gms | German Medical Science

To evaluate the clinical result of surgically treated patients with a tuberculum sellae meningioma.

Clinical-ophthalmological and radio-logical investigations of all patients who were operated on at our institution from 1990 to 2003 were analysed. Visual function was monitored by using a scoring system combining visual acuity and visual fields.

23 patients harboring a meningioma of the tuberculum sellae were operated on (average age 50 years, 18 female, 5 male). The primary symptom was progressive asymmetrical visual loss in 86%. In 14% the tumour was an incidental finding. No patient had any clinical sign or laboratory finding of endo-crinological malfunction. All tumours were operated via a pterional approach. In one case, the meningioma was removed by a two-step bilateral craniotomy. The right side was preferred (85%) unless the tumour extended mainly unilateral and below the right optic nerve and sparing the left. There was no mortality. Visual function improved in 77% of patients with affected vision. In 44% of these patients, visual function could be normalized. The degree of visual improvement was better in patients below the age of 60 years and with duration of symptoms less than 12 months. Patients without visual symptoms had no morbidity. The rate of moderate complications was 9%, comprising 2 patients with anosmia. One 75 years-old patient with the largest tumour and severe visual impairment preoperatively showed an amaurois after surgery. In a follow-up of 1 to 13 years, one reccurrence was observed.

Improvement of visual function after surgical removal of tuberculum sellae meningiomas is to be expected in most cases. Patients below the age of 60 and duration of symptoms less than 12 months have a better prognosis. Surgical removal should be attempted as soon as visual disturbances occur.