Due to their proximity to the visual structures, tuberculum sellae meningiomas are frequently revealed by ophthalmologic impairments. The goal of the surgery is to perform gross total resection and improvement of the visual function. The purpose of this study is to identify predictors of favorable visual outcomes after surgery of tuberculum sellae meningiomas.
We retrospectively collected tuberculum sellae meningiomas treated in 2 neurosurgical centers from 2010 to 2020. We collected clinical, imaging and surgical data and analyzed their impact on visual outcome. Favorable visual outcome was defined as a gain in visual acuity ≥ 0.2 points and/or a gain > 25% of the visual field or complete recovery.
A total of 50 patients were included. Four months after surgery, 30 patients (60%) had visual improvement. Predictors of favorable visual outcome were duration symptoms 0.5, tumor size and tumor in hypersignal T2/FLAIR on MRI. During surgery, soft tumor and clear brain/tumor interface were associated with favorable visual outcome. Preoperative OCT (Optic Coherence Tomography) measurements of RNFL (Retinal Nerve Fiber Layer) thickness > 80 μM and GCC (ganglion cell complex) thickness > 70 μM were also associated with a better ophthalmologic outcome.
In tuberculum sellae meningiomas, rapid surgical treatment must be performed to optimize vision improvement. A hyperintense lesion on T2/FLAIR weighted images and a minor impairment on the initial ophthalmologic presentation may give hope for a favorable outcome. Performing OCT measurements before surgery can clarify the patient’s expectation about recovery.

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