gms | German Medical Science

The standard approach for surgery of parasellar meningiomas is the pterional craniotomy. However, alternative operative strategies like the frontoorbital approach are well described in the literature. The aim of this study is to define the indications for each approach.

In a retrospective analysis, we studied 14 patients with parasellar meningiomas (age range from 31 to 83, male to female ratio 1:4). The primary symptom was visual disturbance in 60%, vertigo in 13%, seizure in 7% and a transitory ischemic event in 7%. In two patients, the meningioma was an accidential finding. According to the preoperative imaging, the location of the tumor was in the region of the tuberculum sellae, the anterior clinoid process and the inner sphenoid wing. For craniotomy, a pterional or frontoorbital approach was used. Extent of resection was classified according to the grading system of Simpson.

The frontoorbital approach was used in 5 patients with meningiomas arising from the tuberculum sellae. Postoperatively, two patients showed a hyposmia, as the olfactory tract was torn by elevation of the frontal lobe during operation. One patient had to be reoperated twice due to local bleeding in the tumor bed and developed an amaurosis. In two patients (40%), visual disturbances improved postoperatively and in two patients visual function was unchanged (40%). The extent of the resection according to Simpson was grade I in two (40%), grade II in two (40%) and grade III in one patient (20%). A pterional craniotomy was performed in 9 patients. In one case, the tumor was located at the tuberculum sellae, in three cases it originated from the inner sphenoid wing and in five cases from the anterior clinoid process. Two patients developed a postoperative cererbrospinal fluid fistula and one of these two patients a meningitis. Visual deficits improved in 2 patients (22%) and in 7 patients visual function was unchanged (78%). The extent of the resection according to Simpson was grade II in five (56%), grade III in two (22%), and grade IV in two patients (22%).

Meningiomas of the parasellar region are not an uniform entity, but display different growth characteristics depending on their location. Tuberculum sellae meningiomas usually grow suprasellarly and, therefore we use the frontoorbital approach. In contrast, meningiomas of the anterior clinoid process and inner sphenoid wing spread more laterally and infrasellarly and are operated via a pterional craniotomy.