Objective: The surgical strategies and outcomes for 70 patients operated on for tuberculum sellae meningioma were analyzed retrospectively. The analysis was based on factors that probably determined the difficulties encountered during surgery, assisted in predicting the extent of resectability, and helped in predicting the surgical outcome.
Methods: Seventy patients with tuberculum sellae meningiomas were operated on in the neurosurgery department at King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Bombay, India, between 1991 and May 2001. The patients were analyzed retrospectively on the basis of clinical and radiological factors that appeared to affect the outcome. Each factor was given points, and for each tumor, the points were added to obtain a score. On the basis of the score, the tumors were then divided into three grades. The grades determined the difficulties that could be anticipated during surgery. The majority of patients were operated on by use of unifrontal craniotomy on the side of worse vision by standard dissection techniques.
Results: Total tumor resection was achieved in 59 patients, and subtotal tumor resection with less than 7% of tumor left behind was achieved in 11 patients. All patients with subtotal resection had higher-grade tumors. Preoperative visual status had a bearing on the visual outcome after surgery. Four patients were misdiagnosed as having a pituitary tumor. Two patients died in the immediate postoperative period. The average follow-up was 46 months (range, 6 mo to 9 yr). There was symptomatic recurrence in one patient in whom a subtotal resection had been performed.
Conclusion: The extent and duration of visual symptoms, encasement of the anterior cerebral artery complex, and size of the tumor were the more important factors that affected the surgery. The grading system gave a reasonable assessment concerning the possible surgical problems.