Instruction : The most important factors for treatment of tuberculum sellae meningioma is complete resection of the tumor without provoking symptoms such as decreased visual acuity and visual field defect. We retrospectively analyzed patients with tuberculum sellae meningioma with regard to postoperative tumor control and visual outcomes. Material and Method : From 1994 to 2008, 17 patients with tuberculum sellae meningioma underwent surgical treatment. Mean age was 49.8 years, mean symptom duration was 12.5 months. The mean follow up period was 67.2 months. 13 patients underwent surgery through extradural anterior clinoidectomy with optic nerve decompression. Subfrontal approach was performed in 2 patients and orbitozygomatic approach in 2 patients. Result : Twelve patients presented with symptoms of optic nerve compression, and hypopituitarism symptoms in 1 patient. Four patients were found incidentally as tuberculum sellae meningioma. Ten patients who presented with visual acuity disturbance before operation, 6 with visual field defect and optic nerve atropy in 5 patient. Gross total resection was achieved in 13 patients. Simpson grade I in 1 case, grade II in 8 cases, grade III in 4 cases and subtotal resectionl in 4 cases. Of the 12 patients with preoperative optic nerve compression symptoms pre-operatively, 8 patients(66.7%) were improved and 4 were unchanged(33.3%). There were no further visual deteriorations for the patients with no visual disturbances before operations. Conclusion : We obtained good outcome via the extradural anterior clinoidectomy with optic nerve decompression. We think that this approach was suitable access to patients with visual deterioration and reduces the risk of intraoperative optic nerve injury.
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