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      Surgical Indications of Exploring Optic Canal and Visual Prognostic Factors in Neurosurgical Treatment of Tuberculum Sellae Meningiomas

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          Abstract

          Background:

          Tuberculum sellae meningiomas (TSMs) present a special symptom because of the adherence and compression to the optic nerve, optic artery, and the chiasm. A significant number of patients with TSMs appear visual deficits. This study aimed to investigate the surgical indications of exploring the optic canal and visual prognostic factors in the neurosurgical treatment of TSMs.

          Methods:

          Totally 21 patients with TSM, who were operated from September 2007 to August 2011 in the Department of Neurosurgery, Tongren Hospital were enrolled in this study. Results of orbital computed tomography (CT) and magnetic resonance imaging (MRI), visual acuity, Goldmann visual field test, orbital color Doppler flow imaging (CDI) test in these patients were retrospectively analyzed.

          Results:

          Visual deficit and optic canal involvement (OCI) were detected in all the 21 patients. Fourteen patients had bone proliferation within the area of the optic canal. After the operation, visual outcomes were improved in 13 patients, unchanged in 7 patients, and deteriorated in 1 patient. All the 21 patients performed orbital CDI test preoperatively, the results showed that if the peak systolic velocity (PSV) of central retinal artery (CRA) value was ≤8 cm/s, the visual outcome would be better.

          Conclusions:

          The surgical indications of exploring optic canal in TSM cases included: (1) The neuroimaging evidences of OCI (CT and/or MRI); (2) PSV of CRA in orbital CDI test was ≤8 cm/s; (3) visual acuity was below 0.1; (4) visual field deficit. The PSV of CRA in CDI test could be a prognostic factor for visual outcomes of TSMs.

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          Most cited references 22

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          Seemingly complete removal of histologically benign intracranial meningioma: late recurrence rate and factors predicting recurrence in 657 patients. A multivariate analysis.

          From 1953 to 1980, 657 patients survived a seemingly complete removal of a histologically benign intracranial meningioma. Recurrence of the tumor was found in 59 of these 657 patients, but some cases of recurrence may have been missed inasmuch as only 69 patients were followed for 20 years. With ordinary life-table analysis, the overall recurrence rate was estimated to be 19% at 20 years. The reliability of this result was evaluated with a modified life-table analysis. Multivariate analysis showed that coagulation of the dural insertion, invasion of bone, and soft consistency of tumor were strong risk factors (p less than 0.01) for recurrence. The recurrence rate at 20 years was estimated to be 11% for the 249 patients with none of these risk factors, 15-24% for those with one factor, and 34-56% for those with two.
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            Pterional surgery of meningiomas of the tuberculum sellae and planum sphenoidale: surgical results with special consideration of ophthalmological and endocrinological outcomes.

            The authors reviewed 47 cases of suprasellar meningiomas with special attention to ophthalmological and endocrinological outcomes. All patients underwent surgery performed via a unilateral pterional approach between January 1983 and January 1998. Ophthalmological and endocrinological examinations were performed before the operation as well as 1 week and 3 months postoperatively. A special scoring system was adopted to quantify the extent of ophthalmological disturbances. Complete tumor resection was possible in all but one patient. There were no fatalities and the rate of visual improvement was 80%. The best prognoses were found in patients younger than 50 years and in patients in whom the duration of symptoms was less than 1 year. Before surgery, tumor-related endocrine disturbances were present in only three women who suffered from secondary hypogonadism; two of these patients recovered after surgery. Postoperatively, no patient needed replacement therapy for pituitary dysfunction. The overall tumor recurrence rate was 2.1% (one of 47 cases). For patients in whom long-term (> 5 years) follow-up data were available, the recurrence rate was 4.2% (one of 24 cases). In this series, complete resection of suprasellar meningiomas was possible through a unilateral pterional craniotomy and was associated with a low morbidity rate and no deaths.
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              Recurrence of cranial base meningiomas.

              Long-term data on the natural history of traditionally treated cranial base meningiomas are necessary to judge the benefit of modern cranial base techniques for individual patients and to understand when nonradical surgery of a meningioma is in the interest of the patient. The only available means of obtaining such data is investigation of patients treated before the present surgical era. The records of 315 patients who were operated on at Karolinska Hospital between January 1, 1947, and December 31, 1982, were reviewed. Of the patients, 10.8% died perioperatively and 9.7% died within 10 years. The remaining patients were followed for 10 to 36 years (mean, 18 yr). The 5-year recurrence rate was 4% for patients undergoing radical surgery (Grades 1 and 2) and 25 to 45% for patients undergoing Grade 3 or 4 operations. Follow-up periods longer than 5 years revealed that 16% of Grade 1 and 20% of Grade 2 patients had symptomatic recurrences, whereas a majority of Grade 4 and 5 patients showed symptomatic progression. Forty-two of 69 patients who underwent Grade 4 or 5 operations died as a result of their tumors, usually within 10 years after the first operation. No patients who underwent Grade 4 or 5 operations were free from symptomatic progression after 20 years. The tumor progression or recurrence was usually detected within the 1st 10 years, but late recurrences were seen < or = 25 years after the operation. The worst outcome was found in medial sphenoid wing/clinoidal meningiomas and in tumors invading the cavernous sinus. Subfrontal tumors showed unexpectedly high recurrence rates, with a mortality rate < or = 14% in the late phase. The findings emphasized the necessity to plan the management of patients with cranial base meningiomas according to a 10- to 20-year perspective. Patients must be followed to evaluate the treatment results and to detect recurrences. Nonradical surgery must be viewed as a temporizing or palliative measure; a continued search for means of radical tumor treatment is warranted in these often surgically difficult tumors.
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                Author and article information

                Journal
                Chin Med J (Engl)
                Chin. Med. J
                CMJ
                Chinese Medical Journal
                Medknow Publications & Media Pvt Ltd (India )
                0366-6999
                05 September 2015
                : 128
                : 17
                : 2307-2311
                Affiliations
                [1 ]Department of Neurosurgery, Tongren Hospital, Capital Medical University, Beijing 100730, China
                [2 ]Department of Radiology, Tongren Hospital, Capital Medical University, Beijing 100730, China
                [3 ]Department of Ophthalmology, Tongren Hospital, Capital Medical University, Beijing 100730, China
                Author notes
                Address for correspondence: Dr. Ji-Di Fu, Department of Neurosurgery, Tongren Hospital, Capital Medical University, Beijing 100730, China E-Mail: fujidi@ 123456sohu.com
                Article
                CMJ-128-2307
                10.4103/0366-6999.163391
                4733794
                26315077
                Copyright: © 2015 Chinese Medical Journal

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                Categories
                Original Article

                meningioma, surgical management, tuberculum sellae, vision

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