Surgical management of Tuberculum sellae meningiomas

To study the clinical characteristics of tuberculum sellae meningiomas, we retrospectively analyzed 43 patients and reviewed the literature with regard to the incidence, clinical manifestations, imaging features, microsurgical anatomy, and postoperative outcomes of tuberculum sellae meningiomas, and the technical aspects of their treatment. CT or MRI enables a correct diagnosis in most cases. Of the patients in the study, unifrontal craniotomy was performed in 24, and pterional craniotomy in 19. Complete tumour resection was achieved in 32 patients (74.4%) and subtotal resection (with less than 7% of the tumour left behind) in 11 (25.6%). Surgical treatment of tuberculum sellae meningioma is among the most challenging of neurosurgical procedures. Bicoronal subfrontal, unifrontal, and pterional transsylvian approaches can all be used. The key to preserving visual function is to minimise direct manipulation of or trauma to the optic nerves and avoid injury to the blood supply of the optic apparatus. Appropriate preoperative imaging and careful intraoperative technique have made it possible to obtain both total removal of tumours and a favourable visual outcome.