Tuberculum Sellae Meningiomas

Tuberculum sellae meningiomas (TSMs) arise from the dura neighboring the tuberculum sellae, frequently lateralized just medial to the optic canal, explaining a relatively easy and precocious invasion of the medial and inferior portion of the optic canal. They usually displace the optic nerve upward and laterally, compressing it against the sharp edge of the falciform ligament, and thus causing asymmetric visual disturbances. Complete surgical resection and optic nerve decompression are the aim of the treatment. We recommend a unilateral fronto-orbital approach with extradural unroofing of the optic canal and early intradural nerve decompression The gross total resection (GTR), evaluated on MRI as Simpson 1–3, was achieved overall in 91.5% of patients adopting this approach in our experience. The cumulative recurrence-free rates 5 years and 10 years after GTR were 92.4% and 66.2%, respectively. Not addressing the intracanalicular part of the tumor could be associated to a higher incidence of residual/recurrent tumor and to an unimproved/worse vision in the post-operative phase. Gamma Knife Stereotactic Radiosurgery (GKSRS) also plays a role for postoperative residual or recurrent tumors. Even asymptomatic small TSMs can be treated by upfront GKSRS considering their critical location.