• Seungjoo Lee, Seok Ho Hong, Young Hyun Cho, Jeong Hoon Kim, and Chang Jin Kim.
• Department of Neurological Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea.
• World Neurosurg. 2016 May 1; 89: 552-61.

ObjectiveTuberculum sellae meningiomas (TSM) arise from the dura mater of tuberculum sellae, limbus sphenoidale, and chiasmatic sulcus and cause asymmetric visual disturbances. In this study, we analyzed the laterality of the origin of TSM and discussed its clinical implications on immediate and long-term visual outcomes.MethodsBetween 1994 and 2013, TSM was diagnosed in 100 patients after microsurgical resection. The medical records, radiologic features, and operative findings were retrospectively reviewed and analyzed in these patients.ResultsVisual disturbances were evident in 95 patients (95%) after neuro-ophthalmologic testing. Among them, 89 patients (89%) showed marked asymmetric visual field defect, and 6 patients (6%) had relatively symmetric visual field defect. On intraoperative inspection, the origin of TSM was at the one lateral end portion of the tuberculum sellae in 85 patients (85%). In 15 patients (15%), the TSM originated from the midline region, including the central portion of the tuberculum sellae (n = 13) and diaphragm sellae (n = 2). Optic canal involvement was observed in 73 patients (73%). Preexisting visual field defects were improved in 70 patients (70%), were stationary in 25 patients (25%), and aggravated in 5 patients (5%) during postoperative follow-up (mean 58 months, 24∼122 months). The preoperative symptom duration, the laterality of the origin of TSM, and optic disc atrophy were associated with long-term poor visual outcomes.ConclusionsMost TSMs that originated from the dura of one lateral end portion of the tuberculum sellae correlated with asymmetric visual symptoms and poor visual outcomes. This microsurgical feature should be considered in the planning of optimal surgical strategy to achieve favorable outcomes.Copyright © 2016 Elsevier Inc. All rights reserved.

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