Meningiomas of the Tuberculum and Diaphragma Sellae

Abstract

Introduction?Although tuberculum sellae (TS) and diaphragma sellae (DS) meningiomas have different anatomical origins, they are frequently discussed as a single entity. Here we review the radiologic and intraoperative findings of TS and DS meningiomas and propose a radiologic classification. Methods?We retrospectively reviewed 10 consecutive TS and DS meningiomas. Data regarding clinical presentation, preoperative imaging, and intraoperative findings were analyzed. Three sellar dimensions were measured on magnetic resonance imaging (MRI): the tuberculum-sellar floor interval (TSFI), the planum-tuberculum interval (PTI), and the total height. Results?Three distinct anatomical patterns were recognized: exclusively tubercular meningiomas (type A) were accompanied by elongation of the TSFI and, more significantly, of the PTI; combined TS and DS meningiomas (type B) were associated with relative elongation of both the PTI and TSFI; and the sole exclusively DS meningioma (type C) was associated with elongation of neither PTI nor TSFI. Conclusion?Suprasellar meningiomas can be classified as tubercular, combined, or diaphragmatic based on preoperative MRI. Exclusively tubercular meningiomas (type A) require only a supradiaphragmatic approach. Tumor involvement of the sellar diaphragm (type B or C) requires resection of the diaphragm and thus a combined infra- and supradiaphragmatic approach.

Suprasellar Meningiomas: An Experience of Four Cases With Brief Review of Literature

“…These tumors are common in females with a female to male ratio of 6:1. The mean age documented in the literature is 52 years (median 50, range 30-78), our cases also fall in this age category [ 8 ].…”

“…Meningiomas themselves constitute only 1% of the sellar masses [ 7 ]. Suprasellar/parasellar meningiomas occur in 5-10% of all intracranial meningiomas [ 8 ]. Meningiomas arising from the diaphragmatic sellae or sellae turcica are seldom seen (1%) [ 7 ].…”

Tuberculum sellae meningioma: Is there an ideal approach?

“…Prognosis is also better in younger patients with a short history of symptoms and good preoperative visual function. 3,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Regarding the surgical act, independently of technique, the initial debulking of the tumor should start from its center, where no vital structures are present. The arachnoid plane is then delineated, starting at the contralateral optic nerve and working toward the undersurface of the optic chiasma and then along the ipsilateral nerve.…”

“…In another study, Ajlan et al 23 noted that recent reviews comparing transcranial vs. endoscopic transnasal resections failed to show superiority of one approach over the other, as far as visual outcomes are concerned. The transnasal endoscopic access, in general, offers less complication from a statistical point of view, although tumor resection rates are less complete when compared to transcranial approaches.…”