title: Tuberculum sellae meningiomas: A series of 41 cases; surgical and ophthalmological outcomes with proposal of a new prognostic scoring system.
abstract: BACKGROUND
  Tuberculum sellae meningiomas have proved difficult to treat, partly because of their intimate association with the optic nerves and chiasma, hypothalamus, and internal carotid arteries.
  
  
  OBJECTIVE
  The aim of this study is to analyze the degree of influence of various prognostic factors affecting visual outcome; the pattern of visual recovery and develop a scoring system for prognostication.
  
  
  METHODS
  This is a retrospective study carried out from January 2004 till June 2011.
  
  
  METHODS
  Patients were analyzed on the basis of clinical, radiological, and surgical factors that appeared to affect the outcome. A special scoring system (according to the guidelines of the German Ophthalmological Society) was adopted to quantify the extent of ophthalmological disturbances.
  
  
  METHODS
  Comparison of categorical variables between the two was performed using chi-square test and a P value of ≤ 0.05 was considered significant. Logistic regression was used when multivariate analysis was required.
  
  
  RESULTS
  Vision improved in 27% and deteriorated in 7.3%. A prognostic scoring system (score 4-13) was developed depending on the degree of influence of significant prognostic factors. The patients with a score of ≤6 had improved vision postoperatively (44%), whereas none of those with a score > 6 improved. Completeness of visual recovery was perceived in 100% of patients within 3 months. Complete resectability was achieved in 73% of patients.
  
  
  CONCLUSIONS
  The proposed scoring system is very useful in prognosticating the visual outcome of these patients. The patients with a score of ≤6 have the best visual outcome postoperatively. Complete resectability is better achieved with extended bifrontal and unilateral frontal approaches. Short-term postoperative visual outcome is a strong indicator of permanent visual outcome after surgery.
authors.affiliation: Department of Neurosurgery, Manipal Super Specialty Hospital, Vijayawada, India.
authors.forename: Arun
authors.initials: A
authors.lastname: Palani
authors.forename: Manas K
authors.initials: MK
authors.lastname: Panigrahi
authors.forename: Anirudh K
authors.initials: AK
authors.lastname: Purohit