Visual Outcomes after Suprasellar Meningioma Resection: A Retrospective Cohort Study and a Machine Learning-Based Predictive Model

Abstract

Objectives In this research, the authors provide a retrospective cohort study of 82 patients with suprasellar meningiomas to identify predictors of the visual outcome following surgery. We also conducted a matched retrospective case-control analysis. Methods This retrospective cohort study included all patients who underwent craniotomy for surgical excision of suprasellar meningiomas at our institution between January 2016 and March 2022. We designed a matched case-control study for patients with and without early intradural optic canal decompression (IOCD). We also developed a machine learning model to have the best possible sensitivity for the prediction of visual recovery after surgery. Results The visual acuity score (VAS) improved in 46.3% of our cases and decreased in 7.4% of the 82 included cases postoperatively. The VAS did not change in 46.3% of the patients after surgery. Statistically, visual complaints, optic atrophy, tuberculum sella involvement, and olfactory groove involvement were associated with lower preoperative VAS and visual field index (VFI). Only intracavernous sinus (ICS) extension and intraoperative vascular involvement were significantly associated with lower postoperative mean VAS correction. The outcome analysis revealed that the improvement in VAS and VFI after surgery was not statistically different between the groups with and without early IOCD ( p -value = 1). Conclusion ICS extension was the only location-related factor associated with increased tumor recurrence or regrowth, which makes postoperative radiotherapy more valuable in patients with cavernous sinus extension. Our study results did not support the efficacy of early IOCD in increasing postoperative VAS and VFI.

Keywords: meningioma; optic canal decompression; suprasellar; visual outcome.

Fig. 1

Flowchart of the study.

Fig. 2

Tumor locations (TS: tuberculum sella, ACP: anterior clinoid process, OLF: olfactory groove, PS: planum sphenoidale, DS: diaphragma sella).

Fig. 3

Optic system involvement (ON: optic nerve, OCH: optic chiasma).

Fig. 4

Major vascular involvement (MCA: middle cerebral artery, ACA: anterior cerebral artery, ICA: internal carotid artery, ACP: anterior clinoid process, TS: tuberculum sella, OLF: olfactory groove, PS: planum sphenoidale).

Fig. 5

The pituitary stalk (indicated with a red arrow) can be distinguished in the sagittal T1 + GAD magnetic resonance imaging (MRI) just posterior to the lesion, special attention should be taken in the dissection of these meningiomas in the posterior edges to prevent endocrine dysfunction.