Microsurgery For Sellar Region Meningioma And Analysis Of Factors Influencing Prognosis

Objective:To summarize the clinical and imaging features of sellar region meningioma and how to choose surgery approaches and analyze factors influencing postoperative visual outcome and quality of life.Methods:A retrospective analysis of44cases with sellar region meningioma treated microsurgery between October2007and October2012in the second hospital of Lanzhou University. Data of the clinical and imaging features, operative approaches and postoperative complications were analyzed. Using non-parametric test and logistic regression analysis was performed to assess potential influencing factors of postoperative visual outcome and quality of life.Results:15patients was male and29female. Patients’age varied from31to68(mean age is47). Main clinical manifestations included visual acuity damage (36cases), visual field defect (33cases) and headache (32cases). Total tumor resection was achieved in32cases, subtotal in12. The fellow up period of patients ranged from3to60months (median22.8months). The mean quality of life score (KPS) was73.2,24patients regained full daily activity (KPS Score80～100) and15patients were able to live at home and care for most personal needs (KPS Score60～70). In36patients with visual acuity damage, the long term fellow-up of34patients were got, visual function improved in35eyes, remained unchanged in23and deteriorated in10.Statistical analysis showed that prognosis visual outcome correlate to the following factors: duration and severity of preoperative visual acuity damage, preoperative change of optic disc, preoperative change of the amplitude of visual evoked potential, texture and location of tumor, direction of tumor invasion, relationship between tumor and optic nerve, morphology of the optic nerve during operation and relationship between tumor and internal carotid arteries, anterior cerebral arteries and/or middle cerebral arteries. However, the multivariate analysis showed that severity of preoperative visual acuity damage, preoperative change of optic disc, preoperative change of the amplitude of visual evoked potential and relationship between tumor and optic nerve are the most influential factors.The following factors were found to be influence postoperative quality of life:preoperative KPS score, postoperative visual outcome, direction of tumor invasion, relationship between tumor and optic nerve, internal carotid arteries, anterior cerebral arteries and/or middle cerebral arteries, extent of tumor removal. However, the multivariate analysis showed postoperative visual outcome, relationship between tumor and optic nerve, internal carotid arteries, anterior cerebral arteries and/or middle cerebral arteries are the most influential factors.Conclusions:1. Proper operative approaches and skilled microsurgical techniques to protect there structure of Optic Nerve, Optic Chiasma, Hypothalamus, Hypophysis and their blood supply are the key points to reduce the postoperative complications of sellar region memingioma.2. Postoperative visual outcome of sellar region memingioma is one of the most influential factors of postoperative quality of life. The following factors were found to be influence visual outcome:duration and severity of preoperative visual acuity damage, preoperative change of optic disc, preoperative change of the amplitude of visual evoked potential, texture and location of tumor, direction of tumor invasion, relationship between tumor and optic nerve, morphology of the optic nerve during operation and relationship between tumor and internal carotid arteries, anterior cerebral arteries and/or middle cerebral arteries. However, the most influential factors are severity of preoperative visual acuity damage, preoperative change of optic disc, preoperative change of the amplitude of visual evoked potential and relationship between tumor and optic nerve.3. In addition to the postoperative visual outcome, preoperative KPS score, direction of tumor invasion, relationship between tumor and optic nerve, hypophysis, internal carotid arteries, anterior cerebral arteries and/or middle cerebral arteries, and extent of tumor removal are factors influencing the postoperative quality of life.