Diaphragma Sellae and Tuberculum Meningiomas: Role of Extended Transsphenoidal Approach

Objective: To show that tuberculum/diaphragma sellae meningiomas can be effectively treated by an extended transsphenoidal approach.

Design: We present our experience, our indications, and the technology necessary to remove these difficult tumors by this approach.

Methods: From 2007 through 2011, 11 patients were operated on with an extended transnasal microsurgical endoscope-assisted approach. Tumors presented with a prevalent median extension and maximum diameter of 2.5 to 4.5 cm. The surgical approach performed consisted of opening only the anterior portion of the sella turcica; the sphenoidal plane; and, in 3 cases, also the posterior part of the ethmoidal plane due to tumoral extension. Operative technology resulted in mandatory removal of the hard fibrous tissue typical of meningiomas.

Results: Gross total removal was achieved in 10 patients, with little tumoral remnants that were, in all cases, intentionally left in situ because of adherence to the supra- and laterosellar nervous and vascular structures. Partial removal was achieved in the first patient of the series because of misdiagnosis with pituitary adenoma and the lack of dedicated instruments. Marked improvement of visual deficits was observed in six patients, moderate improvement was seen in four, and visus remained unchanged in the last patient. No operative mortality and no new neurological deficits occurred during an average follow-up period of 26 months. Two cases of postoperative rhinoliquorrhea occurred.

Conclusions: An extended transsphenoidal approach represents a valid therapeutic option for tuberculum/diaphragma sellae meningiomas in selected patients and in dedicated neurosurgical centers.