The Surgical Management of Tuberculum Sellae Meningiomas

Abstract

Introduction: Tuberculum sellae meningiomas represent 4 to 10% of all intracranial meningiomas. These tumors are surgically challenging because of their close proximity to the visual pathways, arteries of the anterior circulation, and pituitary gland and stalk. A variety of surgical approaches have been described in the literature for removal of these lesions, including the classic bilateral subfrontal craniotomy, the interhemispheric transbasal approach, the unilateral subfrontal approach with or without an orbital osteotomy, the frontotemporal (pterional) craniotomy, and more recently the expanded endonasal approach. Objective: The aim of this presentation is to review our own results and those from the literature of the different surgical approaches to tuberculum sellae meningiomas including completeness of tumor removal, visual outcome, vascular injury, and overall complication rates. Results: Advantages and disadvantages were identified with each surgical approach. Overall morbidity rates (15 to 30%), visual outcome (improvement 42 to 80%, worsening in 11 to 20%), and rates of total removal were comparable among the different approaches. Based on our own results and recent experience with the transbasal interhemispheric approach in 17 patients, this approach is favored because of the reduced need for brain retraction, improved bilateral visualization of critical neurovascular structures, and the ability to interrupt at an early stage the blood supply of the tumor, facilitating tumor resection. Conclusion: The majority of patients with tuberculum sellae meningiomas, regardless of the approach, can have their tumors totally removed with low mobidity and with variable rates of improvement in their vision. The author favors the transbasal interhemispheric approach.