gms | German Medical Science

66th Annual Meeting of the German Society of Neurosurgery (DGNC)
Friendship Meeting with the Italian Society of Neurosurgery (SINch)

German Society of Neurosurgery (DGNC)

7 - 10 June 2015, Karlsruhe

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Prediction of optic canal involvement in parasellar meningiomas: Comparison of preoperative standard MRI, high-resolution MRI, neuroophtalmoloic examination and intraoperative findings

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  • Florian H. Ebner - Klinik für Neurochirurgie, Eberhard-Karls-Universität Tübingen
  • Alex Roman - Klinik für Neurochirurgie, Eberhard-Karls-Universität Tübingen
  • Till K. Hauser - Abteilung für Neuroradiologie, Eberhard-Karls-Universität Tübingen
  • Giulia DelMoro - Klinik für Neurochirurgie, Eberhard-Karls-Universität Tübingen
  • Paulo Mesquita Filho - Klinik für Neurochirurgie, Eberhard-Karls-Universität Tübingen
  • Kristofer Ramina - Klinik für Neurochirurgie, Eberhard-Karls-Universität Tübingen
  • Georgios Naros - Klinik für Neurochirurgie, Eberhard-Karls-Universität Tübingen
  • Florian Roser - Neurological Institute, Clevland Clinic Abu Dhabi
  • Marcos Tatagiba - Klinik für Neurochirurgie, Eberhard-Karls-Universität Tübingen

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocDI.09.04

doi: 10.3205/15dgnc130, urn:nbn:de:0183-15dgnc1308

Published: June 2, 2015

© 2015 Ebner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: To evaluate specificity and sensibility of standard MRI, High-Resolution orbit MRI (HI-MRI) and clinical examination in assessing meningioma growth inside the optic canal, compared to the intraoperative findings.

Method: We assessed 151 patients with parasellar meningiomas operated on from January 2004 to September 2012 at our Neurosurgical Department. On the basis of preoperative standard MRI (58 patients) and HI-MRI (93 patients), the presence of optic canal invasion of the meningiomas was evaluated and compared to the intra-operative findings. Patients' charts were analyzed regarding demographic data, clinical symptoms, pre and post-operative visual status, decompression of the OC, histological tumor type, degree of resection (Simpson criteria) and complications.

Results: Standard MRI sequences (58 patients) showed extension into the OC in 20 cases (35%), whereas in 38 we found no evidence of invasion (65%). Among the latter, the OC was unroofed intra-operatively in 19 cases, showing extension of the tumor into the OC in 17 patients (90%). No tumor was detected 2 of them (10%) (sensitivity 56%, specificity 100%). The HI-MRI (93 patients) showed tumor extension inside the OC in 58 patients. In 45 cases the OC was opened, no tumor was detected in 3 cases. In 13 cases the OC was not opened after microscopic inspection. Hi-MRI showed no tumor invasion in 35 patients. These finding was confirmed in 23 cases, but in 12 cases we detected tumor at surgery (11 openings of the OC, one removal without opening).

There was statistical correlation between intra-OC tumor presence on the MRI and surgical findings (p<0.001). Nominal regression analysis demonstrated pre-operative visual impairment as the strongest predictive factor of intra-OC meningioma (p<0.01). Statistical significant correlation was also encountered between surgical OC-opening and long-term visual outcome (Chi-square test: p<0.05).

Conclusions: Neither standard nor high-resolution MRI predict precisely the topographic relation of a parasellar meningioma with the optic canal. An accurate intraoperative inspection is mandatory. The clinical finding of visual impairment is the strongest predictive factor.