Sellar and Suprasellar Meningiomas: A 12-year-Johns Hopkins Experience

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 88-111-Cushing's Disease & Non-Functioning Hypothalamus-Pituitary Tumors
Clinical
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-101
Ratchaneewan Kwancharoen*1, Ari Blitz2, Fabiana Tavares3, Patrizio Caturegli4 and Roberto Salvatori4
1Johns Hopkins University, Baltimore, MD, 2Johns Hopkins University, MD, 3Johns Hopkins, 4Johns Hopkins Univ Sch of Med, Baltimore, MD
Introduction: Meningiomas account for 10-15% of non-adenomatous pituitary tumors, sometime mimicking non-functioning adenomas. These tumors usually are vascularized, invasive, and adherent to adjacent structures. Due to the rarity of sellar and suprasellar meningiomas, limited clinical data are available on their presentation, history and outcome Methods: We reviewed the records of 1,516 meningioma identified by pathology reports who were operated at our institution between 1/2000 and 5/2012. Cases were identified from radiology reports containing “sellar” or “suprasellar”. Patients <18 yrs or pregnant were excluded. Patients who had repeated surgeries were accounted once, using data from the first presentation. Demographic, clinical, and hormonal data were collected from electronic records. Results: 58 sellar and suprasellar meningiomas were identified. Average age was 52 yrs (median 50, range 30-78). Female to male ratio was 6:1. The three most common chief complaints prompting MRI imaging were visual disturbance (56.9%), headache (17.2%), and incidental finding (12%). Average duration of symptoms was 12.6 months. Symptoms at presentation included visual disturbances (84.5%), headache (50%), amenorrhea/hypogonadism (8.6%), and galactorrhea in women (4%). Hyperprolactinemia was found in 36.4% with average value of 51.6 ng/ml (median 41.8, range 22.5-132). Other pituitary dysfunctions included low serum IGF-1 (37.5%) and adrenal insufficiency (6.3%). The average maximum tumor diameter was 2.8 cm (median 2.6, range 0.9-6.8); tumors enhanced after gadolinium with homogeneous pattern in 91%. Of 46 patients who had not undergone previous operation, meningioma was listed as most likely diagnosis in 54.4% and as possible diagnosis in 8.7% of MRI reports; 5 cases (11%) were diagnosed as adenoma. Presence of a “dural tail” was reported in 36.2%. Most tumors (97.6%) were WHO grade 1. Improvement of vision occurred in 83.6%, but headache only in 6.8%. Post-operative complications at 1 and 3 months occurred 39.7% and 32.7% respectively. They included worsening vision (10.3%, 5.8%), intracranial hemorrhage (6.9%, 0%), diabetes insipidus (12.0%, 11.5%), and anterior pituitary failure (15.5% at 3mo). Residual tumor was seen in 62%, and 52.8% of these (32.8% of total) needed further treatment (additional surgery or radiation). There was zero mortality rate. Conclusion: Sellar and suprasellar location occurs in ~4% of meningiomas, mostly in females during the sixth decade. The diagnosis was considered by the radiologist in approximately 2/3 of the cases. After surgery vision improves but headache does not, and significant residual tumor is often present, with 1/3 of patients needing further treatment. There was no peri-operative mortality but frequent post-operative complications. Because of this, a better way to differentiate these tumors from adenomas would be desirable.

Nothing to Disclose: RK, AB, FT, PC, RS

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