Pterional surgery of meningiomas of the tuberculum sellae and planum sphenoidale: surgical results with special consideration of ophthalmological and endocrinological outcomes

Object. The authors reviewed 47 cases of suprasellar meningiomas with special attention to ophthalmological and endocrinological outcomes. Methods. All patients underwent surgery performed via a unilateral pterional approach between January 1983 and January 1998. Ophthalmological and endocrinological examinations were performed before the operation as well as 1 week and 3 months postoperatively. A special scoring system was adopted to quantify the extent of ophthalmological disturbances. Complete tumor resection was possible in all but one patient. There were no fatalities and the rate of visual improvement was 80%. The best prognoses were found in patients younger than 50 years and in patients in whom the duration of symptoms was less than 1 year. Before surgery, tumor-related endocrine disturbances were present in only three women who suffered from secondary hypogonadism; two of these patients recovered after surgery. Postoperatively, no patient needed replacement therapy for pituitary dysfunction. The overall tumor recurrence rate was 2.1% (one of 47 cases). For patients in whom long-term (> 5 years) follow-up data were available, the recurrence rate was 4.2% (one of 24 cases). Conclusions. In this series, complete resection of suprasellar meningiomas was possible through a unilateral pterional craniotomy and was associated with a low morbidity rate and no deaths.