Tuberculum sellae meningiomas (TSMs) represent special surgical challenge for neurosurgeons. In this review, we summarize the most common clinical manifestations, diagnostic images, surgical approaches and prognostic ...Tuberculum sellae meningiomas (TSMs) represent special surgical challenge for neurosurgeons. In this review, we summarize the most common clinical manifestations, diagnostic images, surgical approaches and prognostic factors for outcome at single tertiary care teaching hospitals. Material and Methods: Prospective study was done between January 2010 and January 2017 (Minimum 24-month follow-up). Imaging and clinical data of 31 consecutive patients with TSMs were collected and analyzed. There were no exclusion criteria. Result: The majority of patients were >40 years old (22 patients;71%). There was a female preponderance 74%: 23 cases (M/F ratio was 1:3). The most common clinical presentation was visual impairment (24;77%). The mean tumor size was 3.3 cm. Thirty-one patients underwent surgical excision by different approaches. The overall visual improvement was 29% (9 of 31 patients) however visual deterioration occurred in 6.4% (2 of 31 patients). Favorable prognosis was found in patients with short preoperative visual affection (less than 6 months). This finding was statistically significant (P ≤ 0.05). Also, visual outcome had significant correlations with edema surrounded tumor: arterial encasement by the tumor and brain-tumor interface. Two patients died 3 weeks postoperatively from brain stem infarction (overall incidence of mortality 6%) while the overall incidence of morbidity was 19% (6 of 31 patients). Conclusion: The most common symptom of Tuberculum sellae meningioma is visual affection. The favorable prognosis was found in patients with short preoperative visual affection (less than 6 months). Also;visual prognosis had significant correlations with peritumoral edema, arterial encasement by the tumor, and brain-tumor interface.展开更多
Background： Tuberculum sellae meningiomas （TSMs） present a special symptom because of the adherence and compression to the optic nerve, optic artery, and the chiasm. A significant number of patients with TSMs appea...Background： Tuberculum sellae meningiomas （TSMs） present a special symptom because of the adherence and compression to the optic nerve, optic artery, and the chiasm. A significant number of patients with TSMs appear visual deficits. This study aimed to investigate the surgical indications of exploring the optic canal and visual prognostic factors in the neurosurgical treatment of TSMs. Methods： Totally 21 patients with TSM, who were operated from September 2007 to August 2011 in the Department of Neurosurgery, Tongren Hospital were enrolled in this study. Results of orbital computed tomography （CT） and magnetic resonance imaging （MRI）, visual acuity, Goldmann visual field test, orbital color Doppler flow imaging （CDI） test in these patients were retrospectively analyzed. Results： Visual deficit and optic canal involvement （OCI） were detected in all the 21 patients. Fourteen patients had bone proliferation within the area of the optic canal. After the operation, visual outcomes were improved in 13 patients, unchanged in 7 patients, and deteriorated in 1 patient. All the 21 patients performed orbital CDI test preoperatively, the results showed that if the peak systolic velocity （PSV） of central retinal artery （CRA） value was 〈8 cm/s, the visual outcome would be better. Conclusions： The surgical indications of exploring optic canal in TSM cases included： （1） The neuroimaging evidences of OCI （CT and/ or MR/）; （2） PSV of CRA in orbital CDI test was ≤8 cm/s; （3） visual acuity was below 0.1 ; （4） visual field deficit. The PSV of CRA in CDI test could be a prognostic factor for visual outcomes of TSMs.展开更多
文摘Tuberculum sellae meningiomas (TSMs) represent special surgical challenge for neurosurgeons. In this review, we summarize the most common clinical manifestations, diagnostic images, surgical approaches and prognostic factors for outcome at single tertiary care teaching hospitals. Material and Methods: Prospective study was done between January 2010 and January 2017 (Minimum 24-month follow-up). Imaging and clinical data of 31 consecutive patients with TSMs were collected and analyzed. There were no exclusion criteria. Result: The majority of patients were >40 years old (22 patients;71%). There was a female preponderance 74%: 23 cases (M/F ratio was 1:3). The most common clinical presentation was visual impairment (24;77%). The mean tumor size was 3.3 cm. Thirty-one patients underwent surgical excision by different approaches. The overall visual improvement was 29% (9 of 31 patients) however visual deterioration occurred in 6.4% (2 of 31 patients). Favorable prognosis was found in patients with short preoperative visual affection (less than 6 months). This finding was statistically significant (P ≤ 0.05). Also, visual outcome had significant correlations with edema surrounded tumor: arterial encasement by the tumor and brain-tumor interface. Two patients died 3 weeks postoperatively from brain stem infarction (overall incidence of mortality 6%) while the overall incidence of morbidity was 19% (6 of 31 patients). Conclusion: The most common symptom of Tuberculum sellae meningioma is visual affection. The favorable prognosis was found in patients with short preoperative visual affection (less than 6 months). Also;visual prognosis had significant correlations with peritumoral edema, arterial encasement by the tumor, and brain-tumor interface.
文摘Background： Tuberculum sellae meningiomas （TSMs） present a special symptom because of the adherence and compression to the optic nerve, optic artery, and the chiasm. A significant number of patients with TSMs appear visual deficits. This study aimed to investigate the surgical indications of exploring the optic canal and visual prognostic factors in the neurosurgical treatment of TSMs. Methods： Totally 21 patients with TSM, who were operated from September 2007 to August 2011 in the Department of Neurosurgery, Tongren Hospital were enrolled in this study. Results of orbital computed tomography （CT） and magnetic resonance imaging （MRI）, visual acuity, Goldmann visual field test, orbital color Doppler flow imaging （CDI） test in these patients were retrospectively analyzed. Results： Visual deficit and optic canal involvement （OCI） were detected in all the 21 patients. Fourteen patients had bone proliferation within the area of the optic canal. After the operation, visual outcomes were improved in 13 patients, unchanged in 7 patients, and deteriorated in 1 patient. All the 21 patients performed orbital CDI test preoperatively, the results showed that if the peak systolic velocity （PSV） of central retinal artery （CRA） value was 〈8 cm/s, the visual outcome would be better. Conclusions： The surgical indications of exploring optic canal in TSM cases included： （1） The neuroimaging evidences of OCI （CT and/ or MR/）; （2） PSV of CRA in orbital CDI test was ≤8 cm/s; （3） visual acuity was below 0.1 ; （4） visual field deficit. The PSV of CRA in CDI test could be a prognostic factor for visual outcomes of TSMs.
