Tuberculum Sellae Meningiomas
Tuberculum Sellae Meningiomas
Tuberculum sellae meningiomas are a classic tumor of the anterior fossa that present in patients with gradual visual deterioration secondary to optic apparatus compression. If untreated, complete blindness can occur. Treatment involves tumor removal and decompression of the optic chiasm via several operative approaches. Gross-total resection (Simpson Grade I or II) is the goal of treatment and can usually be accomplished safely. Special excision-related considerations include appreciation of arachnoid planes separating the tumor from neural tissue, adequate drilling of osseous elements for optimal exposure, and intraoperative preservation of the vascular supply to the optic apparatus. The authors reviewed their experience at the University of California, San Francisco, in cases of tuberculum sellae meningiomas treated between 1992 and 2002. In most patients, improvement of vision can be achieved with minimal postoperative complications and morbidity.
Meningiomas of the tuberculum sellae arise from the limbus sphenoidale, chiasmatic sulcus, and tuberculum. They comprise approximately 3 to 10% of all intracranial meningiomas. Correct diagnosis and management require an appreciation of the unique clinical, neuroimaging, and surgery-related features that distinguish these meningiomas from others of the anterior skull base. Tuberculum sellae meningiomas characteristically lie in a suprasellar subchiasmal midline position, displacing the optic chiasm posteriorly and slightly superiorly, and the optic nerves laterally. In cases involving large tumors extending toward the planum sphenoidale, sellae, and cavernous sinus, it can be difficult to differentiate tuberculum sellae meningiomas from others originating from the planum sphenoidale, olfactory groove, clinoid process, sellae, and medial sphenoid wing. Slowly progressing visual deterioration is the most common initial complaint, and prompt treatment is directed at preserving and improving vision. Management ideally consists of gross-total resection without injury to neighboring vital structures. To limit morbidity and mortality rates, knowledge of the anatomical relations of tuberculum sellae meningiomas is necessary.
Tuberculum sellae meningiomas are a classic tumor of the anterior fossa that present in patients with gradual visual deterioration secondary to optic apparatus compression. If untreated, complete blindness can occur. Treatment involves tumor removal and decompression of the optic chiasm via several operative approaches. Gross-total resection (Simpson Grade I or II) is the goal of treatment and can usually be accomplished safely. Special excision-related considerations include appreciation of arachnoid planes separating the tumor from neural tissue, adequate drilling of osseous elements for optimal exposure, and intraoperative preservation of the vascular supply to the optic apparatus. The authors reviewed their experience at the University of California, San Francisco, in cases of tuberculum sellae meningiomas treated between 1992 and 2002. In most patients, improvement of vision can be achieved with minimal postoperative complications and morbidity.
Meningiomas of the tuberculum sellae arise from the limbus sphenoidale, chiasmatic sulcus, and tuberculum. They comprise approximately 3 to 10% of all intracranial meningiomas. Correct diagnosis and management require an appreciation of the unique clinical, neuroimaging, and surgery-related features that distinguish these meningiomas from others of the anterior skull base. Tuberculum sellae meningiomas characteristically lie in a suprasellar subchiasmal midline position, displacing the optic chiasm posteriorly and slightly superiorly, and the optic nerves laterally. In cases involving large tumors extending toward the planum sphenoidale, sellae, and cavernous sinus, it can be difficult to differentiate tuberculum sellae meningiomas from others originating from the planum sphenoidale, olfactory groove, clinoid process, sellae, and medial sphenoid wing. Slowly progressing visual deterioration is the most common initial complaint, and prompt treatment is directed at preserving and improving vision. Management ideally consists of gross-total resection without injury to neighboring vital structures. To limit morbidity and mortality rates, knowledge of the anatomical relations of tuberculum sellae meningiomas is necessary.
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