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Suprasellar Meningioma Classification: Endoscopic Transnasal Perspective
Abdulrazag Ajlan1, Basim Noor Elahi1,2, Saif Almeshari1
1Division of Neurosurgery, Surgery Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Journal of Neurological Surgery. Part B, Skull Base
|July 5, 2024
Summary
This study proposes a new classification for suprasellar meningiomas based on bone and neurovascular interactions. Chiasmatic sulcus meningiomas are identified as a distinct subtype with unique surgical implications.
Area of Science:
- Neurosurgery
- Oncology
- Radiology
Background:
- Midline suprasellar meningiomas (MSMs) are challenging tumors with existing classification systems having limitations.
- Accurate classification is crucial for surgical planning and predicting outcomes.
Purpose of the Study:
- To develop a novel classification system for MSMs based on their relationship with adjacent bone and neurovascular structures.
- To identify distinct subtypes of MSMs and their clinical and surgical relevance.
Main Methods:
- Retrospective analysis of 40 patients with newly diagnosed MSMs treated via extended endoscopic transnasal approach (2015-2021).
- Evaluation of parameters including chiasmatic sulcus length, optic pathway involvement, and vascular displacement.
- Tumor classification into diaphragma sellae (Type A), tuberculum sellae (Type B), chiasmatic sulcus (Type C), and planum sphenoidale (Type D) meningiomas.
Main Results:
- 40 MSMs were classified: 1 Type A, 10 Type B, 9 Type C, and 10 Type D.
- Asymmetrical visual complaints were most frequent in Type C (66%) and Type B (50%) meningiomas.
- Type C meningiomas exhibited greater separation between the optic chiasm and A1/A2 complex (8.9 mm) and increased chiasmatic sulcus length compared to other types.
Conclusions:
- A preoperative classification based on bone involvement and tumor-neurovascular relationships is feasible for MSMs.
- Chiasmatic sulcus meningioma (Type C) represents a distinct subtype with unique anatomical behavior.
- Understanding this behavior is valuable for surgical planning and optimizing tumor resection outcomes.
