Meningiomas of the tuberculum sellae. Our experience in 69 cases surgically treated between 1973 and 1993.
BACKGROUND
Meningiomas of the tuberculum sellae are lesions with well-defined characteristics in terms of both site of origin and clinical evolution which require differential diagnosis with lesions of the supra- and para-sellar region. The aim of this study is to point out the importance of the size of the lesion and early identification of symptoms for prompt diagnosis, crucially important for evaluating the reversibility of functional damage, especially of the optic nerves.


METHODS
Between 1953 and 1993, 110 cases of tuberculum sellae meningioma were operated at the Neurosurgical Institute, Department of Neurosciences, of Rome "La Sapienza" University; only 69 cases of these cases were operated on after 1973, the year in which microsurgical techniques were introduced into routine surgical practice. Tumor diameter ranged from 3 to 9 cm. Most of the patients presented severe visual loss.


RESULTS
Removal was total in 63 cases (91.3%), sub-total in 6 (8.7%). Besides the surgeons firsthand impression, the grade of removal was evaluated by early CT and/or MRI (24-36 hours after surgery). A minimum follow-up of 3 years was taken into consideration for assessment of late functional results. Five patients died in the postoperative period (7.2%).


CONCLUSIONS
This study clearly demonstrated that a tumor diameter greater than 4 cm is a critical factor for visual function. The size of the lesion was also found to be extremely important, in that it influences the amount of tumor resection possible. Therefore, in our opinion, alternative types of treatment such as radiosurgery should be confined to the tumor residue.
Raco
A
A
Department of Neurosciences-Neurosurgery I and Neurotraumatology, University of Rome La Sapienza.
Bristot
R
R
Domenicucci
M
M
Cantore
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008579:Meningioma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications; D011788:Quality of Life; D012658:Sella Turcica / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome