A Clinical Evaluation Of The Surgical Approaches And Postoperated Effect Of Tuberculum Sellae Meningioma

Objective: To study the neurosurgery therapy and the relative factors of postoperative effect of Tuberculum sellae meningiomas in order to improve the therapeutic efficacies. Methods:A retrospective analysis of 54 cases with Tuberculum Sellae Meningiomas treated microsurgically from January,1998 to October,2007 in the third classic hospital was made.All the patients were confirmed by Pathology. Data of the clinical situation,imageology,common operative approaches, and treatments of postoperative complications were analyzed. The relevant factors affecting the visual outcome were studied.Results:According to the Simpson's classification, there were 21 cases in Simpson Grade I resection,27 cases in Simpson Gradeâ…¡resection and 4 cases in Simpson Gradeâ…¢resection.Postoperatively, 20.1% of the patients had complications and nobody died. Follow-up visits were paid to 42 patients from 5 to 90 months with an average of 27.7 months. 37 of them had better visual function, 2 patient had recurrence and nobody died . The postoperative visual acuity of single eye showed a positive correlation to the pre- operative I visual acuity ( B =0.678,P<0.01)and a negative correlation to the duration grades and degree of optic nerve compressed (B=-0.288,P<0.05 and B =- 0.333,P<0.05) . The eye with preoperative visual acuity more than 0.3, less than 2 years'duration and non-compressed optic nerve could achieve a better postoperative visual acuity.Conclusion:There are several surgical approaches to dealing with Tuberculum sellae meningiomas. The right approach is decided by the position ,size and growing way of tumor. To choose proper approaches and good surgical skill to protect the structure of hypothalamus, hypophysis, optic nerve, optic chiasma and their blood supply are very important in the course of reducing the postoperative complications. The visual condition after surgery is associated with the duration of the visual breakdown,the visual level before surgery and pathologyical change grades of optic papilla.