title: Fronto-basal interhemispheric approach for tuberculum sellae meningiomas; long-term visual outcome.
abstract: We report our experience with the treatment of tuberculum sellae meningiomas using the fronto-basal interhemispheric approach. A retrospective analysis was performed on a series of 24 patients with tuberculum sellae meningiomas who were operated between March 2000 and January 2007. Patients' presenting symptoms, radiological images, operative reports, and clinical follow-up data were reviewed with special consideration for visual outcome. Visual deterioration was the presenting symptom in all patients, followed by headache in 9 patients (37.5%). The average duration of visual symptoms was 17.6 months. The average tumor diameter was 2.63 cm; encasement of the carotid artery was identified in 7 patients (29%). Complete tumor removal was achieved in 21 patients (87.5%). Mean follow-up period was 52 months. Vision improved in 19 patients (79%), remained stable in 4 (17%) and deteriorated in 1 patient (4%). The degree of tumor removal or visual outcome were both unrelated to the tumor size (p = 0.2 and p = 0.6 respectively). While the degree of preoperative visual deficit did not affect the visual improvement rate in the whole group (p = 0.9), those patients with improvement to good functional vision (>20/40) after the surgery, had a less severe preoperative deficit (p < 0.001). The most common complication was anosmia (29.1%) and there was no mortality. The frontobasal interhemispheric approach is safe and provides a direct anatomical approach to tuberculum sellae meningiomas with relatively low incidence of complications. Patients with improved vision to good functional level had a better preoperative visual status.
authors.affiliation: Division of Neurosurgery, Toronto Western Hospital, UHN, University of Toronto, Ontario, Canada.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Ganna
authors.forename: Amir R
authors.initials: AR
authors.lastname: Dehdashti
authors.forename: Konstantina
authors.initials: K
authors.lastname: Karabatsou
authors.forename: Fred
authors.initials: F
authors.lastname: Gentili
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000150:complications / Q000601:surgery*; D008579:Meningioma / Q000150:complications / Q000601:surgery*; D008875:Middle Aged; D000857:Olfaction Disorders / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012658:Sella Turcica; D016896:Treatment Outcome; D014786:Vision Disorders / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D014792:Visual Acuity