Microsurgery For Tuberculum Sellae Meningiomas And Analysis Of Factors Influencing Visual Outcome And Prognosis

Objective:To investigate the technique and experience of microsurgery for tuberculum sellae meningiomas(TSMs) and analyze factors influencing postoperative visual outcome.Methods:The clinical materials of forty-seven patients with TSMs treated between 2003 and 2008 were analyzed retrospectively.All patients underwent microsurgical tumor resection.As far as single eye visual acuity was concerned, univariate analysis and multiplicity,using the chi-square test,non-parametric test and logistic regression analysis,was performed to assess potential influencing factors.Results:37 patients were female and 10 male.Patients' age varied from 23 to75(mean age is 51).Course of disease were between 10 days and 35 years(mean time is 34 months).Main clinical manifestations included visual deterioration(45 cases) and intracranial hypertension(29 cases),with visual acuity damage in 42 and visual field defect in 32.All cases were classified into 4 categories and 5 groups according to the basement location of TSM.Total tumor resection was achieved in 37 cases and subtotal in 10.Postoperatively,visual function improved in 54 eyes, remained unchanged in 24 and deteriorated in 12.The long term Follow-up of 32 patients were got,and 78.1%of them were above 70 by Karnofsky Performance Scale without any recurrence.Statistical analysis showed that prognosis visual outcome correlate to the following factors:age,duration and severity of preoperative visual disturbance,preoperative change of optic disc,relationship between tumor and optic nerve,direction of tumor invasion,texture and size of tumor,and extent of tumor removal.According to logistic regression analysis, preoperative change of optic disc,relationship between tumor and optic nerve,and direction of tumor invasion are the most related factors influencing visual outcome and prognosis.Conclusions:1,Proper operative approaches and skilled microsurgical techniques are the key points to get well surgical effect of TSMs.2,Early diagnosis and treatment are profit to the improvement of visual outcome and prognosis. Postoperative visual outcome mainly depend on the pathological changes of optic nerve and operative procedure.Severe preoperative change of optic disc are always direct hints of little chance for vision remedy,while encasement and adherence by tumor and extensive invasion of tumor often signifies serious injury of optic nerve and difficulty in surgery,in which situation optic nerve and its blood supply may be more apt to be damaged,leading to bad visual outcome and prognosis.