Tuberculum sellae meningioma (TSM) represents a complex skull base tumor. The primary goals of surgical treatment are represented by maximal safe resection and visual recovery; therefore, appropriate patient selection is critical to optimize results. In the last 2 decades, the endoscopic endonasal approach (EEA) has appeared as a successful and viable strategy for the management of these tumors. The authors identified preoperative factors associated with extent of resection and visual outcome after EEA for TSM.

In this retrospective cohort study, the authors analyzed patients who underwent extended endoscopic endonasal surgery for TSM between January 2005 and April 2022 at the Division of Neurosurgery, Università degli Studi di Napoli Federico II, Naples, Italy. Tumor size, vessel encasement, and optic canal involvement were classified according to University of California, San Francisco, score. Visual acuity and visual fields were analyzed according to the visual impairment score (VIS), defined as a four-level classification: grade 1 (VIS 0–25), grade 2 (VIS 26–50), grade 3 (VIS 51–75), and grade 4 (VIS 76–100). Ophthalmological functions were tested preoperatively and during the early postoperative period (within 6 months after surgery) and late postoperative period.

A total of 48 patients were enrolled. Forty-one (85.4%) patients experienced blurred vision or visual field defect as a presenting sign. Gross-total resection was achieved in 40 (83.3%), near-total resection in 2 (4.2%), and subtotal resection in 6 (12.5%). Visual defect improved in 82.9% (34/41) of cases, 12.2% (5/41) had no significant changes, and 2.4% (1/41) had worsened visual defect. The mean change in VIS was 42% (95% CI 58.77–31.23). Visual outcome was poorer when preoperative VIS (VIS-pre) was greater than 25 (p = 0.02). Six postoperative CSF leaks occurred (12.5%), and 1 patient (2.1%) required revision surgery.

The EEA is a safe and effective approach for TSM removal, with the advantage of preserving optic apparatus vascularization, and can promote gross-total resection and visual improvement. The authors have defined four categories based on VIS that relate to postoperative outcome: the lower the VIS-pre, the higher the rate of postoperative VIS improvement. This finding may be useful for predicting a patient’s visual outcome at the preoperative stage.

鞍结节脑膜瘤 (TSM) 是一种复杂的颅底肿瘤。手术治疗的主要目标是最大安全切除和视力恢复；因此，适当的患者选择对于优化结果至关重要。在过去的 20 年中，内窥镜鼻内入路 (EEA) 已成为治疗这些肿瘤的成功且可行的策略。作者确定了与 TSM EEA 后切除范围和视力结果相关的术前因素。

在这项回顾性队列研究中，作者分析了 2005 年 1 月至 2022 年 4 月期间在意大利那不勒斯那不勒斯费德里克二世大学神经外科接受扩大内窥镜鼻内手术治疗 TSM 的患者。根据加州大学旧金山分校的评分对肿瘤大小、血管包裹和视神经管受累进行分类。根据视力障碍评分（VIS）分析视力和视野，定义为四级分类：1级（VIS 0-25）、2级（VIS 26-50）、3级（VIS 51-75） ) 和 4 级 (VIS 76–100)。术前、术后早期（术后6个月内）和术后晚期均进行眼功能测试。

共有 48 名患者入组。四十一名 (85.4%) 患者出现视力模糊或视野缺损的症状。40 例（83.3%）实现大体切除，2 例（4.2%）接近全切除，6 例（12.5%）次全切除。82.9%（34/41）的病例视力缺陷得到改善，12.2%（5/41）的病例无明显变化，2.4%（1/41）的病例视力缺陷恶化。VIS 的平均变化为 42% (95% CI 58.77–31.23)。当术前 VIS (VIS-pre) 大于 25 时，视力结果较差 (p = 0.02)。术后发生 6 例脑脊液漏（12.5%），1 例患者（2.1%）需要翻修手术。

EEA是一种安全有效的TSM切除方法，具有保留视神经器血管化的优点，可促进大体全切除和视力改善。作者根据与术后结果相关的 VIS 定义了四个类别：VIS-pre 越低，术后 VIS 改善率越高。这一发现可能有助于在术前阶段预测患者的视力结果。