Surgical treatment of tuberculum sellae meningioma: A retrospective review of single institutional experience.

Background: Tuberculum sellae meningiomas (TSMs) represent a distinct entity among intracranial meningiomas. Both transcranial approaches (TCAs) and endoscopic endonasal approaches (EEAs) have provided neurosurgeons with options for managing these difficult tumors. Still, controversies persist regarding the selection criteria for the most optimal approach.

Methods: The authors retrospectively reviewed 45 patients treated surgically for TSM between 2018 and 2023. The clinical reports of all subjects were assessed pre-and post-operatively, encompassing demographic information, clinical symptoms, imaging results, ophthalmological evaluations, operative details, and any complications.

Results: A total of 45 patients were included in this study, with 21 patients undergoing EEAs and 24 TCAs. TSMs treated with EEA are smaller than TCA (P = 0.0014), less prevalent in optic canal invasion (P = 0.0291) and in arterial encasement (P = 0.0050), and have no lateral extension (P < 0.0001). The majority of patients (36/45) had visual improvement or stabilization following the surgery, with the rate of achieving gross total resection (GTR) was higher in the EEA group (17/21) than in the TCA group (9/24) (P = 0.0032). The mortality tends to be higher in the TCA group and is related to arterial encasement, although statistically insignificant.

Conclusion: Both traditional TCAs and EEAs offer options for the surgical management of TSM, each with its advantages and limitations. Based on our experiences, several factors (lateral extension and arterial encasement) may guide the suitable approach, and multidisciplinary considerations, with the overarching goals of achieving maximal tumor resection and minimizing postoperative complications.