Characteristics of midline suprasellar meningiomas based on their origin and growth pattern

Abstract

Background: The aim of the present study was to elucidate clinical and prognostic characteristics of the midline suprasellar meningiomas based on their origin and growth pattern.

Methods: A retrospective review of the medical records was conducted for patients undergoing surgical resection of the midline suprasellar meningioma. The meningiomas were divided into group A - planum sphenoidale meningioma (PSM), group B - tuberculum sellae meningioma (TSM) and group C - diaphragma sellae meningioma (DSM), based on their growth pattern in relation to the optic pathway and pituitary stalk, group C was then divided into groups C1 and C2.

Results: The mean age of 32 men and 74 women was 48.5±13.1 years (range, 20-78 years). The rate of visual impairment was highest in patients in group C2 and lowest in group A patients (P<0.001). The h-p axis impairment and MRI evidence of the pituitary stalk involvement was more frequent in patients with group C1 meningioma (P<0.001). The gross total resection (GTR) was achieved in 84/106 (79%) patients. The mean follow-up period was 70.4 months (median 86 months, range 64.5-76.3 months). The fronto-temporal approach was the only significant predictor of the postoperative visual acuity impairment (P=0.001, OR: 8.2, CI: 2.45-27.42) and visual field impairment (P=0.016, OR: 0.071, CI: 0.008-0.607). The meningiomas in groups B (P=0.024, OR: 0.198, CI: 0.049-0.812) and C1 (P=0.012, OR: 0.082, CI: 0.012-0.580) were significant predictors of the postoperative visual field deficits. The group C1 (P=0.036, OR: 0.244, CI: 0.065-0.912) and surgical approach employed (P=0.032, OR: 0.013, CI: 0.000-0.684) was significant predictors of the postoperative h-p function impairment. The mean recurrence free survival (RFS) time and rate were 102.9±3.2 months and 86%. The group C1 meningiomas had the lowest RFS rate and time (33.3% and 55.6±8.3 months). The subtotal resection and the group C1 meningioma (P=0.001, OR: 15.6, CI: 2.9-82.8) were the significant predictors of recurrence (P=0.008, OR: 0.08, CI: 0.014-0.529).

Conclusion: The group A meningioma had the high rate of complete resection and favorable RFS. Groups B and C2 involve optic pathway and optic canal predominately. The group C1 DSM was an independent predictor of subtotal resection, postoperative visual field and h-p axis impairment. The subtotal resection was an independent predictor of the recurrence.

Keywords: Diaphragma sellae; Meningioma; Outcomes; Planum sphenoidale; Tuberculum sellae.