title: Clinical outcomes of tuberculum sellae meningiomas focusing on reversibility of postoperative visual function.
abstract: BACKGROUND
  Tuberculum sellae meningiomas present a special challenge because of their proximity to major arteries, visual pathways, and the hypothalamus. The aim of this study was to determine the prognostic determinants of clinical and visual outcomes of these tumors, focusing on the functional reversibility of an unserviceable eye after surgery.
  
  
  METHODS
  We retrospectively reviewed 86 patients on the basis of clinical and radiological factors that appeared to affect outcome. The visual acuity and visual fields were analyzed according to the visual impairment score (VIS). Unserviceable visual acuity included no perception of light (NPL), hand movement (HM), and counting fingers (CF). Ophthalmological functioning was tested in the preoperative period, the postoperative short-term period (≤2 weeks after surgery), and the postoperative long-term period (>6 months after surgery). Our own clinical outcome criteria including tumor control, visual improvement, and complications were used for evaluation.
  
  
  RESULTS
  Seventy-four of 86 patients (86 %) underwent total removal of the tumor. In three of these cases (3.4 %), recurrence developed. Thirty patients were classified into the "Excellent" group, 21 into the "Good" group, 20 into the "Fair" group, and 15 into the "Poor" group. In multivariate analysis, adhesion to optic nerve was an independent and significant predictor of clinical outcome. Favorable visual outcomes in both short- and long-term postoperative periods were achieved in 80.8 % of cases. Preoperative and short-term visual outcomes were closely related to long-term visual outcome. Six of eight patients with preoperative CF status showed reversibility to a serviceable status after surgery. However, there was no conversion to serviceable status from NPL or HM.
  
  
  CONCLUSIONS
  For patients with unilateral unserviceable visual function, maintenance of serviceable visual function on the opposite side might be more important. Of the patients with unserviceable visual function, careful surgery might be able to improve the visual function in CF eyes.
authors.affiliation: Department of Neurosurgery, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Gangnam-Gu, Seoul, 135-710, South Korea.
authors.forename: Ho Jun
authors.initials: HJ
authors.lastname: Seol
authors.forename: Ho-Young
authors.initials: HY
authors.lastname: Park
authors.forename: Do-Hyun
authors.initials: DH
authors.lastname: Nam
authors.forename: Doo-Sik
authors.initials: DS
authors.lastname: Kong
authors.forename: Jung-Il
authors.initials: JI
authors.lastname: Lee
authors.forename: Jong Hyun
authors.initials: JH
authors.lastname: Kim
authors.forename: Kwan
authors.initials: K
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008579:Meningioma / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications; D020127:Recovery of Function; D012189:Retrospective Studies; D012658:Sella Turcica; D016896:Treatment Outcome; D014786:Vision Disorders / Q000209:etiology* / Q000601:surgery*; D014792:Visual Acuity / Q000502:physiology; D014794:Visual Fields / Q000502:physiology; D055815:Young Adult