Tuberculum sellae meningioma (TSM) [Neurosurgery Wiki]

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====== Tuberculum sellae meningioma (TSM) ======

//J.Sales-Llopis//
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//Neurosurgery Department, University General Hospital of Alicante, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Alicante, Spain//


The site of origin of these tumors is only about 2 cm posterior to that of [[olfactory groove meningioma]]
((Al-Mefty O, Sekhar LN, Janecka IP. Tuberculum Sella and Olfactory Groove Meningiomas. In: Surgery of Cranial Base Tumors. New York: Raven Press; 1993:
507–519))

The [[tuberculum sellae]] is the bony elevation between the chiasmatic sulcus and the sella turcica. By definition, the [[limbus sphenoidale]] (which is the anterior margin of the chiasmatic sulcus) is the demarcation between the anterior and [[middle cranial fossa]]. Therefore these tumors originate in the middle fossa (unlike [[planum sphenoidale meningioma]]s which are in the [[anterior fossa]]).
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They are traditionally grouped together with other [[suprasellar meningioma]]s [[diaphragma sellae meningioma]]s and the more anterior [[planum sphenoidale meningioma]]s

[[Suprasellar meningioma]] usually arises from the [[tuberculum sellae]] or the [[sulcus chiasmatis]]. Due to the close proximity to the optic apparatus, the same may be involved even when the lesions are small. 

[[Tuberculum sellae]] [[meningioma]]s originate in the [[middle fossa]] (unlike [[planum sphenoidale meningioma]]s which are in the [[anterior fossa]]).


They are in a deep and sensitive location, proximity to critical neurovascular elements, [[hypothalamus]] with often dense and fibrous nature.

Characteristically lie in a suprasellar subchiasmal midline position, displacing the [[optic chiasm]] posteriorly and slightly superiorly, and the [[optic nerve]]s laterally
((Chi JH, McDermott MW. Tuberculum sellae meningiomas. Neurosurg Focus. 2003;14:e6.)).

Although tuberculum sellae (TS) and [[diaphragma sellae meningioma]]s have different anatomical origins, they are frequently discussed as a single entity.
===== Epidemiology =====

[[Tuberculum sellae meningioma epidemiology]]


===== Classification =====

[[Tuberculum Sellae Meningioma Classification]].

===== Clinical Features =====

[[Tuberculum sellae meningioma clinical features]].

===== Diagnosis =====

[[Tuberculum sellae meningioma diagnosis]].


===== Differential diagnosis =====

When a TSM grows posteriorly into the [[sella turcica]] it may be mistaken for a [[pituitary macroadenoma]].

[[Magnetic resonance imaging]] has supplanted [[computed tomography]] as the imaging modality of choice for [[sellar lesion]]s and [[parasellar lesion]]s, but unenhanced MR imaging does not reliably distinguish between all [[tuberculum sellae meningioma]]s and [[pituitary macroadenoma]]s. Accurate differentiation between these alternative diagnoses of a suprasellar mass is important because a tuberculum sellae meningioma always requires a [[craniotomy]], whereas a [[transsphenoidal]] route is preferred for removing most pituitary macroadenomas. The gadolinium-enhanced MR images of seven patients with tuberculum sellae meningioma and seven with pituitary macroadenoma were reviewed retrospectively. Although no specific radiological feature was pathognomonic, a combination of several features allowed the correct diagnosis in all cases. Three characteristics of tuberculum sellae meningiomas distinguish them from pituitary macroadenomas: 1) bright homogeneous enhancement with gadolinium, as opposed to heterogeneous, relatively poor enhancement; 2) a suprasellar rather than a sellar epicenter of tumor; and 3) tapered extension of an intracranial dural base. Each of these findings can be subtle, but careful examination of gadolinium-enhanced, high-quality, thin section coronal and sagittal MR images of the [[parasellar region]] for this constellation of findings will allow the correct preoperative [[diagnosis]] in patients with either of these tumors
((Taylor SL, Barakos JA, Harsh GR 4th, Wilson CB. Magnetic resonance imaging of tuberculum sellae meningiomas: preventing preoperative misdiagnosis as pituitary macroadenoma. Neurosurgery. 1992 Oct;31(4):621-7; discussion 627. doi: 10.1227/00006123-199210000-00002. PMID: 1407446.)). 


===== Treatment =====
see [[Tuberculum sellae meningioma treatment]].


===== Outcome =====

[[Tuberculum Sellae Meningioma Outcome]].

===== Case series =====

see [[Tuberculum sellae meningioma case series]].

===== Videos =====

[[Tuberculum Sellae Meningioma Videos]].

===== Case reports =====

[[Tuberculum Sellae Meningioma Case Reports]].


===== References =====