title: Technical nuances in the management of tuberculum sellae and diaphragma sellae meningiomas.
abstract: OBJECTIVE
  Tuberculum sellae meningiomas (TSMs) and diaphragma sellae meningiomas (DSMs) are challenging lesions to treat due to their proximity to neurovascular structures.
  
  
  METHODS
  The authors reviewed the medical records of patients who underwent surgical excision of TSMs and DSMs from 1990 to 2013. They also describe the technical strategies used to minimize injury to the optic apparatus, vascular structures, and pituitary stalk.
  
  
  RESULTS
  Twenty-four patients with TSM and 6 patients with DSM were included in the study. Seventy percent of the tumors were large (≥ 5 cm). The pterional approach was employed in most cases. Optic canal involvement was observed in 4 patients. Twenty-one patients (70%) had visual dysfunction before surgery. At follow-up (median 18 months), visual improvement was noted in 10 (47.6%) of 21 patients. Gross-total excision was achieved in 22 patients (91.6%) with TSM and 5 (83.3%) with DSM. At last follow-up, 28 patients (93.3%) had a Glasgow Outcome Scale score of 5. There were no deaths in this series.
  
  
  CONCLUSIONS
  Tuberculum and diaphragma sellae meningiomas present a unique subset of tumors due to their location. They can be safely excised with minimal morbidity and mortality using microsurgical techniques. Attention to technical details during surgery leads to greater respectability and superior visual outcome.
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana.
authors.forename: Anil
authors.initials: A
authors.lastname: Nanda
authors.forename: Sudheer
authors.initials: S
authors.lastname: Ambekar
authors.forename: Vijayakumar
authors.initials: V
authors.lastname: Javalkar
authors.forename: Mayur
authors.initials: M
authors.lastname: Sharma
mesh_terms: D000328:Adult; D000368:Aged; D003964:Diaphragm / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery*; D008579:Meningioma / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010902:Pituitary Gland / Q000473:pathology; D012189:Retrospective Studies; D012658:Sella Turcica / Q000473:pathology*; D019292:Skull Base Neoplasms / Q000601:surgery*