Surgical outcome in tuberculum sellae meningioma with non-serviceable preoperative vision in atleast one eye.

BACKGROUND: Tuberculum sellae meningioma (TSM) frequently causes significant visual morbidity owing primarily to its proximity to the optic apparatus and associated vasculature. Data on surgical outcome in patients presenting with non-serviceable vision or blindness in the preoperative period remain limited. This study evaluates the postoperative visual recovery in this group of patients and examines the interplay of the potential predictive factors. METHODS: Patients with TSM presenting with severe visual loss or blindness in at least one eye and undergoing first time surgical resection at our center between 2014 and 2024 were analyzed. Clinical, radiological, surgical, and follow-up data were analyzed. Visual outcomes were categorized as improved, unchanged, or deteriorated as per WHO (World Health Organization) criteria. Univariate and multivariate logistic regression analyses were performed. RESULTS: Thirty-seven patients were studied. Immediate postoperative visual improvement was seen in 37.8% patients, increasing to 59.5% at follow-up (mean 47 months). Improvement from non-serviceable to serviceable vision was also observed in a subset of patients. Patients undergoing supraorbital keyhole approach (SOKHA) had predominantly smaller tumors and tumors of meningothelial histology. Interestingly, patients who presented late (> 6 months) had larger tumors and lesser optic canal invasion compared to those presenting early. On the multivariate analysis, a younger patient age (AOR of 0.91, p = 0.049),the SOKHA (AOR = 7.16; p = 0.032), optic canal unroofing (AOR = 19.76; p = 0.030) and a longer duration of preoperative visual symptoms (AOR = 21.323;p = 0.043) correlated with long term postoperative visual improvement. CONCLUSION: Meaningful visual recovery is achievable even in patients with severe preoperative visual impairment. Despite limitations inherent to the nature of the study, our findings testify to the value of timely surgery, role of minimally invasive approach in properly selected patients and optic canal unroofing during surgery as some of the surgeon modifiable factors contributing to a favorable visual outcome in these patients.