Tuberculum Sellae Meningiomas

Abstract

Tuberculum sellae (TS) meningiomas arise from the dura of the TS, chiasmatic sulcus, limbus sphenoidale, and diaphragma sellae. As they grow in the subchiasmal area compressing the optic nerves, TS meningiomas produce quite distinctive clinical, radiologic, and microsurgical features (Fig. 35-1) [1, 2]. The first report of a TS meningioma, in 1897, was as an incidental finding at an autopsy [3], and the first successful removal of this tumor was reported by Cushing in 1916 [4]. The clinical feature typical of TS meningiomas, primary optic atrophy with bitemporal hemianopsia in an adult with normal sella turcica on plain radiograph, has been recognized as a suprasellar chiasmal syndrome [1,4,5]. In most patients, however, visual loss appears to be asymmetric, in that the vision of one eye deteriorates earlier while that of the other eye stays relatively intact until the later stage [6–15]. The asymmetric nature of TS meningiomas has also been observed in preoperative magnetic resonance (MR) images, which show that the epicenter of the tumor is often slightly off the midline, although the main location is grossly on the central structures (Fig. 35-1). The laterality of the tumor epicenter has been reported to correspond to the side on which vision is more compromised [12]. Anterior-posterior views of cerebral angiograms show that dural feeders of the tumor, which appear to be stained in a sunburst fashion, are mostly off the mid-line, suggesting that the tumor does not originate in the exact midline microanatomically (Fig. 35-2).