Surgical Treatment of Tuberculum Sellae Meningiomas : The Importance of Opening the Entrance of the Optic Canal

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  • 鞍結節部髄膜腫の手術 : 視神経管入口部開放の重要性について

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Purpose : The tuberculum sellae meningiomas sometimes extend into the optic canals. We evaluated the importance of preoperative diagnosis and opening the entrance of the optic canals during the operation. Material and method : We operated on five cases of tuberculum sellae meningiomas between March 1994 and December 1998. There was one male and four females, and the mean age was 35 years (range, 29-40). All patients suffered from visual disturbance. Magnetic resonance (MR) imaging and intraoperative findings were compared in three cases concerning the tumor's extension into the entrance of optic canal. All patients were operated on by the pterional approach. Results : Total removal was achieved in four cases. In one case, the tumor extended into the dorsal portion of the dorsum sellae, and his part of the tumor was treated by gamma knife radiosurgery. T2-weighted coronal magnetic resonance imaging demonstrated well the extension of the tumor into the entrance of the optic canal and correlated well with the intraoperative findings. The visual disturbance improved in three cases, but in two cases it deteriorated after the operation. Conclusion : We emphasize the usefulness of T2-weighted MR imaging for the diagnosis of the tumor extension into the entrance of the optic canal and the importance of opening this portion during the operation on tuberculum sellae meningiomas.

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