Visual Prognostic Factors in Surgery of Tubercule Sellae Meningiomas

Background: Meningiomas of the tuberculum sellae account for 8% of all meningiomas operated on in our department. Visual acuity deterioration is the primary symptom, and the surgical goal is the removal of the meningioma while preserving or improving visual acuity. The objective of this study is to evaluate the factors influencing the postoperative visual prognosis of tuberculum sellae meningiomas operated on via the lateral supraorbital approach. Methods: This is a retrospective study of patients operated on for TS meningioma, conducted in the Department of Neurosurgery at Dr. Benbadis University Hospital in Constantine, Algeria. All patients were evaluated by an ophthalmologist before and after surgery. MRI is used to study tumor size, tumor extension and tumor relationships with vessels of the anterior part of the polygon of Willis. It also provides postoperative evaluation of the quality of resection and follow-up of tumor residue. The different factors we will be studying are duration of visual impairment, degree of visual loss at time of diagnosis, funduscopic examination and existence of optic atrophy, tumor size, intraoperative optic nerve appearance, tumor extension into the optic canal and tumor resection quality. Results: We report a retrospective study of 16 patients operated on for TS Meningioma during the period from September 2019 until May 2023. The findings highlighted several factors, particularly preoperative ones: Visual acuity impairment was observed in 93.75% of patients at the time of diagnosis. The average duration of visual acuity decline was 31.5 months. Tumor size was between 20 and 40 mm in 75% of cases, and larger than 40 mm in 18.75% of cases. Postoperatively: Visual acuity improved in 62.5% of patients. Total tumor resection was achieved in 75% of cases. In one patient, subtotal resection was performed due to tumor infiltration of the A1 segment of the anterior cerebral artery, which was completely involved by the tumor. Conclusion: The prognostic factors for visual outcome in TSM surgery remain controversial. The aim of surgery is to achieve improvement of vision. The key to preserving visual function is to minimize direct manipulation of the optic nerves and avoid injury to the blood supply to the optic apparatus.