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Factors influencing postoperative visual improvement in 208 patients with tuberculum sellae meningiomas

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Abstract

Objective

Tuberculum sellae meningiomas (TSMs) usually compress the optic nerve and optic chiasma, thus affecting vision. Surgery is an effective means to remove tumors and improve visual outcomes. On a larger scale, this study attempted to further explore and confirm the factors related to postoperative visual outcomes to guide the treatment of TSMs.

Methods

Data were obtained from 208 patients with TSMs who underwent surgery at our institution between January 2010 and August 2022. Demographics, ophthalmologic examination results, imaging data, extent of resection, radiotherapy status, and surgical approaches were included in the analysis. Univariate and multivariate logistic regressions were used to assess the factors that could lead to favorable visual outcomes.

Results

The median follow-up duration was 63 months, and gross total resection (GTR) was achieved in 174 (83.7%) patients. According to our multivariate logistic regression analysis, age < 60 years (odds ratio [OR] = 0.310; P = 0.007), duration of preoperative visual symptoms (DPVS) < 10 months (OR = 0.495; P = 0.039), tumor size ≤ 27 mm (OR = 0.337; P = 0.002), GTR (OR = 3.834; P = 0.006), and a tumor vertical-to-horizontal dimensional ratio < 1 (OR = 2.593; P = 0.006) were found to be significant independent predictors of favorable visual outcomes.

Conclusion

Age, DPVS, tumor size, GTR, and the tumor vertical-to-horizontal dimensional ratio were found to be powerful predictors of favorable visual outcomes. This study may help guide decisions regarding the treatment of TSMs.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Arai H, Sato K, Okuda O, Miyajima M, Hishii M, Nakanishi H, Ishii H (2000) Transcranial transsphenoidal approach for tuberculum sellae meningiomas. Acta Neurochir (Wien) 142:751–6 (discussion 756–7)

    Article  CAS  PubMed  Google Scholar 

  2. Bassiouni H, Asgari S, Stolke D (2006) Tuberculum sellae meningiomas: functional outcome in a consecutive series treated microsurgically. Surg Neurol 66:37–44

    Article  PubMed  Google Scholar 

  3. Bove I, Solari D, Colangelo M, Fabozzi GL, Esposito F, Tranfa F, Cappabianca P, Cavallo LM (2023) Analysis of visual impairment score in a series of 48 tuberculum sellae meningiomas operated on via the endoscopic endonasal approach. J Neurosurg 140(3):696–704

    PubMed  Google Scholar 

  4. Brastianos PK, Galanis E, Butowski N, Chan JW, Dunn IF, Goldbrunner R, Herold-Mende C, Ippen FM, Mawrin C, McDermott MW, Sloan A, Snyder J, Tabatabai G, Tatagiba M, Tonn JC, Wen PY, Aldape K, Nassiri F, Zadeh G, Jenkinson MD, Raleigh DR (2019) Advances in multidisciplinary therapy for meningiomas. Neuro Oncol 21:i18–i31

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Chen L, Gao M, Zhang H, Chen W, Sun K, Xu R (2024) Effect of Optic Canal Opening on Postoperative Visual Acuity in Patients with Tuberculum Sellae Meningiomas. J Neurol Surg A Cent Eur Neurosurg 85:1–6

    Article  PubMed  Google Scholar 

  6. Chi JH, McDermott MW (2003) Tuberculum sellae meningiomas. Neurosurg Focus 14:e6

    Article  PubMed  Google Scholar 

  7. Chokyu I, Goto T, Ishibashi K, Nagata T, Ohata K (2011) Bilateral subfrontal approach for tuberculum sellae meningiomas in long-term postoperative visual outcome. J Neurosurg 115:802–810

    Article  PubMed  Google Scholar 

  8. Deng J, Hua L, Bian L, Chen H, Chen L, Cheng H, Dou C, Geng D, Hong T, Ji H, Jiang Y, Lan Q, Li G, Liu Z, Qi S, Qu Y, Shi S, Sun X, Wang H, You Y, Yu H, Yue S, Zhang J, Zhang X, Wang S, Mao Y, Zhong P, Gong Y (2022) Molecular diagnosis and treatment of meningiomas: an expert consensus (2022). Chin Med J (Engl) 135:1894–1912

    Article  PubMed  Google Scholar 

  9. Feng Z, Li C, Cao L, Liu C, Qiao N, Wu W, Ma G, Gui S (2023) Comparative analysis of outcomes following craniotomy and expanded endoscopic endonasal approach resection of tuberculum sellae meningiomas: a single-institution study. Front Neurol 14:1139968

    Article  PubMed  PubMed Central  Google Scholar 

  10. Galldiks N, Hattingen E, Langen KJ, Tonn JC (2023) Imaging characteristics of meningiomas. Adv Exp Med Biol 1416:21–33

    Article  CAS  PubMed  Google Scholar 

  11. Karsy M, Raheja A, Eli I, Guan J, Couldwell WT (2017) Clinical outcomes with transcranial resection of the tuberculum sellae meningioma. World Neurosurg 108:748–755

    Article  PubMed  Google Scholar 

  12. Kihlström L, Mathiesen T (2006) Visual outcome of tuberculum sellae meningiomas after extradural optic nerve decompression. Neurosurgery 59:570–576

    Article  PubMed  Google Scholar 

  13. Kim T-W, Jung S, Jung T-Y, Kim I-Y, Kang S-S, Kim S-H (2009) Prognostic factors of postoperative visual outcomes in tuberculum sellae meningioma. Br J Neurosurg 22:231–234

    Article  Google Scholar 

  14. Koutourousiou M, Fernandez-Miranda JC, Stefko ST, Wang EW, Snyderman CH, Gardner PA (2014) Endoscopic endonasal surgery for suprasellar meningiomas: experience with 75 patients. J Neurosurg 120:1326–1339

    Article  PubMed  Google Scholar 

  15. Leclerc A, Gaberel T, Laville M-A, Derrey S, Quintyn J-C, Emery E (2022) Predictive factors of favorable visual outcomes after surgery of tuberculum sellae meningiomas: a multicenter retrospective cohort study. World Neurosurg 164:e557–e567

    Article  PubMed  Google Scholar 

  16. Lefevre E, Terrier LM, Bekaert O, Simonneau A, Rogers A, Vignal-Clermont C, Boissonnet H, Robert G, Lot G, Chauvet D (2020) Microsurgical transcranial approach of 112 paraoptic meningiomas: a single-center case series. Oper Neurosurg (Hagerstown) 19:651–658

    Article  PubMed  Google Scholar 

  17. Magill ST, Schwartz TH, Couldwell WT, Gardner PA, Heilman CB, Sen C, Akagami R, Cappabianca P, Prevedello DM, McDermott MW (2023) International Tuberculum Sellae Meningioma Study: Surgical Outcomes and Management Trends. Neurosurgery 93:1259–1270

    Article  PubMed  Google Scholar 

  18. Margalit N, Shahar T, Barkay G, Gonen L, Nossek E, Rozovski U, Kesler A (2013) Tuberculum Sellae meningiomas: surgical technique, visual outcome, and prognostic factors in 51 cases. J Neurol Surg B Skull Base 74:247–258

    Article  PubMed  PubMed Central  Google Scholar 

  19. Mortazavi MM, Brito da Silva H, Ferreira M Jr, Barber JK, Pridgeon JS, Sekhar LN (2016) Planum sphenoidale and tuberculum sellae meningiomas: operative nuances of a modern surgical technique with outcome and proposal of a new classification system. World Neurosurg 86:270–286

    Article  PubMed  Google Scholar 

  20. Mou J, Wang X, Huo G, Ruan L, Jin K, Tan S, Wang F, Hua H, Yang G (2019) Endoscopic Endonasal surgery for craniopharyngiomas: a series of 60 patients. World Neurosurg 124:e424–e430

    Article  PubMed  Google Scholar 

  21. Nakamura M, Roser F, Struck M, Vorkapic P, Samii M (2006) Tuberculum Sellae Meningiomas. Neurosurgery 59:1019–1029

    Article  PubMed  Google Scholar 

  22. Nozaki K, Kikuta K, Takagi Y, Mineharu Y, Takahashi JA, Hashimoto N (2008) Effect of early optic canal unroofing on the outcome of visual functions in surgery for meningiomas of the tuberculum sellae and planum sphenoidale. Neurosurgery 62:839–44 (discussion 844–6)

    Article  PubMed  Google Scholar 

  23. Ostrom QT, Cioffi G, Waite K, Kruchko C, Barnholtz-Sloan JS (2021) CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2014–2018. Neuro Oncol 23:iii1-iii105

  24. Otani N, Muroi C, Yano H, Khan N, Pangalu A, Yonekawa Y (2006) Surgical management of tuberculum sellae meningioma: role of selective extradural anterior clinoidectomy. Br J Neurosurg 20:129–138

    Article  PubMed  Google Scholar 

  25. Palani A, Panigrahi MK, Purohit AK (2012) Tuberculum sellae meningiomas: A series of 41 cases; surgical and ophthalmological outcomes with proposal of a new prognostic scoring system. J Neurosci Rural Pract 3:286–293

    Article  PubMed  PubMed Central  Google Scholar 

  26. Pamir MN, Özduman K, Belirgen M, Kilic T, Özek MM (2005) Outcome determinants of pterional surgery for tuberculum sellae meningiomas. Acta Neurochir (Wien) 147:1121–1130

    Article  CAS  PubMed  Google Scholar 

  27. Park C-K, Jung H-W, Yang S-Y, Seol HJ, Paek SH, Kim DG (2006) Surgically Treated Tuberculum Sellae and Diaphragm Sellae Meningiomas: The Importance of Short-term Visual Outcome. Neurosurgery 59:238–243

    Article  PubMed  Google Scholar 

  28. Park HH, Sung KS, Moon JH, Kim EH, Kim SH, Lee K-S, Hong C-K, Chang JH (2019) Lateral supraorbital versus pterional approach for parachiasmal meningiomas: surgical indications and esthetic benefits. Neurosurg Rev 43:313–322

    Article  PubMed  Google Scholar 

  29. La Rocca G, Della Pepa GM, Sturiale CL, Sabatino G, Auricchio AM, Puca A, Olivi A, Marchese E, Albanese A (2018) Lateral supraorbital versus pterional approach: analysis of surgical, functional, and patient-oriented outcomes. World Neurosurg 119:e192–e199

    Article  PubMed  Google Scholar 

  30. Simpson D (1957) The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20:22–39

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Song D, Zhang M, Duan C, Wei M, Xu D, An Y, Zhang L, Wang F, Feng M, Qian Z, Gao Q, Guo F (2023) A machine learning-based integrated clinical model for predicting prognosis in atypical meningioma patients. Acta Neurochir (Wien) 165:4191–4201

    Article  PubMed  Google Scholar 

  32. Trittmacher S, Traupe H, Schmid A (1988) Pre- and postoperative changes in brain tissue surrounding a meningioma. Neurosurgery 22:882–885

    Article  CAS  PubMed  Google Scholar 

  33. Troude L, Boucekine M, Baucher G, Farah K, Boissonneau S, Fuentes S, Graillon T, Dufour H (2021) Ipsilateral vs controlateral approach in tuberculum sellae meningiomas surgery: a retrospective comparative study. Neurosurg Rev 44:3581–3591

    Article  PubMed  Google Scholar 

  34. Wang F, Xu D, Liu Y, Lin Y, Wei Q, Gao Q, Lei S, Guo F (2019) Risk factors associated with postoperative recurrence in atypical intracranial meningioma: analysis of 263 cases at a single neurosurgical centre. Acta Neurochir (Wien) 161:2563–2570

    Article  PubMed  Google Scholar 

  35. Weber DC, Ares C, Villa S, Peerdeman SM, Renard L, Baumert BG, Lucas A, Veninga T, Pica A, Jefferies S, Ricardi U, Miralbell R, Stelmes JJ, Liu Y, Collette L, Collette S (2018) Adjuvant postoperative high-dose radiotherapy for atypical and malignant meningioma: A phase-II parallel non-randomized and observation study (EORTC 22042–26042). Radiother Oncol 128:260–265

    Article  PubMed  Google Scholar 

  36. Xiao F, Shen J, Zhang L, Yang J, Weng Y, Fang Z, Zhang C, Ye H, Zhan R, Zheng X (2021) Unilateral Subfrontal Approach for Giant Tuberculum Sellae Meningioma: Single Center Experience and Review of the Literature. Front Oncol 11:708235

    Article  PubMed  PubMed Central  Google Scholar 

  37. Yamaguchi R, Tosaka M, Miyagishima T, Osawa T, Horiguchi K, Honda F, Yoshimoto Y (2019) Sagittal bending of the optic nerve at the entrance from the intracranial to the optic canal and ipsilateral visual acuity in patients with sellar and suprasellar lesions. J Neurosurg 134:180–188

    Article  PubMed  Google Scholar 

  38. Yamaguchi R, Tosaka M, Shinohara Y, Todokoro D, Mukada N, Miyagishima T, Akiyama H, Yoshimoto Y (2022) Analysis of visual field disturbance in patients with sellar and suprasellar lesions: relationship with magnetic resonance imaging findings and sagittal bending of the optic nerve. Acta Neurol Belg 122:1031–1041

    Article  PubMed  Google Scholar 

  39. Yang C, Fan Y, Shen Z, Wang R, Bao X (2019) Transsphenoidal versus transcranial approach for treatment of tuberculum sellae meningiomas: a systematic review and meta-analysis of comparative studies. Sci Rep 9:4882

    Article  ADS  PubMed  PubMed Central  Google Scholar 

  40. Yu P, Xu T, Wu X, Liu Z, Wang Y, Wang Y (2021) The expanded endoscopic endonasal approach for treatment of tuberculum sellae meningiomas in a series of 40 consecutive cases. Sci Rep 11:4993

    Article  ADS  CAS  PubMed  PubMed Central  Google Scholar 

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Funding

This work was supported by the National Key Research and Development Program of China (2021YFE0204700), the Leading Project of Henan Province Young Medical Research (LJRC2023010) and the Henan Province Science and Technology Research Project (232102310127).

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Author notes

  1. Chengcheng Duan and Dengpan Song contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, No.1, East Jianshe Road, Zhengzhou, Henan Province, 450001, China

    Chengcheng Duan, Dengpan Song, Fang Wang, Youjun Wang, Mingkun Wei, Junhao Fang, Tingting Zhai, Yuan An, Yuchao Zuo, Yan Hu, Guihong Li, Zhiyun Yu & Fuyou Guo

  2. International Joint Laboratory of Nervous System Malformations, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China

    Chengcheng Duan, Dengpan Song, Fang Wang, Youjun Wang, Mingkun Wei, Junhao Fang, Tingting Zhai, Yuan An, Yuchao Zuo, Yan Hu, Guihong Li, Zhiyun Yu & Fuyou Guo

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  1. Chengcheng Duan
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Contributions

Chengcheng Duan conducted statistical analysis and manuscript writing. Youjun Wang, Mingkun Wei, Junhao Fang, Tingting Zhai and Yuan An sifted and collected the data. Yan Hu, Guihong Li and Zhiyun Yu evaluated the data and results. Chengcheng Duan and Dengpan Song conceptualized the manuscript outline. Fang Wang, Yuchao Zuo and Fuyou Guo revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Fuyou Guo.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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The authors declare no competing interests.

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Comments

The authors tried to investigate the possible factors for postoperative visual outcome in 208 patients with tuberculum sellae meningiomas (TSMs). They assessed their obtained data such as visual function, tumor images and treatments for visual outcomes by using the multivariate logistic regression analysis. From the huge population, it was found that the age, duration of preoperative visual symptom, tumor size, gross total removal, and tumor vertical-to-horizontal dimensional ratio were powerful positive predictors for good visual outcomes in the patients with TSMs. This study has some limitations (single-center, retrospective, without detailed ophthalmic and MRI data, etc.) and the further evaluation with MRI findings, surgical approaches including endonasal endoscopic approach and long-term follow-up is needed. However, those predictive factors from the current study with large number of patients must be valuable to decide the surgical indication for the patients with TSMs.

Yutaka Mine

Tokyo, Japan

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Supplementary Information

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701_2024_6033_MOESM1_ESM.tif

Supplementary file1 represents the maximum diameter on the transversal sequence of the enhanced MRI. (B) The red line represents the maximum diameter on the coronal sequence of the enhanced MRI. (C) The red line represents the maximum diameter on the sagittal sequence of the enhanced MRI. (D) Red arrow represents annular cerebrospinal fluid signals (brain-tumor interface) between tumor and brain tissue on T2-weighted MRI. (E, F) The tumor involves the right optic canal. (TIF 4841 KB)

Supplementary file2 Supplementary Fig. 2 Correlation analysis between variables. (TIF 1638 KB)

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Duan, C., Song, D., Wang, F. et al. Factors influencing postoperative visual improvement in 208 patients with tuberculum sellae meningiomas. Acta Neurochir 166, 140 (2024). https://doi.org/10.1007/s00701-024-06033-x

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