Suprasellar Meningioma: A Novel Classification

Introduction: Suprasellar meningioma account for 10% of all meningiomas. They usually present with visual deterioration of one eye more than the other due to extension and compression of optic nerve within the optic canal. Meningiomas of suprasellar area arise from different sites including the most anterior planum sphenoidale, followed by limbus sphenoidal, chiasmatic sulcus, tuberculum sellae and finally diaphragma sellae. Meningiomas of suprasellar area arise from different sites including the most anterior planum sphenoidale, followed by limbus sphenoidal, chiasmatic sulcus, tuberculum sellae and finally diaphragma sellae. Suprasellar meningiomas approached transcranially or transnasally. We reviewed the radiological and intraoperative finding of suprasellar meningioma to propose new anatomical classification with possible standardize one approach over the other

Methodology: We reviewed 40 cases retrospectively of suprasellar meningioma. Data of clinical presentation, preoperative imaging to identify the visual apparatus displacement and vascular structure, as well as patency of diaphragma sellae, and intraoperative finding of arachnoid separation between the tumor and visual apparatus, patency of diaphragma sellae, tumor extension into optic canals, and direction of displacement of neurovascular structure were analyzed.

Result: Four subtypes of suprasellar meningiomas identified: planum sphenoidale (10), chiasmatic sulcus (9), tuberculum sellae (10), and diaphragma sellae (1). Canal extension was located inferiorly to optic nerve in diaphragma sellae meningioma, medial in tuberculum sellae and chiasmatic sulcus meningioma, and superomedial in planum sphenoidale. Optic chiasm was displaced posteriorly and displaced from A1/A2 complex in all cases corresponded to new subtype chiasmatic sulcus meningioma.

Conclusion: Chiasmatic sulcus meningioma is distinct subtype, its behavior toward neurovascular structure and bone reaction is different from other subtype. The location of the arachnoid layer and its protection to the visual apparatus is distinct and can be appreciated in different location based on the type during endoscopic transnasal approach.

Publication History

Article published online:
01 February 2023