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Optic canal involvement in tuberculum sellae meningiomas: influence on approach, recurrence, and visual recovery
Mohamed Mahmoud1, Remi Nader, Ossama Al-Mefty
1Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Background:
Tuberculum sellae meningiomas frequently extend into the optic canals.
Objective:
To emphasize the high frequency of optic canal (OC) involvement in tuberculum sellae meningiomas; the importance of opening the OC and of removing tumor within the canal; and the effect of this maneuver on visual outcome, recurrence rates, and surgical approach selection.
Methods:
A retrospective review of 58 patients with tuberculum sellae meningiomas treated surgically by the senior author (O.A.M) between 1993 and 2009 was performed. The frequency of involvement of the OC was documented, as well as the impact of removal of this part of the tumor on visual outcome and recurrence.
Results:
Total resection (Simpson grade 1) was achieved in 51 of 58 patients (87.9%). The tumor invaded the optic canal in 67%. Tumor resection from the optic nerve was achieved in all cases, and most (92%) underwent deroofing of the OC for this purpose. The dura over the tuberculum sella and/or planum sphenoidale was removed in all patients. Eighty-three percent required removal of affected hyperostotic bone. Vision was improved and/or spared in 88%. The average follow-up period was 23 months with 1 recurrence detected.
Conclusion:
In the majority of cases, tuberculum sellae meningiomas extend into 1 or both OCs. Opening the OC for resection of the intracanalicular portion of the tumor enabled us to achieve excellent visual outcome. The supraorbital craniotomy remains the favored approach for removal of such tumors because it allows unroofing of both OCs, wide excision of the dura, and drilling of the affected bone.