Surgical Outcomes Following Resection of Tuberculum Sellae Meningiomas: A Comprehensive Analysis

Introduction/Background: Tuberculum sellae meningiomas (TSM) constitutes 5-10% of intracranial meningiomas and is saddled with high morbidity from compression of the optic nerve and chiasm. Although there is advancement in surgical techniques, surgery is associated with high morbidity, and it needs to be examined further. Common treatment modalities include microsurgical resection via transcranial or endoscopic endonasal routes. The objective is to analyze the results of surgical resection in TSM. Methods: This systematic review was conducted in accordance with the PRISMA guidelines, as illustrated in the flowchart below. Two notable databases were utilized: PubMed and Web of Science. All preliminary steps, including full-text screening of the systematic review, were conducted using Rayyan.Ai. Quality assessment was performed using the Joanna Briggs critical appraisal research tool. Statistical Analysis was conducted through Microsoft Excel and R 04.21.02 (RStudio). The graphs, figures, and tables were created using MATLAB version R2024a (MathWorks). Results: Several studies fully met the inclusion criteria, providing comprehensive comparative data. A survey of 52 anterior skull base meningiomas (with 35 being TSM), had 26 operated on with endoscopic endonasal (EEE) with 26 having transcranial approach (TCA). In this study, gross total resection was achieved in 73% of cases, with rates of 69% in EEE and 77% in TCA, both of which are statistically similar. Even so, there were recurrence rates, with 19% in EEE versus 11.5% in TCA (p = 0.69). A separate study in 208 TSM patients had resection in 83.7% of patients. Multivariate analysis found predictors for better visual outcomes: younger age (age