Meningiomas of the sellar region presenting with visual impairment: Impactof various prognostic factors on surgical outcome in 62 patients

Background. Meningiomas of the supra- and parasellar region can cause insid ious visual loss by optic nerve compression. 62 cases with such tumours aff ecting the anterior optic pathways were analysed to assess the surgical res ults and prognostic factors with particular attention to visual outcome. Method. In all patients, visual deterioration was the first clinical manife station, Eleven lesions had their origin at the anterior clinoid process, 2 4 at the tuberculum sellae, 10 at the planum sphenoidale. two in the optic canal, 10 in the medial sphenoidal wing, and five in the olfactory groove. All patients underwent microsurgical tumour resection. Median age at the ti me of operation was 54 years. median duration of symptoms seven months. The mean follow-up time was 5.2 years (range 2 to 8 years). Statistical analys is of prognostic factors (gender, age, tumour location, tumour size, durati on of symptoms. brain tumour interface. resection grade. preoperative visua l loss. Glascow Outcome Score) was performed using univariate and multivari ate analysis. Findings. The severe morbidity rate H as 6.4%. Two patients died within the first 30 postoperative days. Overall, vision improved in 39 (65%) patients , in 11 (18%) it was unchanged, and worse in 10 (17%). Visual prognosis was favourably affected by age under 54 years (p < 0,025), duration of symptom s of less than seven months (p < 0,037), and the presence of an intact arac hnoid membrane around the lesion (p < 0,001). Severe preoperative loss of v isual acuity (<0,02) appeared to be an unfavourable prognostic factor (p <0 ,047). Interpretation. Possible difficulties and surgical outcome in such patients can be predicted successfully. These facts in connection with new therapeu tic modalities (radiosurgery, adjuvant therapies) will demand a careful ris k assessment and should influence the treatment strategies and the degree o f operative aggressiveness in the future.