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Updated: Apr 25, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Characteristics of midline suprasellar meningiomas based on their origin and growth pattern
Yi Liu1, Silky Chotai1, Chen Ming1
1Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Background:
The aim of the present study was to elucidate clinical and prognostic characteristics of the midline suprasellar meningiomas based on their origin and growth pattern.
Methods:
A retrospective review of the medical records was conducted for patients undergoing surgical resection of the midline suprasellar meningioma. The meningiomas were divided into group A - planum sphenoidale meningioma (PSM), group B - tuberculum sellae meningioma (TSM) and group C - diaphragma sellae meningioma (DSM), based on their growth pattern in relation to the optic pathway and pituitary stalk, group C was then divided into groups C1 and C2.
Results:
The mean age of 32 men and 74 women was 48.5±13.1 years (range, 20-78 years). The rate of visual impairment was highest in patients in group C2 and lowest in group A patients (P<0.001). The h-p axis impairment and MRI evidence of the pituitary stalk involvement was more frequent in patients with group C1 meningioma (P<0.001). The gross total resection (GTR) was achieved in 84/106 (79%) patients. The mean follow-up period was 70.4 months (median 86 months, range 64.5-76.3 months). The fronto-temporal approach was the only significant predictor of the postoperative visual acuity impairment (P=0.001, OR: 8.2, CI: 2.45-27.42) and visual field impairment (P=0.016, OR: 0.071, CI: 0.008-0.607). The meningiomas in groups B (P=0.024, OR: 0.198, CI: 0.049-0.812) and C1 (P=0.012, OR: 0.082, CI: 0.012-0.580) were significant predictors of the postoperative visual field deficits. The group C1 (P=0.036, OR: 0.244, CI: 0.065-0.912) and surgical approach employed (P=0.032, OR: 0.013, CI: 0.000-0.684) was significant predictors of the postoperative h-p function impairment. The mean recurrence free survival (RFS) time and rate were 102.9±3.2 months and 86%. The group C1 meningiomas had the lowest RFS rate and time (33.3% and 55.6±8.3 months). The subtotal resection and the group C1 meningioma (P=0.001, OR: 15.6, CI: 2.9-82.8) were the significant predictors of recurrence (P=0.008, OR: 0.08, CI: 0.014-0.529).
Conclusion:
The group A meningioma had the high rate of complete resection and favorable RFS. Groups B and C2 involve optic pathway and optic canal predominately. The group C1 DSM was an independent predictor of subtotal resection, postoperative visual field and h-p axis impairment. The subtotal resection was an independent predictor of the recurrence.
Insights
Midline suprasellar meningiomas vary in clinical and prognostic features. Group C1 diaphragma sellae meningiomas are linked to poorer outcomes, including visual deficits and higher recurrence rates, emphasizing the importance of surgical approach and resection extent.
Area of Science:
- Neurosurgery
- Oncology
- Ophthalmology
Background:
- Midline suprasellar meningiomas present diverse clinical and prognostic characteristics.
- Understanding these features based on tumor origin and growth pattern is crucial for patient management.
Purpose of the Study:
- To elucidate the clinical and prognostic features of midline suprasellar meningiomas.
- To correlate tumor origin and growth patterns with patient outcomes and treatment strategies.
Main Methods:
- Retrospective review of medical records for patients undergoing surgical resection.
- Classification of meningiomas into groups based on origin and growth pattern relative to optic pathways and pituitary stalk: Planum Sphenoidale Meningioma (PSM), Tuberculum Sellae Meningioma (TSM), and Diaphragma Sellae Meningioma (DSM) (further divided into C1 and C2).
Main Results:
- Visual impairment rates varied significantly by group (highest in C2, lowest in A).
- Group C1 meningiomas showed higher rates of pituitary stalk involvement and postoperative visual field deficits.
- Gross total resection (GTR) was achieved in 79% of patients; the fronto-temporal approach predicted visual acuity and field impairment.
- Group C1 meningiomas had the lowest recurrence-free survival (RFS) rate (33.3%).
- Subtotal resection and Group C1 meningioma were significant predictors of recurrence.
Conclusions:
- Planum Sphenoidale Meningioma (Group A) demonstrated high complete resection rates and favorable RFS.
- Tuberculum Sellae Meningioma (Group B) and Group C2 meningiomas predominantly involved the optic pathway.
- Diaphragma Sellae Meningioma (Group C1) was an independent predictor of subtotal resection, visual field deficits, and pituitary axis impairment.
- Subtotal resection emerged as a significant predictor of tumor recurrence.
