Meningiomas of the Sellar Region Presenting with Visual Impairment: Impact of Various Prognostic Factors on Surgical Outcome in 62 Patients

Summary

 Background. Meningiomas of the supra- and parasellar region can cause insidious visual loss by optic nerve compression. 62 cases with such tumours affecting the anterior optic pathways were analysed to assess the surgical results and prognostic factors with particular attention to visual outcome.

 Method. In all patients, visual deterioration was the first clinical manifestation. Eleven lesions had their origin at the anterior clinoid process, 24 at the tuberculum sellae, 10 at the planum sphenoidale, two in the optic canal, 10 in the medial sphenoidal wing, and five in the olfactory groove. All patients underwent microsurgical tumour resection. Median age at the time of operation was 54 years, median duration of symptoms seven months. The mean follow-up time was 5.2 years (range 2 to 8 years). Statistical analysis of prognostic factors (gender, age, tumour location, tumour size, duration of symptoms, brain tumour interface, resection grade, preoperative visual loss, Glascow Outcome Score) was performed using univariate and multivariate analysis.

 Findings. The severe morbidity rate was 6,4%. Two patients died within the first 30 postoperative days. Overall, vision improved in 39 (65%) patients, in 11 (18%) it was unchanged, and worse in 10 (17%). Visual prognosis was favourably affected by age under 54 years (p<0,025), duration of symptoms of less than seven months (p<0,037), and the presence of an intact arachnoid membrane around the lesion (p<0,001). Severe preoperative loss of visual acuity (<0,02) appeared to be an unfavourable prognostic factor (p<0,047).

 Interpretation. Possible difficulties and surgical outcome in such patients can be predicted successfully. These facts in connection with new therapeutic modalities (radiosurgery, adjuvant therapies) will demand a careful risk assessment and should influence the treatment strategies and the degree of operative aggressiveness in the future.