stalk involvement (91%). The most common optic nerve involvement appeared in patients from postfixed optic chiasm DSM group (67%). Patients from the PSM group had the highest meningioma resection rate (86%). Frontotemporal approach was considered as an independent risk factor for deterioration of visual acuity. TSM, prefixed optic chiasm DSM, DSM, and frontotemporal approach were independent risk factors for postoperative visual field defects. Prefixed optic chiasm DSM and surgical approach were independent risk factors for postoperative hypothalamic-pituitary axis injury. Prefixed optic chiasm DSM was an independent risk factor of tumor resection rate. Prefixed optic chiasm DSM and subtotal resection were independent risk factors for tumor relapse. Tumor recurrence was noted in 14 patients during the follow-up; the mean recurrence-free survival rate was 95%, 93%, 33% and 89%, and the mean recurrence-free time was (103.9±3.9), (107.1±4.6), (55.6±8.3) and (105.3±4.5) months in the above groups, respectively. Conclusions Origin site and tumor growth pattern are important factors for surgery and prognosis of TSM; total resection rate and progression-free survival rate in PSM are high. High incidence of postoperative optic nerve damage is noted in patients with TSM and postfixed optic chiasm DSM; subtotal resection is an independent risk factor for recurrence. Key words: Sphenoidal planum; Tuberculum sellae; Diaphragma sellae; Meningioma; Prognosis