Tuberculum sellae meningiomas: A series of 41 cases; surgical and ophthalmological outcomes with proposal of a new prognostic scoring system

Abstract

Context: 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.

Aims: 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.

Settings and design: This is a retrospective study carried out from January 2004 till June 2011.

Materials and 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.

Statistical analysis used: 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.

Keywords: Meningioma; prognostic factors; tuberculum sellae; visual outcome.

Figure 1

Tables demonstrating visual acuity and visual field deficit according to the German Ophthalmological Society for calculation of the visual impairment score. For example, a patient with visual acuity of 0.4 (4/10) in the left eye and 0.2 (2/10) in the right eye has a visual acuity impairment score of 35, and if bitemporal visual field deficit is associated, a visual field impairment score of 22. The addition of both the scores gives the visual impairment score (VIS). The score ranges from 0 to 100

Figure 2

Pre-op (1a) and post-op (1b) images of Tuberculum sellae meningioma with left optic canal extension.