Management and Surgical Outcome of Suprasellar Meningiomas

  • Jean Brihaye
  • M. Brihaye-Van Geertruyden
Part of the Acta Neurochirurgica Supplementum 42 book series (NEUROCHIRURGICA, volume 42)


The authors analyse 22 cases of suprasellar meningiomas, drawing attention to factors influencing on the surgical outcome. In all but one case, symptomatology began with progressive visual failure in one eye. Bilateral anosmia was noted in 4 patients with large tumour. Mental disorders were conspicuous in 5 cases and 3 patients suffered from epilepsy. Headache was severe in 5 cases. Endrocrinological disorders were observed in 3 patients. The sella turcica was of normal shape in all cases. Marked hyperostosis of the planum or tuberculum existed in 7 cases. The tumour was heavy-calcified in 2 cases. CT scanning showed everytime a marked enhancement of the tumour and in 4 cases, a large hypodense area surrounded the tumour. The patients were operated on through a bifrontal approach or a unilateral frontal flap. A partial anterior frontal lobectomy was regularly performed on one side. While the tumour is piecemeal exacavated, the durai attachment at the base is reached as quickly as possible. Complications consisted in rhinorrhea of CSF in 2 cases, once in a transitory diabetes insipidus and in a secondary hydrocephalus. Postoperative mortality remains high. Among the eleven cases of large tumours, a direct postoperative death occurred, due to a severe arterial bleeding. Two other patients died 4 and 6 weeks respectively after operation. An other patient died 8 years after operation, from meningitis. Among the 5 cases of medium-sized tumours, one postoperative death occurred in a young female, 30 of age, following urinary infection by Klebsiella, complicated by toxicemia. No death and no morbidity occured in the cases of small-sized tumour. Recurrences were observed 3 and 7 years respectively after surgery in 2 patients. In conclusion: multiple factors influence on surgical outcome of suprasellar meningiomas: time interval between the onset of symptoms and the operation, tumour size, heavy calcification of the tumour, big zone of hypodensity, commonly interpreted as brain oedema, circumscribing the tumour. It has been postulated that the occurence of cerebral oedema in combination with meningioma is associated with growing factors of the tumour and results from a breakdown of the blood-brain barrier. The impairment of the blood supply to the surrounding brain (frontal lobes and hypothalamic region) is really aggravated by the intraoperative manipulations. Brain hypodensity associated with suprasellar meningioma appears to us a major factor influencing on the overall outcome.


Mitral Valve Disease Sella Turcica Optic Canal Anterior Clinoid Process Dural Attachment 
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Copyright information

© Springer-Verlag/Wien 1988

Authors and Affiliations

  • Jean Brihaye
    • 1
  • M. Brihaye-Van Geertruyden
    • 2
  1. 1.Department of Neurosurgery, Institut BordetFree University of BrusselsBelgium
  2. 2.Department of Ophthalmology, Akademisch ZiekenhuisVrij Universiteit BrusselBelgium

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