Surgical Approach for Suprasellar Meningiomas Based on Attachment—Single-Surgeon Experience

Abstract

Suprasellar meningioma(SMs) can originate from midline or para-median dura. Complexity of surgery and visual outcome depend on the attachment of SM. Conventional surgery for SM was ipsilateral to the visual deficit. We report our experience of surgical management of SM after choosing surgical approach based on attachment of the SM. Sixty consecutive patients who underwent surgery for SM between January 2016 and January 2022, formed the study population. In patients with SM attached to midline, surgical approach was ipsilateral to the side of vision loss. Whereas, in those with a para-median attachment, the approach was contralateral. Outcome variables included extent of resection achieved, recurrence and assessment for visual acuity and fields, done at three, six months after surgery and at every year subsequently. Average age of the study population was 49.99±13.38(13-74) years with 23(38.3%) men. Surgery for SM was done via ipsilateral approach in 18(30.0%) and by contralateral approach in 42(70.0%) patients. The average preoperative VIS score was 54.68±37.55. Gross total resection(GTR) was achieved in 58(96.7%) patients. The average duration of follow-up was three years and at latest follow-up, improvement in vision was reported in 46(76.6%) patients. In patients with SM undergoing surgical resection, opting an ipsilateral approach when SM had midline attachment and contralateral approach if the SM had para-median attachment may ensure greater resection of the lesion and better clinical outcomes. Our findings need validation in larger, randomized studies.