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Journal of Neurosurgical Sciences 1999 Dicembre;43(4):253-62

lingua: Inglese

Menin­gio­mas of ­the tuber­cu­lum sel­lae. ­Our expe­ri­ence in 69 cas­es sur­gi­cal­ly treat­ed ­between 1973 ­and 1993

Raco A. 1, Bristot R. 1, Domenicucci M. 2, Cantore G. 1

1 Depart­ment of Neu­ros­ci­enc­es - Neu­ro­sur­gery I , Uni­ver­sity of ­Rome “La Sapien­za”, ­Rome;
2 Neu­ro­trau­ma­tol­o­gy, Uni­ver­sity of ­Rome “La Sapien­za”, ­Rome


Back­ground. Menin­gio­mas of ­the tuber­cu­lum sel­lae ­are ­lesions ­with ­well-­defined char­ac­ter­is­tics in ­terms of ­both ­site of ori­gin ­and clin­i­cal evo­lu­tion ­which ­require dif­fe­ren­tial diag­no­sis ­with ­lesions of ­the ­supra- ­and ­para-sel­lar ­region. ­The ­aim of ­this ­study is to ­point ­out ­the impor­tance of ­the ­size of ­the ­lesion ­and ear­ly iden­tifi­ca­tion of symp­toms ­for ­prompt diag­no­sis, cru­cial­ly impor­tant ­for eval­u­at­ing ­the rever­sibil­ity of func­tion­al dam­age, espe­cial­ly of ­the ­optic ­nerves.
Meth­ods. ­Between 1953 ­and 1993, 110 cas­es of tuber­cu­lum sel­lae menin­gio­ma ­were oper­at­ed at ­the Neu­ro­sur­gi­cal Insti­tute, Depart­ment of Neu­ros­ci­enc­es, of ­Rome “La Sapien­za” Uni­ver­sity; ­only 69 cas­es of ­these cas­es ­were oper­at­ed on ­after 1973, ­the ­year in ­which micro­sur­gi­cal tech­niques ­were intro­duced ­into rou­tine sur­gi­cal prac­tice. ­Tumor diam­e­ter ­ranged ­from 3 to 9 cm. ­Most of ­the ­patients pre­sent­ed ­severe vis­u­al ­loss.
­Results. Remov­al ­was ­total in 63 cas­es (91.3%), ­sub-­total in 6 (8.7%). ­Besides ­the surge­ons first­hand impres­sion, ­the ­grade of remov­al ­was eval­u­at­ed by ear­ly CT ­and/or ­MRI (24-36 ­hours ­after sur­gery). A min­i­mum fol­low-up of 3 ­years ­was tak­en ­into con­sid­er­a­tion ­for assess­ment of ­late func­tion­al ­results. ­Five ­patients ­died in ­the post­op­er­a­tive peri­od (7.2%).
Con­clu­sions. ­This ­study clear­ly dem­on­strat­ed ­that a ­tumor diam­e­ter great­er ­than 4 cm is a crit­i­cal fac­tor ­for vis­u­al func­tion. ­The ­size of ­the ­lesion ­was ­also ­found to be extreme­ly impor­tant, in ­that it influ­enc­es ­the ­amount of ­tumor resec­tion pos­sible. There­fore, in ­our opin­ion, alter­na­tive ­types of treat­ment ­such as radio­sur­gery ­should be con­fined to ­the ­tumor res­i­due.

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