Optimal microsurgical treatment of dorsum sellae meningioma

Background There are few reports of micresurgical treatment of dorsum sellae meningiomas-which,because of location,size,and differences in growth direction,clinical presentations,degree of surgical difficulty,have varied posttreatment sequelae.In pursuit of an optimal micresurgical treatment option for dorsum sellae meningioma patients,we performed a retrospective analysis of eight microsurgery-treated patients in our set up.Methods Clinical data of eight microsurgery-treated dorsum sellae meningioma patients were analyzed.Dorsum sellae meningiomas were classified into 2 types based on tumor location,size,and direction of growth.Type Ⅰ tumors (dorsum sellae-inferior third ventricle type,four cases) were resected by craniotomy via the frontotemporal or orbitozygomatic approach.Type Ⅱ tumors (dorsum sellae-third ventricle type,4 cases) were resected by frontal craniotomy via the transcallosal-interfomiceal approach.Results Complete tumor resection was achieved in all the eight patients.In Type Ⅰ tumor patients,the only postoperative complication was oculomotor nerve palsy.In Type Ⅱ tumor patients,the postoperative complications included hyperthermia,electrolyte imbalances,endocrinologic disturbances,and hydrocephalus.The mean follow-up was 2.1 years.Four patients returned to normal life and found a job,two were able to live independently,one required assistance,while one died.Conclusions Dorsum sellae meningioma surgery is challenging,and resection of Type Ⅱ tumors is more difficult than Type Ⅰ tumors.The selection of a suitable microsurgical approach based on tumor type,and the active treatment of postoperative complications are important means of increasing therapeutic efficacy.