Tuberculum Sellae Meningioma vs Macroadenoma Hypophysis : How to Differentiate Preoperatively?

Abstract

Background: Sellar region tumors may origin from a various number of structures and each of them have

a specific clinical and radiological appearance. Among these pathological processes, one of the most

challenging is to distinguish between tuberculumsellae meningioma and macroadenomahypophysis.

Differentiating these two entities preoperatively is very important to decide which approach will be most

suitable and beneficial. The purpose of this study is to produce a simple preoperative scoring system to

differentiate these two that can be used in specific conditions where MRI is not avalable or could not be

performed.

Methods: This analytical retrospective cohort study contains data obtained from patients treated in

Neurosurgery Department of Hasan Sadikin General Hospital-Bandung from 1 January 2008 until 31

December 2010. 34 patients were enrolled in this study, in which 15 of them were diagnosed with

macroadenomahypophysis and remainining 19 patients as tuberculumsellae meningioma which was

confirmed with pathology examination.

Results: From clinical presentation we found that the event of endocrinopathyoccurs significantly in

macroadenoma hypophysis (p=0.0.002). Whereas from radiological evaluation there were 7 parameters that

significantly distinguish these two enties including hyperostosis, sellar floor configuration, homogeneity of

mass, confrast agent enhancement, waist configuration, peritumoral edema, and duralattachment. From

these findings, we propose a simple scoring system to differentiate macroadenomahypophysis and

tuberculumsellae meningioma with a 84.2% sensititivity and 100% specificity.

Conclusion: Although MRI is the modality of choice in differentiating macroadenoma hypophysis and

tuberculum sellae meningioma but our scoring system can be used as an aid in choosing best surgicallical

approach.