Optimal microsurgical treatment of dorsum sellae meningioma

• Published in: Chinese medical journal Vol. 122; no. 16; pp. 1857 - 1861
• Main Authors: Geng, Su-min, Zhang, Jun-ting, Zhang, Li-wei, Wu, Zhen, Wang, Zhong-cheng
• Format: Journal Article
• Language: English
• Published: China Department of Neurosurgery,Beijng Tiantan Hospital,Capital Medical University,Beijing 100050,China 20-08-2009
• Subjects: Adult; Female; Humans; Magnetic Resonance Imaging; Male; Meningeal Neoplasms - pathology; Meningeal Neoplasms - surgery; Meningioma - pathology; Meningioma - surgery; Microsurgery - methods; Middle Aged; Postoperative Complications; Retrospective Studies; Treatment Outcome; 临床分析; 术后并发症; 治疗方法; microsurgery; dorsum sellae,meningioma
• ISSN: 0366-6999; 2542-5641
• DOI: 10.3760/cma.j.issn.0366-6999.2009.16.004

Background There are few reports of microsurgical treatment of dorsum sellae meningiomas--which, because of location, size, and differences in growth direction, clinical presentations, degree of surgical difficulty, have varied posttreatment sequelae. In pursuit of an optimal microsurgical treatment option for dorsum sellae meningioma patients, we performed a retrospective analysis of eight microsurgery-treated patients in our set up. Methods Clinical data of eight microsurgery-treated dorsum sellae meningioma patients were analyzed. Dorsum sellae meningiomas were classified into 2 types based on tumor location, size, and direction of growth. Type Ⅰ tumors （dorsum sellae-inferior third ventricle type, four cases） were resected by craniotomy via the frontotemporal or orbitozygomatic approach. Type Ⅱ tumors （dorsum sellae-third ventricle type, 4 cases） were resected by frontal craniotomy via the transcallosal-interforniceal approach. Results Complete tumor resection was achieved in all the eight patients. In Type Ⅰ tumor patients, the only postoperative complication was oculomotor nerve palsy. In Type Ⅱ tumor patients, the postoperative complications included hyperthermia, electrolyte imbalances, endocrinologic disturbances, and hydrocephalus. The mean follow-up was 2.1 years. Four patients returned to normal life and found a job, two were able to live independently, one required assistance, while one died. Conclusions Dorsum sellae meningioma surgery is challenging, and resection of Type Ⅱ tumors is more difficult than Type Ⅰ tumors. The selection of a suitable microsurgical approach based on tumor type, and the active treatment of postoperative complications are important means of increasing therapeutic efficacy.