Surgically treated tuberculum sellae and diaphragm sellae meningiomas: the importance of short-term visual outcome.
OBJECTIVE
The visual outcome in patients with tuberculum and diaphragm sellae meningiomas treated with microsurgery was evaluated. Prognostic and diagnostic values of short- and long-term postoperative visual outcome and etiology for postoperative visual deterioration are discussed with special attention.


METHODS
Clinical data for 30 surgically treated patients with tuberculum and diaphragm sellae meningiomas were reviewed retrospectively. The mean duration of the follow-up period was 75.9 months (range, 12-151 mo). Mean tumor diameter and volume was 25.9 mm (range, 16.3-63.3 mm) and 12.4 cm (range, 2.3-125.6 cm). A visual impairment score was used to assess the short-term (< or =2 wk after surgery) and the long-term (>6 mo after surgery) postoperative visual outcome. Various predictive factors for visual outcome were tested statistically.


RESULTS
Complete resection was achieved in 23 out of 30 (76.7%) patients. Average preoperative, short- and long-term visual impairment scores were 48.2, 43.4, and 40.9, respectively. Favorable visual outcome was achieved in 80% of patients in the short term and 70% in the long term. Short-term postoperative aggravation of visual function was an ominous sign of further aggravation or at least of little hope for recovery, whereas there was a tendency to improve in the long term if short-term postoperative visual function showed favorable outcome. Recurrence or regrowth of tumor fully was responsible for late deterioration of visual function. No significant prognostic factor for visual outcome could be found.


CONCLUSIONS
Short-term postoperative visual outcome was a strong indicator of permanent visual outcome after surgery for tuberculum sellae and diaphragm sellae meningiomas.
Park
Chul-Kee
CK
Department of Neurosurgery, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, Seoul, Korea.
Jung
Hee-Won
HW
Yang
Seung-Yeob
SY
Seol
Ho Jun
HJ
Paek
Sun Ha
SH
Kim
Dong Gyn
DG
D000328:Adult; D000368:Aged; D002343:Carotid Artery, Internal / Q000473:pathology / Q000601:surgery; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods / Q000592:standards; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008579:Meningioma / Q000098:blood supply / Q000503:physiopathology / Q000601:surgery*; D008833:Microcirculation / Q000473:pathology / Q000601:surgery; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods / Q000592:standards; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000503:physiopathology / Q000517:prevention & control; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods / Q000592:standards; D009900:Optic Nerve / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D020221:Optic Nerve Injuries / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D011379:Prognosis; D012658:Sella Turcica / Q000473:pathology* / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000098:blood supply / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014787:Vision Tests / Q000592:standards; D015354:Vision, Low / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control