Planum Sphenoidalis, Tuberculum, and Diaphragma Sellae Meningiomas: A Unique or Three Different Entities?

Objective: Demonstrate within this group the existence of distinct patterns, which could influence the type of treatment. Study Design: Planum sphenoidalis, tuberculum sellae, and diaphragma sellae meningiomas are usually considered as the same entity, known as TSM (tuberculum sellae meningiomas). TSM can origin from dura covering the planum sphenoidalis, limbus sphenoidalis, chiasmatic sulcus, tuberculum sellae, or diaphragma sellae. Methods: In the last 13 years, at our department have been treated 44 TSM. The majority of these cases have been treated by transcranial route. Most of the surgical interventions were performed by pterional approach. Data collection has been based on anatomical characteristics, radiological appearance, and clinical patterns, distinguishing some categories. Results: We suspect that some features could determine the treatment of these lesions: position of nearest vessels (hypophyseal arteries); optic nerves and chiasm position; pituitary stalk displacement; cavernous sinus invasion. Size of lesion is also important for surgical decision-making, including anteroposterior extension and laterolateral diameter. Conclusion: From our analysis, we conclude that some lesions are better approached by transcranial route, respect to diaphragma sellae meningiomas, which could be easily and safely treated by endoscopic approach.