Clinical features of intrasellar meningiomas treated with endoscopic endonasal surgery: a case series and comparison with other parasellar meningiomas and a literature review.

Abstract

The purpose of this study was to investigate the clinical characteristics of parasellar meningioma patients treated with endoscopic endonasal surgery (EES) to determine the characteristics of the rare group of intrasellar (IS) meningiomas.Thirty-six patients (5 males and 31 females; age range, 28-89 years) with parasellar meningioma underwent EES from 2011 to 2022 at our institution. The patients were divided into groups according to the tumor site. We retrospectively compared clinical data of IS meningioma patients with other parasellar meningioma patients before and after surgery.There were 5 IS, 26 tuberculum sellae, 2 anterior clinoid process, 2 cavernous sinus, and 1 sphenoid-cavernous-petroclival (SCP) meningioma cases. Imaging revealed compression of the pituitary lobe or pituitary stalk in 22 patients, 5 of whom had IS meningiomas or SCP meningiomas occupying the intrasellar region. All the IS meningiomas were occupying the sella turcica; 4/5 had different preoperative diagnoses, and 4/5 induced hypopituitarism. Cavernous sinus invasion was observed in three cases of IS meningiomas, with total resection achieved in one case. In patients with other parasellar meningiomas, preoperative hypopituitarism was observed only in SCP meningiomas. There was no significant difference in the incidence of postoperative diabetes insipidus and hyponatremia between IS meningiomas and other parasellar meningiomas.EES may enable the successful removal of IS meningiomas, but total resection may be difficult in the presence of cavernous sinus invasion. Preoperative hypopituitarism occurs in patients with tumors occupying the sella turcica.