TY - JOUR
T1 - International Tuberculum Sellae Meningioma Study
T2 - Surgical Outcomes and Management Trends
AU - on behalf of the International Tuberculum Sellae Meningioma Study Authors
AU - Magill, Stephen T.
AU - Schwartz, Theodore H.
AU - Couldwell, William T.
AU - Gardner, Paul A.
AU - Heilman, Carl B.
AU - Sen, Chandranath
AU - Akagami, Ryojo
AU - Cappabianca, Paolo
AU - Prevedello, Daniel M.
AU - McDermott, Michael W.
AU - Przybylowski, Colin J.
AU - Almefty, Kaith K.
AU - Patel, Akash J.
AU - Khan, A. Basit
AU - Wu, Kyle C.
AU - Bi, Wenya Linda
AU - Dunn, Ian F.
AU - Mamelak, Adam N.
AU - Ehsan, Mohammad U.
AU - Bruce, Jeffrey N.
AU - Englander, Zachary K.
AU - Wang, Linda M.
AU - Youngerman, Brett
AU - Anand, Vijay K.
AU - Kacker, Ashutosh
AU - Tabaee, Abtin
AU - Clarke, David B.
AU - Walling, Simon A.
AU - Hebb, Andrea L.O.
AU - Macki, Mohamed
AU - Anand, Sharath K.
AU - Rock, Jack P.
AU - Baskin, David S.
AU - Yewah Gwei, Larisse K.
AU - Guthikonda, Bharat
AU - Kosty, Jennifer
AU - Nanda, Anil
AU - Sun, Hai
AU - Culicchia, Frank
AU - Morrow, Kevin
AU - Fannin, Erin
AU - Germanwala, Anand V.
AU - Prabhu, Vikram C.
AU - Patel, Chirag R.
AU - Chaichana, Kaisorn
AU - Quinones-Hinojosa, Alfredo
AU - ReFaey, Karim
AU - Barnett, Samuel L.
AU - Mickey, Bruce E.
AU - Garzon-Muvdi, Tomas
N1 - Publisher Copyright:
© Congress of Neurological Surgeons 2023. All rights reserved.
PY - 2023/12/1
Y1 - 2023/12/1
N2 - BACKGROUND AND OBJECTIVES: Tuberculum sellae meningiomas (TSMs) can be resected through transcranial (TCA) or expanded endonasal approach (EEA). The objective of this study was to report TSMmanagement trends and outcomes in a large multicenter cohort. METHODS: This is a 40-site retrospective study using standard statistical methods. RESULTS: In 947 cases, TCA was used 66.4% and EEA 33.6%. The median maximum diameter was 2.5 cm for TCA and 2.1 cm for EEA (P < .0001). The median follow-up was 26 months. Gross total resection (GTR) was achieved in 70.2% and did not differ between EEA and TCA (P = .5395). Vision was the same or better in 87.5%. Vision improved in 73.0% of EEA patients with preoperative visual deficits compared with 57.1% of TCA patients (P < .0001). On multivariate analysis, a TCA (odds ratio [OR] 1.78, P = .0258) was associated with vision worsening, while GTR was protective (OR 0.37, P < .0001). GTR decreased with increased diameter (OR: 0.80 per cm, P = .0036) and preoperative visual deficits (OR 0.56, P = .0075). Mortality was 0.5%. Complications occurred in 23.9%. New unilateral or bilateral blindness occurred in 3.3% and 0.4%, respectively. The cerebrospinal fluid leak ratewas 17.3% for EEA and 2.2% for TCA (OR 9.1, P < .0001). The recurrence ratewas 10.9%(n = 103). Longer follow-up (OR 1.01 per month, P < .0001),World Health Organization II/III (OR 2.20, P = .0262), and GTR (OR: 0.33, P < .0001) were associated with recurrence. The recurrence rate after GTR was lower after EEA compared with TCA (OR 0.33, P = .0027). CONCLUSION: EEA for appropriately selected TSM may lead to better visual outcomes and decreased recurrence rates afterGTR, but cerebrospinal fluid leak rates are high, and longer follow-up is needed. Tumors were smaller in the EEA group, and follow-up was shorter, reflecting selection, and observation bias. Nevertheless, EEA may be superior to TCA for appropriately selected TSM.
AB - BACKGROUND AND OBJECTIVES: Tuberculum sellae meningiomas (TSMs) can be resected through transcranial (TCA) or expanded endonasal approach (EEA). The objective of this study was to report TSMmanagement trends and outcomes in a large multicenter cohort. METHODS: This is a 40-site retrospective study using standard statistical methods. RESULTS: In 947 cases, TCA was used 66.4% and EEA 33.6%. The median maximum diameter was 2.5 cm for TCA and 2.1 cm for EEA (P < .0001). The median follow-up was 26 months. Gross total resection (GTR) was achieved in 70.2% and did not differ between EEA and TCA (P = .5395). Vision was the same or better in 87.5%. Vision improved in 73.0% of EEA patients with preoperative visual deficits compared with 57.1% of TCA patients (P < .0001). On multivariate analysis, a TCA (odds ratio [OR] 1.78, P = .0258) was associated with vision worsening, while GTR was protective (OR 0.37, P < .0001). GTR decreased with increased diameter (OR: 0.80 per cm, P = .0036) and preoperative visual deficits (OR 0.56, P = .0075). Mortality was 0.5%. Complications occurred in 23.9%. New unilateral or bilateral blindness occurred in 3.3% and 0.4%, respectively. The cerebrospinal fluid leak ratewas 17.3% for EEA and 2.2% for TCA (OR 9.1, P < .0001). The recurrence ratewas 10.9%(n = 103). Longer follow-up (OR 1.01 per month, P < .0001),World Health Organization II/III (OR 2.20, P = .0262), and GTR (OR: 0.33, P < .0001) were associated with recurrence. The recurrence rate after GTR was lower after EEA compared with TCA (OR 0.33, P = .0027). CONCLUSION: EEA for appropriately selected TSM may lead to better visual outcomes and decreased recurrence rates afterGTR, but cerebrospinal fluid leak rates are high, and longer follow-up is needed. Tumors were smaller in the EEA group, and follow-up was shorter, reflecting selection, and observation bias. Nevertheless, EEA may be superior to TCA for appropriately selected TSM.
KW - Complications
KW - Endoscopic
KW - Expanded endonasal approach
KW - Meningioma
KW - Skull base
KW - Transsphenoidal
KW - Tuberculum
UR - http://www.scopus.com/inward/record.url?scp=85176382610&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85176382610&partnerID=8YFLogxK
U2 - 10.1227/neu.0000000000002569
DO - 10.1227/neu.0000000000002569
M3 - Article
C2 - 37389475
AN - SCOPUS:85176382610
SN - 0148-396X
VL - 93
SP - 1259
EP - 1270
JO - Neurosurgery
JF - Neurosurgery
IS - 6
ER -