Surgical treatment of meningiomas involving the sella region

Introduction: Meningiomas of the parasellar region still represent difficult entities for surgical treatment. They comprise between 4-10% of all intracranial meningiomas. Meningiomas located mainly within the sella turcica are even more uncommon. We studied such meningiomas in order to detect the particular surgical characteristics and outcome of these patients. Methods: Between 1979 and 1995, 70 patients were operated upon of sellar and parasellar meningiomas. Careful review of the radiological studies and patients charts selected 20 cases of meningiomas mainly located within the sella. Results: Radiological analysis displayed that 60% (12 cases) of the tumors were larger than 30 × 30 mm. Compression of the optic nerve was showed in 18 cases (90%). Sings of radiological invasion of the cavernous sinus were present in 7 cases (35%). The most common symptom was unilateral gradual visual loss in 18 cases (90%) followed by headache in 7 cases (35%). Pterional approach was performed in 14 patients (70%) and 6 cases were operated by bifrontal craniotomy. Radical Resection was achieved in 17 patients (85%). Discussion/Conclusions: Meningiomas located mainly in the sella turcica are rare entities. The most important clinical presentation is indolent visual disturbance. Endocrinological impairment is found only in a small number of patients. Many different approaches have been already reported to remove such lesions involving the sella region. The pterional approach seems to provide enough exposure of the tumor allowing radical resection with minimal morbidity. Preoperative vision impairment usually improves or remains unchanged after the surgery. Transient postoperative endocrinological disturbance is common.