Microsurgery of tuberculum sellae meningiomas

In this retrospective study, clinical–ophthalmological investigations of all patients operated on at our institution for a tuberculum sellae meningioma from 1991 to 2001 were analyzed. Twenty patients were operated on. There were 16 women and 4 men (average age 50 years). The primary symptom was progressive asymmetrical visual loss in 85%. In 15% the tumor was an incidental finding. All tumors were removed via a pterional approach. The right side was preferred (85%) unless the tumor extended mainly unilateral and below the right optic nerve and sparing the left. There was no mortality. Visual function improved in 77% of patients with affected vision. The degree of visual improvement was better in patients below the age of 60 years and with duration of symptoms less than 12 months. Patients without visual symptoms had no morbidity. The rate of moderate complications was 9%. In a follow-up of 1–11 years, no recurrence was observed. Improvement of visual function after surgical removal of tuberculum sellae meningiomas can be expected in most cases. Patients below 60 years and with symptoms less than 12 months have a better prognosis. Surgical removal should be attempted as soon as visual disturbances occur.