gms | German Medical Science

Suprasellar meningiomas are often diagnosed because of vision impairment, in few cases also incidentally. Not only the surgical technique but also the initial clinical severity of the symptoms may influence the outcome of these patients. Our retrospective analysis should reveal whether the latter consideration may be correct.

We analyzed clinical data of patients with meningiomas located in the suprasellar region, including those arising from the tuberculum sellae or the medial sphenoidal ridge extending to the suprasellar area. We operated 783 meningiomas from 1993 to 2003. There were 35 operations on 34 patients with suprasellar meningiomas. We focused on the clinical symptoms leading to diagnosis and the outcome of these patients comparing the Karnofsky score (KS) and the change of visual acuity. The mean observation time amounted to 1.5 years, ranging from 2 weeks to 10 years.

The female-male-ratio was 2:1, the age ranged between 29 and 79 years (mean 57). Most of the patients (94%) suffered from visual disorder which particularly were combined visual field defects and worsening of visual acuity in 23 cases, 4 cases of scotomas, 9 patients only had a sight disorder. Seizures occurred in one case. One of the patients had no symptoms, MRI imaging revealed the recurrence of a meningioma which has been operated 2 years before. There were no patients with hormonal disorders. The Karnofsky score ranged between 70 and 90 (mean 90) at admission, and from 10 to 100 (mean also 90) at the end of the observation period. It was unchanged in 17 (50%), improved in 13 (38%) and worsened in 4 cases (12%). A total removal (Simpson I and II) could be performed in 28 (82%) cases. There was no perioperative mortality and only 1 case (3%) of severe complication, a secondary hemorrhage. We achieved an improvement of visual acuity in 19 patients (56%), no change in 8 (24%) cases and a deterioration in 5 (14%) (2 of them were postoperatively amaurotic). 12 of 13 patients with an unchanged or worsened vision had a severe visual field defect or a vision less than 50% before the operation.

Visual disorders are obviously the most common symptoms leading to diagnosis. The better the visual status at admission, the better is the probability of improvement.