Tuberculum sellae meningiomas: functional outcome in a consecutive series treated microsurgically

Bassiouni, Hischam; Asgari, Siamak; Stolke, D.

doi:10.1016/j.surneu.2005.11.059

Cited by 127 publications

(103 citation statements)

References 35 publications

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“…Two patients had lesions involving arteries, one patient had a lesion that invaded the pituitary stalk, and one patient had a tumor involving both optic nerves. The extension of tumoral resection according to Simpson I and II classification varies from 62% to over 90% 5,[17][18][19][20] and, gen- erally, depends on the consistency of the tumor, vascular encasement, tumor size, and clinical condition of the patients 17,19 . Large tumors seem to be a crucial factor for prediction of surgical outcome 17,19 .…”

Section: Discussionmentioning

confidence: 99%

“…Margalit et al 11 reported a case of stroke secondary to supraclinoid ICA occlusion. Bassiouni et al 18 described a patient who presented bilateral deterioration of visual acuity after injury of one segment of the ACA and another patient who suffered a stroke in the dominant hemisphere and whose ICA was lacerated and had to be clipped. The risk of lesion to the arteries involved by the tumor is higher in patients with hard tumors.…”

Section: Discussionmentioning

confidence: 99%

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Tuberculum sellae meningiomas: surgical considerations

Landeiro

Gonçalves

Guimarães

et al. 2010

Arq. Neuro-Psiquiatr.

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We report our experience on the treatment of tuberculum sellae meningiomas (TSMs) regarding the involvement of the optic canal and clinical outcomes. We reviewed 23 patients who were operated on between January 1997 and December 2008. The surgical approach was unilateral subfrontal supraorbital osteotomy in one piece. Attempts were made to improve visual function via extra/intradural unroofing of the optic canal, which released the optic nerve. Visual symptoms were present preoperatively in 21 patients, and two patients were asymptomatic. Visual acuity remained intact in 6 patients, improved in 10, was unchanged in 5 patients, and worsened in 2 patients. The postoperative visual field was normal or improved in 17 patients, unchanged in four patients, and worsened in two patients. The optic canal and clinoid were drilled extradurally in eight patients and intradurally in nine patients. Total resection of TSMs was achieved in 19 patients. Incomplete resection occurred in two patients. Decompression of the optic canal seemed to increase the visual outcome. Key words: tuberculum sellae meningioma, optic canal, visual symptoms. Meningiomas do tuberculo selar: aspectos cirúrgicos resuMoApresentamos nossa experiência em 23 pacientes operados com meningiomas do tubérculo da sela, com enfoque na descompressão do nervo óptico e nos sintomas visuais do pós-operatório. Vinte e três pacientes com meningiomas do tubérculo da sela foram operados entre janeiro de 1997 e dezembro de 2008, através do acesso subfrontal via ostetomia supraorbital. Remoção do teto do canal óptico por via extra ou intradural foi realizada em 17 pacientes. Sintomas visuais no pré-operatório ocorreram em 21 pacientes, 2 eram assintomáticos. Melhora visual ocorreu em 10, permaneceu inalterada em 5 e piorou em 2 pacientes. No pós-operatório o campo visual normalizou-se em 17 pacientes, permaneceu inalterado em 4 e diminuiu em 2. Descompressão dos nervos ópticos foi realizada em 17 pacientes. Ressecção total dos meningiomas do tubérculo da sela foi possível em 19 pacientes. Abertura do canal óptico permitiu a manipulação do nervo óptico sem novos déficites. Palavras-chave: meningioma, tubérculo selar, nervo óptico, sintomas visuais.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Tuberculum sellae meningiomas: surgical considerations

Landeiro

Gonçalves

Guimarães

et al. 2010

Arq. Neuro-Psiquiatr.

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“…3) The standard treatment for meningioma is surgical resection through craniotomy, targeted at gross total removal. 2,4,6,9,16,23,24,31,35) The treatment goal is longterm tumor control with minimal neurological morbidity. However, the tumor often extends to important neurovascular structures in the skull base, so total tumor resection (Simpson grades 1-2) is achieved in only 20-87.5% of patients.…”

Section: Introductionmentioning

confidence: 99%

“…However, the tumor often extends to important neurovascular structures in the skull base, so total tumor resection (Simpson grades 1-2) is achieved in only 20-87.5% of patients. 2,4,23,24,31,35) Unacceptably high incidences of symptomatic recurrence are observed after subtotal resection of meningiomas. 20,33) In addition, postoperative complications occur in 16.1-61.5% of patients, although overall complication rates are not always reported.…”

Section: Introductionmentioning

confidence: 99%

“…20,33) In addition, postoperative complications occur in 16.1-61.5% of patients, although overall complication rates are not always reported. 2,23,31,35) Stereotactic radiosurgery has now become a less invasive and effective treatment option for intracranial meningioma, especially in patients with high-risk tumors such as skull base lesions. 1,[11][12][13][14][15][16]18,19,21,22,26,27,30,32,34,37) Stereotactic radiosurgery provides excellent outcomes with local tumor control rates of 85-100%, but these rates tend to fall with longer follow-up periods.…”

Section: Introductionmentioning

confidence: 99%

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Stereotactic Radiosurgery for Skull Base Meningioma

Igaki

Maruyama

Koga

et al. 2009

Neurol. Med. Chir.(Tokyo)

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Stereotactic radiosurgery is now a treatment option for meningiomas, especially for high-risk patients such as those with skull base lesions. The clinical outcomes were retrospectively analyzed of stereotactic radiosurgery using the Leksell Gamma Knife  performed for 98 patients with 106 skull base meningiomas at the University of Tokyo Hospital between June 1990 and April 2006 and followed up for more than a year. After a median follow-up period of 53.2 months (range 12.2-204.4 months), local tumor control rates were 86.9% and 78.9% at 5 years and 10 years, respectively. Tumors with volume of 4 cm 3 or smaller (97.5% vs. 76.1% at 5 years, p ＝ 0.001) and tumors completely included within the isodose line of 14 Gy or more (97.5% vs. 67.2% at 5 years, p ＝ 0.0006) had higher local control rates. Postoperative residual tumors treated by stereotactic radiosurgery were controlled in all 25 cases. Cranial nerve deficits were improved, stable, and deteriorated in 12, 64, and 3 patients, respectively, after stereotactic radiosurgery. Stereotactic radiosurgery was effective treatment method for local control of skull base meningiomas, especially for small or postoperative residual tumors. Correct combination of microsurgery and radiosurgery leads to excellent local control.

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