Suprasellar meningiomas - Neurological and visual outcome at long term follow-up in a homogeneous series of patients treated microsurgically

Most of the previously published surgical series of suprasellar meningiomas have two disadvantages: (1) patients involved were treated within a relati vely long time period, making analysis more difficult, (2) radiographic lon g term follow-up examinations with either CT- or MRI-scans were not perform ed. Both disadvantages were overcome in our retrospective clinical study, c onsisting of 50 consecutive patients with suprasellar meningiomas treated b t tu een 1982 and 1991. Radiological, ophthalmological, and neurological in vestigations were performed pre-operatively, postoperatively and at long te rm follow-up (mean: 5.7 years). A radiologically confirmed radical tumour r emoval could be achieved in 84% of patients. Both. the peri-operative morta lity (2%) and serious operative morbidity (6%) were low. However, 12% of pa tients developed late onset epilepsy. At long term follow-up, visual functi on was improved in 67%, unchanged in 9% and worsened in 24%. In more than 5 0% of patients the vision showed recovery over a longer time period than th e first 10 days after operation. Radiographic control examinations revealed tumour recurrences in 2 patients (both asymptomatic) and progress of resid ual tumour in 5 patients (2 symptomatic, 3 asymptomatic). Since introductio n of modern neurosurgery, a clear improvement in the surgical treatment of suprasellar meningiomas can be observed. However, the still long delay in d iagnosing these tumours correctly prevents a further improvement of the oph thalmological results at long-term follow-up. Due to a relatively high rate of late onset epilepsy, anticonvulsive prophylaxis for 6 months seems to b e justified. Regarding present pre-operative diagnostic measures, ia-BSA se ems only be indicated in patients with CT/MRI-scans, suspicious for tumouro us narrowing or invasion of major cerebral arteries. III addition, we recom mend radiographic control examinations at regular time intervals to confirm radical tumour removal and to detect the "ideal" point of time for renewed treatment.