PNA Medical Corner: Sellar and Suprasellar Meningiomas

This month the PNA Medical Corner features an article co-written by two professional members of the PNA, Drs. Roberto Salvatori and Gary Gallia at John's Hopkins Hospital.
The title is Clinical features of sellar and suprasellar meningiomas.

Salvatori1 Gallia1
Roberto Salvatori, MD Gary Gallia, MD



Here is the abstract:

Kwancharoen R, Blitz AM, Tavares F, Caturegli P, Gallia GL, Salvatori R.

Pituitary. 2013 Aug 22. [Epub ahead of print]
PMID: 23975080

Division of Endocrinology and Metabolism, Department of Medicine, Pituitary Center, Johns Hopkins University School of Medicine Baltimore, 1830 East Monument Street #333, Baltimore, MD, 21287, USA.

Meningiomas account for about 1 % of sellar masses. Although they can mimic pituitary adenomas, they are more vascularized and invasive. To gain insights that would enhance our ability to establish a pre-surgical diagnosis of meningioma, we performed a retrospective study of these tumors. Query of the surgical pathology database identified 1,516 meningiomas operated at out institution between January 2000 and May 2012. Cases were matched to the radiology database to identify a strictly defined sellar and/or suprasellar location. We identified 57 meningiomas. F:M ratio was 6:1. The mean age was 52 years (median 50, range 30-78). The most common symptoms were visual disturbance (58 %), headache (16 %) and incidental finding (12 %). The mean duration of symptoms was 13 months. Hyperprolactinemia was found in 36 %, with mean value of 51.6 ng/ml (median 41.8, range 22.5-132). Mean maximal diameter was 2.9 cm (median 2.7, range 0.9-6.8), and most tumors enhanced homogeneously on MRI after gadolinium. A "dural tail" sign was reported in a third. The radiologist reported "likely meningioma" in 65 %, "possible meningioma" in 8.7 %, and pituitary adenoma in 11 %. After surgery, visual disturbances improved in most patients (80 %) but headache only in 7 %. Post-operative complications at 1 and 3 months occurred 38.6 and 33.3 % respectively. There was no mortality. Sellar/suprasellar meningiomas represent 4 % of all meningiomas, and have a particularly high female predominance. The diagnosis is suggested by the radiologist in approximately 2/3 of the cases. An improved method to differentiate preoperatively these tumors from adenomas would be desirable.




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