A literature review of anatomical considerations and surgical approaches for planum sphenoidale and tuberculum sellae meningiomas

Background: Planum sphenoidale meningiomas (PSMs) and tuberculum sellae meningiomas (TSMs) represent a surgically challenging subset of anterior skull base tumors because of their close relationship with the optic apparatus, internal carotid arteries, anterior cerebral arteries, pituitary stalk, and hypothalamus. Although traditional anatomical distinctions have guided the choice between endoscopic endonasal and transcranial approaches (TCAs), increasing evidence suggests that individualized tumor-specific factors should drive surgical decision-making. Methods: A narrative review of the literature was performed to evaluate anatomical considerations, classification systems, surgical approaches, outcomes, and complications associated with PSMs and TSMs. Evidence regarding transcranial, endoscopic endonasal, and minimally invasive approaches was synthesized to develop a practical decision-making framework. Results: Contemporary literature shows that both transcranial and endoscopic endonasal approaches (EEAs) can achieve favorable outcomes when appropriately selected. TCAs remain advantageous for tumors with marked lateral extension, vascular encasement, or complex neurovascular relationships. EEAs may offer improved visualization of midline lesions, early devascularization, optic canal (OC) decompression, and favorable visual outcomes, although they are associated with a higher risk of cerebrospinal fluid leakage. Surgical experience, reconstruction techniques, tumor size, OC invasion, vascular involvement, and lateral extension are key determinants of outcome. Conclusion: Management of PSMs and TSMs should be individualized rather than based solely on rigid anatomical classifications. The proposed algorithm integrates anatomical, radiological, and surgical factors to support approach selection and optimize patient outcomes.