International Tuberculum Sellae Meningioma Study: Surgical Outcomes and Management Trends

on behalf of the International Tuberculum Sellae Meningioma Study Authors

doi:10.1227/neu.0000000000002569

International Tuberculum Sellae Meningioma Study: Surgical Outcomes and Management Trends

on behalf of the International Tuberculum Sellae Meningioma Study Authors

Neurological Surgery

Research output: Contribution to journal › Article › peer-review

10 Scopus citations

Abstract

BACKGROUND AND OBJECTIVES: Tuberculum sellae meningiomas (TSMs) can be resected through transcranial (TCA) or expanded endonasal approach (EEA). The objective of this study was to report TSMmanagement trends and outcomes in a large multicenter cohort. METHODS: This is a 40-site retrospective study using standard statistical methods. RESULTS: In 947 cases, TCA was used 66.4% and EEA 33.6%. The median maximum diameter was 2.5 cm for TCA and 2.1 cm for EEA (P < .0001). The median follow-up was 26 months. Gross total resection (GTR) was achieved in 70.2% and did not differ between EEA and TCA (P = .5395). Vision was the same or better in 87.5%. Vision improved in 73.0% of EEA patients with preoperative visual deficits compared with 57.1% of TCA patients (P < .0001). On multivariate analysis, a TCA (odds ratio [OR] 1.78, P = .0258) was associated with vision worsening, while GTR was protective (OR 0.37, P < .0001). GTR decreased with increased diameter (OR: 0.80 per cm, P = .0036) and preoperative visual deficits (OR 0.56, P = .0075). Mortality was 0.5%. Complications occurred in 23.9%. New unilateral or bilateral blindness occurred in 3.3% and 0.4%, respectively. The cerebrospinal fluid leak ratewas 17.3% for EEA and 2.2% for TCA (OR 9.1, P < .0001). The recurrence ratewas 10.9%(n = 103). Longer follow-up (OR 1.01 per month, P < .0001),World Health Organization II/III (OR 2.20, P = .0262), and GTR (OR: 0.33, P < .0001) were associated with recurrence. The recurrence rate after GTR was lower after EEA compared with TCA (OR 0.33, P = .0027). CONCLUSION: EEA for appropriately selected TSM may lead to better visual outcomes and decreased recurrence rates afterGTR, but cerebrospinal fluid leak rates are high, and longer follow-up is needed. Tumors were smaller in the EEA group, and follow-up was shorter, reflecting selection, and observation bias. Nevertheless, EEA may be superior to TCA for appropriately selected TSM.

Original language	English (US)
Pages (from-to)	1259-1270
Number of pages	12
Journal	Neurosurgery
Volume	93
Issue number	6
DOIs	https://doi.org/10.1227/neu.0000000000002569
State	Published - Dec 1 2023

Funding

Stephen T. Magill is supported by the Northwestern Medicine Malnati Brain Tumor institute of the Lurie Cancer Center. Paul A. Gardner has consulting agreements with SPIWay and Lazic. Daniel M. Prevedello is a consultant for BK Medical, Stryker Corp, Medtronic Corp and Integra LifeSciences Corp., has equity on 3 rivers LLC, and Soliton LLC, and receives royalties from KLS-Martin, ACE Medical and Mizuho. Michael W. McDermott is a consultant and has stock options with Deinde. The members of The International Tuberculum Sellae Meningioma project group have the following disclosures: Adam N. Mamelak has equity ownership and is a paid consultant to Blaze Bioscience, Seattle, WA; Ricardo L. Carrau is a consultant for Medtronic Corp. Michael R. Chicoine received funding from 1) IMRIS Inc. for an unrestricted educational grant to support an iMRI database and outcomes analysis project, the IMRIS Muliticenter intraoperative MRI Neurosurgery Database (I-MiND), 2) The Head for the Cure Foundation, and 3) Mrs. Carol Rossfeld and The Alex & Alice Aboussie Family Charitable Foundation. I-MiND is maintained in The REDCap server at Washington University in St. Louis is Supported by Clinical and Translational Science Award (CTSA) Grant [UL1 TR000448] and The Siteman Comprehensive Cancer Center and NCI Cancer Center Support Grant P30 CA091842. The project was supported by the UCSF Wolfe Meningioma Program Project.

Keywords

Complications
Endoscopic
Expanded endonasal approach
Meningioma
Skull base
Transsphenoidal
Tuberculum

ASJC Scopus subject areas

Surgery
Clinical Neurology

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10.1227/neu.0000000000002569

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@article{8b335ce4e0074975a8ec8a904025c1d2,

title = "International Tuberculum Sellae Meningioma Study: Surgical Outcomes and Management Trends",

abstract = "BACKGROUND AND OBJECTIVES: Tuberculum sellae meningiomas (TSMs) can be resected through transcranial (TCA) or expanded endonasal approach (EEA). The objective of this study was to report TSMmanagement trends and outcomes in a large multicenter cohort. METHODS: This is a 40-site retrospective study using standard statistical methods. RESULTS: In 947 cases, TCA was used 66.4% and EEA 33.6%. The median maximum diameter was 2.5 cm for TCA and 2.1 cm for EEA (P < .0001). The median follow-up was 26 months. Gross total resection (GTR) was achieved in 70.2% and did not differ between EEA and TCA (P = .5395). Vision was the same or better in 87.5%. Vision improved in 73.0% of EEA patients with preoperative visual deficits compared with 57.1% of TCA patients (P < .0001). On multivariate analysis, a TCA (odds ratio [OR] 1.78, P = .0258) was associated with vision worsening, while GTR was protective (OR 0.37, P < .0001). GTR decreased with increased diameter (OR: 0.80 per cm, P = .0036) and preoperative visual deficits (OR 0.56, P = .0075). Mortality was 0.5%. Complications occurred in 23.9%. New unilateral or bilateral blindness occurred in 3.3% and 0.4%, respectively. The cerebrospinal fluid leak ratewas 17.3% for EEA and 2.2% for TCA (OR 9.1, P < .0001). The recurrence ratewas 10.9%(n = 103). Longer follow-up (OR 1.01 per month, P < .0001),World Health Organization II/III (OR 2.20, P = .0262), and GTR (OR: 0.33, P < .0001) were associated with recurrence. The recurrence rate after GTR was lower after EEA compared with TCA (OR 0.33, P = .0027). CONCLUSION: EEA for appropriately selected TSM may lead to better visual outcomes and decreased recurrence rates afterGTR, but cerebrospinal fluid leak rates are high, and longer follow-up is needed. Tumors were smaller in the EEA group, and follow-up was shorter, reflecting selection, and observation bias. Nevertheless, EEA may be superior to TCA for appropriately selected TSM.",

keywords = "Complications, Endoscopic, Expanded endonasal approach, Meningioma, Skull base, Transsphenoidal, Tuberculum",

author = "{on behalf of the International Tuberculum Sellae Meningioma Study Authors} and Magill, {Stephen T.} and Schwartz, {Theodore H.} and Couldwell, {William T.} and Gardner, {Paul A.} and Heilman, {Carl B.} and Chandranath Sen and Ryojo Akagami and Paolo Cappabianca and Prevedello, {Daniel M.} and McDermott, {Michael W.} and Przybylowski, {Colin J.} and Almefty, {Kaith K.} and Patel, {Akash J.} and Khan, {A. Basit} and Wu, {Kyle C.} and Bi, {Wenya Linda} and Dunn, {Ian F.} and Mamelak, {Adam N.} and Ehsan, {Mohammad U.} and Bruce, {Jeffrey N.} and Englander, {Zachary K.} and Wang, {Linda M.} and Brett Youngerman and Anand, {Vijay K.} and Ashutosh Kacker and Abtin Tabaee and Clarke, {David B.} and Walling, {Simon A.} and Hebb, {Andrea L.O.} and Mohamed Macki and Anand, {Sharath K.} and Rock, {Jack P.} and Baskin, {David S.} and {Yewah Gwei}, {Larisse K.} and Bharat Guthikonda and Jennifer Kosty and Anil Nanda and Hai Sun and Frank Culicchia and Kevin Morrow and Erin Fannin and Germanwala, {Anand V.} and Prabhu, {Vikram C.} and Patel, {Chirag R.} and Kaisorn Chaichana and Alfredo Quinones-Hinojosa and Karim ReFaey and Chandler, {James P.} and Fernandez, {Luis G.} and Oyon, {Daniel E.}",

year = "2023",

month = dec,

day = "1",

doi = "10.1227/neu.0000000000002569",

language = "English (US)",

volume = "93",

pages = "1259--1270",

journal = "Neurosurgery",

issn = "0148-396X",

publisher = "Lippincott Williams and Wilkins",

number = "6",

}

TY - JOUR

T1 - International Tuberculum Sellae Meningioma Study

T2 - Surgical Outcomes and Management Trends

AU - on behalf of the International Tuberculum Sellae Meningioma Study Authors

AU - Magill, Stephen T.

AU - Schwartz, Theodore H.

AU - Couldwell, William T.

AU - Gardner, Paul A.

AU - Heilman, Carl B.

AU - Sen, Chandranath

AU - Akagami, Ryojo

AU - Cappabianca, Paolo

AU - Prevedello, Daniel M.

AU - McDermott, Michael W.

AU - Przybylowski, Colin J.

AU - Almefty, Kaith K.

AU - Patel, Akash J.

AU - Khan, A. Basit

AU - Wu, Kyle C.

AU - Bi, Wenya Linda

AU - Dunn, Ian F.

AU - Mamelak, Adam N.

AU - Ehsan, Mohammad U.

AU - Bruce, Jeffrey N.

AU - Englander, Zachary K.

AU - Wang, Linda M.

AU - Youngerman, Brett

AU - Anand, Vijay K.

AU - Kacker, Ashutosh

AU - Tabaee, Abtin

AU - Clarke, David B.

AU - Walling, Simon A.

AU - Hebb, Andrea L.O.

AU - Macki, Mohamed

AU - Anand, Sharath K.

AU - Rock, Jack P.

AU - Baskin, David S.

AU - Yewah Gwei, Larisse K.

AU - Guthikonda, Bharat

AU - Kosty, Jennifer

AU - Nanda, Anil

AU - Sun, Hai

AU - Culicchia, Frank

AU - Morrow, Kevin

AU - Fannin, Erin

AU - Germanwala, Anand V.

AU - Prabhu, Vikram C.

AU - Patel, Chirag R.

AU - Chaichana, Kaisorn

AU - Quinones-Hinojosa, Alfredo

AU - ReFaey, Karim

AU - Chandler, James P.

AU - Fernandez, Luis G.

AU - Oyon, Daniel E.

PY - 2023/12/1

Y1 - 2023/12/1

N2 - BACKGROUND AND OBJECTIVES: Tuberculum sellae meningiomas (TSMs) can be resected through transcranial (TCA) or expanded endonasal approach (EEA). The objective of this study was to report TSMmanagement trends and outcomes in a large multicenter cohort. METHODS: This is a 40-site retrospective study using standard statistical methods. RESULTS: In 947 cases, TCA was used 66.4% and EEA 33.6%. The median maximum diameter was 2.5 cm for TCA and 2.1 cm for EEA (P < .0001). The median follow-up was 26 months. Gross total resection (GTR) was achieved in 70.2% and did not differ between EEA and TCA (P = .5395). Vision was the same or better in 87.5%. Vision improved in 73.0% of EEA patients with preoperative visual deficits compared with 57.1% of TCA patients (P < .0001). On multivariate analysis, a TCA (odds ratio [OR] 1.78, P = .0258) was associated with vision worsening, while GTR was protective (OR 0.37, P < .0001). GTR decreased with increased diameter (OR: 0.80 per cm, P = .0036) and preoperative visual deficits (OR 0.56, P = .0075). Mortality was 0.5%. Complications occurred in 23.9%. New unilateral or bilateral blindness occurred in 3.3% and 0.4%, respectively. The cerebrospinal fluid leak ratewas 17.3% for EEA and 2.2% for TCA (OR 9.1, P < .0001). The recurrence ratewas 10.9%(n = 103). Longer follow-up (OR 1.01 per month, P < .0001),World Health Organization II/III (OR 2.20, P = .0262), and GTR (OR: 0.33, P < .0001) were associated with recurrence. The recurrence rate after GTR was lower after EEA compared with TCA (OR 0.33, P = .0027). CONCLUSION: EEA for appropriately selected TSM may lead to better visual outcomes and decreased recurrence rates afterGTR, but cerebrospinal fluid leak rates are high, and longer follow-up is needed. Tumors were smaller in the EEA group, and follow-up was shorter, reflecting selection, and observation bias. Nevertheless, EEA may be superior to TCA for appropriately selected TSM.

AB - BACKGROUND AND OBJECTIVES: Tuberculum sellae meningiomas (TSMs) can be resected through transcranial (TCA) or expanded endonasal approach (EEA). The objective of this study was to report TSMmanagement trends and outcomes in a large multicenter cohort. METHODS: This is a 40-site retrospective study using standard statistical methods. RESULTS: In 947 cases, TCA was used 66.4% and EEA 33.6%. The median maximum diameter was 2.5 cm for TCA and 2.1 cm for EEA (P < .0001). The median follow-up was 26 months. Gross total resection (GTR) was achieved in 70.2% and did not differ between EEA and TCA (P = .5395). Vision was the same or better in 87.5%. Vision improved in 73.0% of EEA patients with preoperative visual deficits compared with 57.1% of TCA patients (P < .0001). On multivariate analysis, a TCA (odds ratio [OR] 1.78, P = .0258) was associated with vision worsening, while GTR was protective (OR 0.37, P < .0001). GTR decreased with increased diameter (OR: 0.80 per cm, P = .0036) and preoperative visual deficits (OR 0.56, P = .0075). Mortality was 0.5%. Complications occurred in 23.9%. New unilateral or bilateral blindness occurred in 3.3% and 0.4%, respectively. The cerebrospinal fluid leak ratewas 17.3% for EEA and 2.2% for TCA (OR 9.1, P < .0001). The recurrence ratewas 10.9%(n = 103). Longer follow-up (OR 1.01 per month, P < .0001),World Health Organization II/III (OR 2.20, P = .0262), and GTR (OR: 0.33, P < .0001) were associated with recurrence. The recurrence rate after GTR was lower after EEA compared with TCA (OR 0.33, P = .0027). CONCLUSION: EEA for appropriately selected TSM may lead to better visual outcomes and decreased recurrence rates afterGTR, but cerebrospinal fluid leak rates are high, and longer follow-up is needed. Tumors were smaller in the EEA group, and follow-up was shorter, reflecting selection, and observation bias. Nevertheless, EEA may be superior to TCA for appropriately selected TSM.

KW - Complications

KW - Endoscopic

KW - Expanded endonasal approach

KW - Meningioma

KW - Skull base

KW - Transsphenoidal

KW - Tuberculum

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UR - http://www.scopus.com/inward/citedby.url?scp=85176382610&partnerID=8YFLogxK

U2 - 10.1227/neu.0000000000002569

DO - 10.1227/neu.0000000000002569

M3 - Article

C2 - 37389475

AN - SCOPUS:85176382610

SN - 0148-396X

VL - 93

SP - 1259

EP - 1270

JO - Neurosurgery

JF - Neurosurgery

IS - 6

ER -

International Tuberculum Sellae Meningioma Study: Surgical Outcomes and Management Trends

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