Tuberculum sellae meningiomas are meningiomas that originate from the tuberculum sellae, diaphragma sellae, anterior clinoid processes, or platform of the sphenoid bone. They commonly occur in middle-aged individuals, with a higher prevalence in females; the male-to-female ratio is approximately 1:2.06. These tumors are typically located above the sella and generally exhibit slow progression. Common symptoms include visual disturbances, headaches, and endocrine dysfunction. Typical clinical presentations include decreased vision, blindness, headache, reduced libido, excessive thirst, amenorrhea, polyuria, erectile dysfunction, obesity, memory loss, and drowsiness.
CT imaging often reveals a supra-sellar isodense or hyperdense mass with clear boundaries, broad-based attachment to the dura mater and/or inner table of the skull, and hyperostosis of the tuberculum sellae. MRI findings for T1-weighted imaging (T1WI) typically show isointense or slightly hypointense signals, while T2-weighted imaging (T2WI) shows hyperintense or isointense signals. A low-signal arachnoid interface is often present between the tumor and adjacent brain tissue. The tumor exhibits a broad-based attachment to the platform of the sphenoid bone, the optic chiasm groove, and the dura of the tuberculum sellae. Characteristic signs such as a "tail sign" or dural tail may be observed.
Head CTA (computed tomography angiography) can clarify the relationship between the tumor and the bilateral internal carotid arteries, middle cerebral arteries, and anterior cerebral arteries. MRI findings for T1-weighted imaging typically show isointense or slightly hypointense signals. Pathologically, tuberculum sellae meningiomas can be classified into four subtypes:
- Endothelial type
- Angiomatous type
- Fibrous type
- Psammomatous type
The prognosis for tuberculum sellae meningiomas is generally favorable. For smaller tumors, a high likelihood of complete cure is observed, with low mortality rates. Treatment primarily involves transnasal endoscopic tumor removal, though a small number of cases may require a combined transcranial approach with transnasal endoscopic assistance.