gms | German Medical Science

61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010
Joint Meeting mit der Brasilianischen Gesellschaft für Neurochirurgie am 20. September 2010

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21. - 25.09.2010, Mannheim

Tuberculum sellae meningiomas: Ophthalmological and endocrinological outcome after microsurgical resection in a consecutive series of 75 patients

Meeting Abstract

  • Hischam Bassiouni - Neurochirurgische Klinik, Universitätsklinik Essen, Deutschland; Neurochirurgische Klinik, Westpfalz-Klinikum GmbH, Kaiserslautern, Deutschland
  • Siamak Asgari - Neurochirurgische Klinik, Universitätsklinik Essen, Deutschland; Neurochirurgische Klinik, Klinikum Ingolstadt, Ingolstadt, Deutschland
  • Erol I. Sandalcioglu - Neurochirurgische Klinik, Universitätsklinik Essen, Deutschland
  • Ulrich Sure - Neurochirurgische Klinik, Universitätsklinik Essen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocV1551

DOI: 10.3205/10dgnc028, URN: urn:nbn:de:0183-10dgnc0283

Veröffentlicht: 16. September 2010

© 2010 Bassiouni et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: We reviewed the ophthalmological and endocrinological short- and long-term follow-up results in a consecutive microsurgical series of patients harboring a tubercullum sellae meningioma.

Methods: The clinical records of 75 patients harboring a tuberculum sellae meningioma and who underwent microsurgical tumor resection between January 1990 and January 2008 were retrospectively reviewed. Data analysis particularly focused on ophthalmological and endocrinological results.

Results: The 57 women and 18 men had a mean age of 54 years (range 29 to 81 years). 66 patients (88%) presented with a compromised vision. Preoperative ophthalmological examination revealed a decreased visual acuity on one eye in 26 (35%) and binocular in 35 patients (47%). A visual field defect was disclosed on examination in 50 patients (67%). The visual field cut was restricted to one eye in 28 patients (37%) and involved both eyes in 22 cases (29%). No patient primarily presented with endocrinological symptoms, however, 11 patients (15%) had hormonal abnormalities on preoperative endocrinological survey, the lactotropic and corticotropic axis being most commonly effected. Complete tumor removal defined as a Simpson grade I and II resection was achieved in 92% of the patients, usually via a pterional approach. Postoperative ophthalmological examination demonstrated improvement in visual acuity in 44% of the patients with preoperative visual compromise. No change was observed in 30% and a deterioration was observed in 17% of the cases. The visual field defect showed improvement in 21 (42%), remained unchanged in 18 (36%) and deteriorated in 8 (16%) of the cases. Permanent hormonal replacement was required in 13 (17%) of the patients. Three (4%) tumor recurrences were observed after a mean follow-up period of 7.3 years (1.5 to 17 years) with clinical and MRI examination and had to be re-operated.

Conclusions: Although optic nerve dislocation can be accurately visualized on preoperative magnetic resonance imaging, the exact relationship between the optic nerves and the tumor (e.g. adherence and encasement) affecting postoperative visual outcome can only be fully appreciated during microsurgery. Preservation of the microvasculature supplying the optic apparatus seems to play an important role in visual results.