The Roentgenologic Manifestations of Meningiomas in the Region of the Tuberculum Sella

Although meningiomas of the tuberculum sellae had been described previously, Cushing and Eisenhardt (1) made the first extensive study of these tumors, emphasizing the fact that they seldom caused gross roentgen abnormalities. More recently Weyand and Camp (2) and di Chiro and Lindgren (3) have shown that evidence of such tumors often can be detected by careful roentgenographic evaluation of the sella turcica.

Carotid angiography and cerebral pneumography have been used widely for the study of suprasellar tumors. List and Hodges (4) and Wood (5) have found angiography useful. Wickbom (6) believed that pneumoencephalography and carotid angiography should be used as complementary diagnostic examinations.

Schlezinger and Teplick (7) and Dyke and Davidoff (8) described the abnormalities noted on pneumoencephalographic examinations. Many of the published series have included suprasellar tumors other than meningiomas of the tuberculum sellae.

Present Study

The present study was undertaken to re-evaluate abnormal appearances in standard head roentgenograms from a series of cases of meningioma of the tuberculum sellae, and to appraise the angiographic and pneumographic abnormalities encountered. The series included 51 patients operated on at the Mayo Clinic between Jan. 1, 1946, and July I, 1956. Thirty-nine were women and 12 were men. The average age of the group was 48.4 years, with a range from twenty-nine to seventy years. Seventy per cent of the patients were between the ages of forty and fifty-nine.

The histopathologic findings are summarized in Table I. Twelve per cent of the meningiomas were hypercellular and active, presenting mitotic figures. Since it is not yet agreed that such cellularity is certainly indicative of malignant change, we have chosen to leave the question open and designate these lesions as “active.”

Correlations With Tumor Size: The relationship between the size of the tumor and the roentgen findings was studied. The estimate of size was based on the recorded observations of the surgeons and pathologists (which necessarily are gross judgments) Thirty-four tumors were of average dimensions, weighing 25 gm. or less, with a diameter not exceeding 2.5 cm.; 17 were large, measuring up to 6 cm. in diameter and weighing as much as 60 gm. The size was considered important. The large tumors produced the most notable angiographic abnormalities. They caused decalcification of the posterior clinoid processes and the dorsum sellae more frequently than did the typical tumors and were more frequently responsible for unusual neurologic findings.

Findings in Standard Roentgenograms of the Head

Sites and Affected Tissues: The abnormalities detected in standard roentgen examinations are summarized in Table II.