Giant tuberculum sellae meningioma with unruptured anterior. A technical purview on pterional approach anil nanda1 devi prasad patra1 amey rajan savardekar1 nasser mohammed1 vinayak narayan1 shyamal c. Introduction although tuberculum sellae ts and diaphragma sellae ds meningiomas have different anatomical origins, they are frequently discussed as a single entity. They arise from the tuberculum sellae, chiasmatic sulcus, limbus sphenoidale, and diaphragma sellae and grow in a subchiasmal position.
They comprise approximately 3 to 10% of all intracrani. Suprasellar meningioma usually arises from the tuberculum sellae or the sulcus chiasmatis. Here, we reported a case of tuberculum sellae meningioma with beak of kiwi bird enhancement in contrast mri at our department. Meningiomas of the tuberculum sellae and planum sphenoidale. Although tuberculum sellae ts and diaphragma sellae meningiomas have different anatomical origins, they are frequently discussed as a single entity. Conclusion we think that tuberculum and diaphragma sellae meningiomas are anatomically indistinguishable and should be termed tuberculum sellae meningioma. All patients underwent craniotomy, with an operating microscope being used in 62 cases. They arise from the tuberculum sellae, planum sphenoidale, and chiasmatic sulcus and account for 5 to 10% of all intracranial meningiomas. They comprise approximately 3%10% of all intracranial meningiomas 2. Einseitige opticusatrophie mit amaurose mehr oder weniger ausgepragt. The sellae turcica is usually not expanded or only slightly enlarged in tuberculum sellae meningiomas, in contrast to pituitary adenomas, which usually expand the sellae. Meningiomas of the tuberculum sellae arise from the. Tuberculum sellae meningiomas constitute 510% of intracranial meningiomas 12,25.
This can be avoided by meticulous internal decompression and. Results sixtythree patients with either an optic nerve sheath n 16 or a sphenoid ridge or tuberculum sellae meningioma n 47 were seen mean age. The series included 51 patients operated on at the mayo clinic between jan. The main purpose of surgery for tuberculum sellae meningioma tsm is the improvement andor stabilization of patients visual function. There were 16 women and 4 men ranging from 27 to 75 years. The coexistence of a pituitary macroadenoma and a tuberculum sellae meningioma is very rare 3. A delay in the diagnosis of meningiomas of the tuberculum sellae and planum sphenoidale can lead to poor surgical results in terms of visual prognosis, morbidity, and mortality. Tuberculum sellae meningiomas neurosurgery oxford academic. Surgical management of tuberculum sellae meningiomas. On brain magnetic resonance imaging, a tuberculum sellae meningioma was found, and hyperintense white matter lesions with possible tacrolimusinduced neurotoxicity were seen on fluidattenuated inversion recovery images. Magnetic resonance imaging of tuberculum sellae meningiomas. Anterior interhemispheric approach for tuberculum sellae.
Meningiomas of the tuberculum and diaphragma sellae. Therefore, they must be distinguished from tumors arising from different sites, such as the olfactory groove. Visual prognosis is variable, with most series reporting an improvement in visual function in. Neurosurgery department, university general hospital of alicante, foundation for the promotion of health and biomedical research in the valencian region fisabio, alicante, spain. Tuberculum sellae meningiomas represent 3% to 10% of all meningiomas 1. Slowly progressing visual deterioration is the most common initial complaint, and prompt treatment is directed at preserving and improving vision. Complete tumor resection with preservation or improvement of visual function is the goal of tuberculum sellae meningioma tsm treatment. The aim of this study was to evaluate visual outcome in patients with tuberculum sellae meningioma tsm treated microsurgically using the frontolateral or. Visual impairment was the most common initial complaint.
The difficulty in surgically excising a tuberculum sellae meningioma comes from its anatomical relationship to the optic nerves and chiasm and to the anterior cerebral and internal carotid arteries and their perforators. This study illustrates a number of important signs of how to distinguish a suprasellar mass from one arising from the pituitary. Pure endoscopic expanded endonasal approach for olfactory groove and tuberculum sellae meningiomas. Their location in the parasellar region, in close vicinity. Options for the side of lateral approaches usually were restricted for nondominant rightsided craniotomy or to the side of impaired vision ipsilateral approaches. Microsurgery of tuberculum sellae meningiomas sciencedirect. Optic tract edema in a meningioma of the tuberculum sellae.
Meningiomas of the anterior skull base account for 40% of all intracranial meningiomas. To evaluate the endocrinological and ophthalmological results of the tuberculum sellae meningioma surgery. Representing 5 to 10% of intracranial meningiomas, tuberculum and diaphragm sellae meningiomas are intimately involved with the critical suprasellar structures. They originate from the dura mater of tuberculum sellae, planum sphenoidale, and chiasmatic sulcus and comprise 5% to 10% of all intracranial meningiomas 1. The frontopterional approach represents a natural, simple, and elegant approach to this area enabling surgeon to have a direct control on all anatomical structures. Transsphenoidal versus transcranial approach for treatment. In 17 patients, progressive asymmetrical visual loss from 3 to 48 months was the symptom leading to medical consultation. Tuberculum sellae meningiomas tsms are not uncommon variety among the intracranial meningiomas. Tuberculum sella meningioma the neurosurgical atlas, by.
A retrospective analysis was done on 53 patients 40 female with meningiomas originating from the tuberculum sellae who underwent surgery between 1991 and 2002. Prospective study was done between january 2010 and january 2017. We describe a 33 year old female pregnant patient who presented with deterioration in vision of the left eye during her 28. A new classification system that can guide the surgical approach and may predict surgical risk is proposed. We report a modern surgical technique specific for planum sphenoidale and tuberculum sellae meningiomas with associated outcome.
Meningiomas of the tuberculum and diaphragma sellae europe. Paper surgical management of tuberculum sellae meningiomas. The standard surgical approach consisted of pterional. The pathogenesis of this edema in meningioma is controversial. A total of 18 patients diagnosed with tuberculum sellae meningioma received surgical treatment at neurosurgery clinic at military medical. Although the safety and effectiveness of ipsilateral transcranial approach was proved. The female patient was 32yearold, suffering from progressive loss of vision for about 6 months.
Olfactory groove and tuberculum sella meningioma duration. Contrary to a prior report on this topic, edema along the optic tract is not only seen in craniopharyngiomas but may be seen although rarely in other common parasellar tumors, as in our case of a tuberculum sellae meningioma. From 1991 to 2001, 20 patients harboring a meningioma of the tuberculum sellae were operated on. A variable slight to prominent median elevation forming the posterior boundary of the chiasmatic groove and the anterior boundary of the hypophysial fossa. Pdf on jan 1, 2019, mohamed khallaf and others published tuberculum sellae meningiomas. Such lesions are classically removed through a variety of wellstandardized transcranial approaches. These tumors are a distinct clinical entity, displacing the optic pathways upward and laterally and, thus, occupying a subchiasmal location. The potential injury to the aca junction during eea is more often due to the avulsion of perforators from aca 4, 7, 1011. Harvey cushing conducted the autopsy of one of his patients who had suffered most likely from a tuberculum sella or medial sphenoid wing meningioma circa 19image courtesy of the cushing brain tumor registry at yale university. Tuberculum sellae meningiomas are a classic tumor of the anterior fossa that present in patients with gradual visu al deterioration secondary to optic apparatus. The tuberculum sellae or the tubercle of the sella turcica is a part of the sphenoid bone that is an elevation behind the chiasmatic groove. In three patients, the meningioma was an incidental finding. A tumoral remnant grade iii or iv resection was intentionally left in four patients.
Treatment involves tumor removal and decompression of the optic chiasm via several operative approaches. They are more common in women between the ages of 30 and 60 years. To present a large series of surgically treated tuberculum sellae meningiomas with particular regard to involvement of the optic canal and visual outcome. The eyebrow supraorbital keyhole approach is gradually preferred to treat tuberculum sellae and planum sphenoidale meningiomas as a less invasive approach compared to the more traditional approaches. Although no specific radiological feature was pathognomonic, a combination of several features allowed the correct diagnosis in all cases. It accounts for up to 10% of all intracranial meningiomas. The tuberculum sellae is the ridged process of the sphenoid bone which forms the anterior wall of the sella turcica gross anatomy relations. A case of tuberculum sellae meningioma with beak of kiwi. Simpson grade i or ii was achieved in 19 patients, and grade iii or iv was attained in four cases. We report a case of tuberculum sellae meningioma with optic tract edema. Although the safety and effectiveness of ipsilateral. Deep location of tumor, vascular and nerve encasement, and pituitary stalk involvement are the main technical issues. Tuberculum sellae meningiomas tsms represent 5 to 10% of intracranial meningiomas 12,17,35,40,44,49. May 19, 2015 university of pittsburgh center for skull base surgery associate director juan c.
Tuberculum sellar meningioma ucla pituitary tumor program. Tuberculum sellae meningiomas represent 5 to 10% of all intracranial meningiomas. Our patient was a 57yearold female with progressive visual deterioration and a complex sellarsuprasellar lesion. The extended endonasal transsphenoidal route, under either microscopic or endoscopic visualization, has only recently been proposed as a viable surgical technique. Tuberculum sellae meningiomas tsms represent a distinct clinical entity among the intracranial meningiomas. Meningiomas of the tuberculum sella account for 4 to 10% of meningiomas, and they almost universally present with varying degrees of visual loss. A pterional craniotomy with microsurgical dissection of the sylvian fissure allows access to these tumors with minimal neurological and ophthalmological morbidity. Transsphenoidal versus transcranial approach for treatment of. Interestingly, the patient showed no visual field defects, and his blood tacrolimus concentration was within therapeutic ranges. Mar 16, 2020 the main purpose of surgery for tuberculum sellae meningioma tsm is the improvement andor stabilization of patients visual function.
With time, clearer terminology evolved, as most neurosurgeons recognize the importance of anatomic origin in surgical planning. Tuberculum sellae meningiomas characteristically lie in a suprasellar subchiasmal midline position, displacing the optic chiasm posteriorly and slightly superiorly, and the optic nerves laterally. Giant tuberculum sellae meningioma with unruptured. Tuberculum sellae meningioma remains a surgical challenge. We report our experience on the treatment of tuberculum sellae meningiomas tsms regarding the involvement of the optic canal and clinical outcomes. The aim of this study was to evaluate visual outcome in patients with tuberculum sellae meningioma tsm treated microsurgically using the frontolateral or frontoorbital approach and optic canal. Anterior interhemispheric approach, surgical removal, tuberculum sellae meningioma, visual impairment score, visual outcome neurosurgery 68ons suppl 1. We report our personal case series of 38 patients with tuberculum sellae meningiomas. Case report a 64yearold man presented at the neurosurgery department in our hospital. The following search terms in various combinations were used. To emphasize the high frequency of optic canal oc involvement in tuberculum sellae meningiomas. Tuberculum sellae meningioma with possible tacrolimus. Meningioma has an accelerated growth during pregnancy.
Outcome assessment after surgical treatment of tuberculum sellae. Tuberculum sella meningiomas represent a unique set of surgical challenges due to their threedimensional relationship with the optic. The tuberculum sellae meningioma is a challenge for neurosurgeons. Tuberculum sellae meningiomas tsms represent special surgical challenge for neurosurgeons. Mar 19, 2019 the following search terms in various combinations were used.
In the majority of patients with tuberculum sellae meningiomas, total resection may be achieved through a pterional approach with minimal complications. University of pittsburgh center for skull base surgery associate director juan c. It is an elongated ridge located immediately posterior to the chiasmatic groove, hence is related to the optic chiasm and anterior portions of. Planum sphenoidale and tuberculum sellae meningiomas. The present study was undertaken to reevaluate abnormal appearances in standard head roentgenograms from a series of cases of meningioma of the tuberculum sellae, and to appraise the angiographic and pneumographic abnormalities encountered. Pdf case report surgical management of tuberculum sellae. Hence, tuberculum sellae meningioma involvement of the aca junction without luminal narrowing, whether engulfment or encasement, is likely to be extraarachnoidal. Mri of a 63yearold male patient showing a tuberculum sellae meningioma after contrast. Due to the complex anatomy of the tuberculum sellae region, decision making is very difficult. Sep 30, 2018 representing 5 to 10% of intracranial meningiomas, tuberculum and diaphragm sellae meningiomas are intimately involved with the critical suprasellar structures.
The optic nerves and chiasm may be elevated or displaced with the increasing size of the tumor. The tuberculum sellae forms the anterior wall of the sella turcica, which houses the pituitary gland. When choosing an approach, neurosurgeons must carefully analyze which is the best alternative for each case, because these are among the most challenging surgeries in the neurosurgical. Additionally, a suprasellar base, optic canal extension, and a tapered dural tail are both suggestive of meningioma rather than pituitary adenoma. Pdf pure endoscopic expanded endonasal approach for. The roentgenologic manifestations of meningiomas in the. Tuberculum sellae meningiomas represent approximately 5 to 10% of intracranial meningiomas 2, 12, 25, 28, 29, 33. Tuberculum sellae meningiomas is a serious challenge for neurosurgeons.
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