Microsurgical strategies and efficacy analysis of parasellar meningiomas

Yang Aimin; Sun Jianrui; Wang Shukai

doi:10.11850/j.issn.1009-122X.2025.03.007

Abstract：Objective To investigate the surgical strategies for parasellar meningiomas and analyze the factors affecting the efficacy.Methods Clinical data of 64 patients with parasellar meningiomas were analyzed retrospectively.The clinical symptoms included vision loss in 32 cases,headache and dizziness in 25,limb weakness in 3,consciousness impairment in 1,physical examination in 3.All patients underwent preoperative cranial MRI plain scans with contrast enhancement.The maximum diameter of the tumor was 11-80 mm,with an average of 35.2 mm.The tumors were located in the sellar tubercle in 27 cases,in the medial sphenoid crest in 22,and in the anterior bed process in 15.Among them,there were 15 cases involving the cavernous sinus,3 doing sphenoid-orbital communication,and 2 doing sellar septum.All the tumors were excised by microsurgery.Results Total resection(Simpson gradeⅠ-Ⅲ)was performed in 54 cases(84.4%),and subtotal resection(Simpson gradeⅣ)in 10(15.6%).Postoperative complications included oculomotor nerve palsy in 4 cases,intracranial infection in 5,and postoperative hematoma in 1,which improved after secondary surgical evacuation.There were no deaths.Patient prognosis was evaluated 12 months postoperatively using the modified Rankin Scale(mRS),with 52 cases(81.2%)scoring 0-1,8(12.5%)scoring 2,and 4(6.3%)scoring 3.Univariate analysis showed that unclear tumor margin,internal carotid artery invasion,cavernous sinus involvement and pathological grade(WHO grade Ⅱ)were the factors affecting the total tumor resection(all P<0.05).Multivariate analysis showed that cavernous sinus involvement and pathological grade of tumor were independent risk factors for total resection,which would increase the rate of incomplete tumor resection by 18.5 times and 30 times(both P<0.01).Conclusions Total resection of parasellar meningioma with cavernous sinus invasion and WHO gradeⅡis not easy to achieve.According to the preoperative imaging characteristics,the individualized surgical approach and microsurgery strategy should be selected to maximize the resection of the tumor,protect the surrounding important blood vessels and nerves,protect the small perforatorial vessels,and strive to reduce postoperative complications and improve the prognosis of patients.