Can you see it? Visual outcomes in surgically treated tuberculum sellae meningiomas: a systematic review and meta-analysis
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João Vítor Miranda Porto de Oliveira1, Marcio Saquy Rassi1, Alex Michel Daoud1
1Division of Neurosurgery, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP) and Santa Casa de São Paulo School of Medical Sciences (FCMSCSP), São Paulo, SP, Brazil.
Introduction:
Meningiomas located on the tuberculum sellae often exhibit a strong association with the optic apparatus. Hence, ophthalmologic dysfunction often serves as the most common manifestation of tuberculum sellae meningiomas.
Objective:
To assess visual outcomes following transcranial microsurgical resection of tuberculum sellae meningiomas.
Material And Methods:
A systematic review and meta-analysis adhering to Cochrane Standards and PRISMA framework were conducted. PubMed, Embase, and Web Of Science databases were searched until May 2024. A subgroup analysis was performed based on the optic nerve decompression. Studies were categorized into two groups: Group 1 included papers in which less than 50 % of patients underwent optic nerve decompression, while Group 2 comprised studies where more than 50 % of patients received some form of optic nerve decompression. The study has been registered on PROSPERO, with the registration number CRD42024530649.
Results:
Thirty-two studies (N = 1.941) met the inclusion criteria. Visual function improvement rate was found to be 61 % (95 % CI: 55-66 %), while for the unchanged it was 26 % (95 % CI: 20-32 %) and worsened by 11 % (95 % CI: 8-13 %). The overall gross total removal rate across the studies was 85 % (95 % CI: 82-88 %) and recurrence was 4 % (95 % CI: 3-6 %). Among the studies that did not perform optic canal unroofing in the majority of cases (Group 1), the visual improvement rate was 60 % (95 % CI: 51-70 %), gross total remove rate was 87 % (95 % CI: 82-92 %) and recurrence was 3 % (95 % CI: 1-6 %). Group 2 showed rates of 69 % (95 % CI: 60-78 %), 89 % (95 % CI: 84-94 %), and 1 % (95 % CI: 0-3 %), respectively.
Conclusions:
In conclusion, the study findings suggest that transcranial microsurgical resection of for tuberculum sellae meningiomas yields positive outcomes in terms of improving visual function, gross total resection rates, and recurrence, especially those that did the optic nerve decompression in the majority of the cases.