Long-Term Outcomes of Endoscopic Endonasal Resection for Tuberculum Sella Meningiomas

Tuberculum sella meningiomas (TSM) constitute 5% to 10% of intracranial meningiomas and pose surgical challenges because of their proximity to critical neurovascular structures and the optic chiasm. We aimed to evaluate the long-term efficacy of the endoscopic endonasal approach (EEA) for TSMs at a university skull base center.

A retrospective study of patients with TSM treated using EEA between 2008 and 2024 with a minimum 6 months of follow-up. Clinical outcomes, including the extent of resection, visual outcomes, complications, and recurrence rates, were evaluated.

The 92 patients were predominantly female (82.6%), with a median age of 58.3 (range 27.5-82.1) years. Eighteen patients (19.6%) had multiple meningiomas, and 10 (10.9%) were treated for recurrent TSM. The median maximum diameter of tumor was 2.0 (range 0.4-5.4) cm. Most TSMs were World Health Organization grade I (97.8%). Simpson Grade 1 resection was achieved in 72 cases (78.3%). 57/80 patients (71.3%) with preoperative visual dysfunction reported improvement, and 2 (2.5%) reported decline. Of patients with postoperative testing, the visual acuity improved in 38/52 patients (73.1%) and declined in 1 patient, and visual fields improved in 42/54 patients (77.8%) and declined in 3 patients. Postoperative complications were observed in 19 (20.7%) patients, including 12 (13%) with cerebrospinal fluid leak and 1 Heubner infarct. Seven patients (7.6%) experienced recurrence and the median follow-up was 52 months (IQR 24.0-91.4). On multivariable Cox proportional hazard analysis, only non-Simpson Grade 1 resection (hazard ratio = 22.5, P = .004) was associated with recurrence or regrowth.

EEA is a safe and effective primary treatment for TSMs, yielding a high Simpson Grade 1 rate, resultantly low long-term recurrence rate, and improved visual outcomes.