Tuberculum Sellae and Planum Sphenoidale Meningioma
Meningiomas just in front of and above the pituitary gland, where vision loss is typically the presenting and only sign.
Quick Answer
A tuberculum sellae meningioma arises from the covering of the skull base just in front of and above the pituitary gland, directly beneath where the optic nerves cross. Because of that position, gradual and painless loss of vision — often in one eye first — is usually the presenting symptom and frequently the only one. It is commonly attributed to a routine eye problem, and loss can be substantial before the cause is identified. Hormone function is usually normal, which helps distinguish these tumors from pituitary tumors nearby. Treatment is surgical, either through the nose or through a skull base craniotomy and vision often improves considerably when the nerves are decompressed.
Key Takeaways
- These tumors arise directly beneath the optic nerves, just in front of and above the pituitary gland.
- Gradual, painless loss of vision — often in one eye first — is usually the only symptom.
- Hormone function is usually normal, which helps distinguish them from pituitary tumors.
- Vision loss is frequently attributed to a routine eye problem, and can be substantial before the cause is found.
- Surgery can be performed through the nose or through a craniotomy at the skull base, and both are used depending on the tumor.
- Vision improves in most patients when the nerves are decompressed, and the sooner that happens the better the recovery.
At a Glance
| Where it arises | From the skull base just in front of and above the pituitary gland, beneath the optic nerves |
|---|---|
| Typical first symptom | Gradual painless loss of vision, often in one eye first |
| Key structures at risk | The optic nerves and their blood supply, the carotid arteries, and the pituitary stalk |
| Imaging emphasis | MRI with contrast, formal visual fields, and hormone testing |
| Usual approach | Endoscopic endonasal, or a orbitozygomatic or pterional craniotomy |
| Extent of removal | Complete removal is the goal and is achievable in most cases |
| Role of radiation | Reserved for residual or recurrent tumor and for higher-grade tumors |
| Outlook | Good, with visual improvement in the majority when treated before loss is long-standing |
This page focuses specifically on Tuberculum Sellae and Planum Sphenoidale Meningioma. For a broader look at meningiomas—including grades, symptoms, diagnosis and treatment options—visit our Meningioma overview
Symptoms
The optic nerves cross immediately above where these tumors grow, and a tumor pushing upward compresses the optic nerves from below. This accounts for nearly all of how these tumors present.
Vision loss usually begins in one eye and is gradual and painless. Patients describe dimming, a washed-out quality to colors, or difficulty reading with one eye, rather than a defined blind spot. Because the other eye compensates, the loss is often not noticed until it is advanced, or until it is picked up at a routine eye examination. As the tumor enlarges, the pattern typically becomes loss of peripheral vision on the outer side of both eyes.
Pituitary hormone function is normally preserved, which is one of the more useful distinguishing features from a pituitary tumor growing upward into the same space. Headache may occur but is often mild. Many patients have no symptom at all other than their vision.
A patient whose vision dims in one eye is usually seen first by an optometrist or ophthalmologist, and the eye itself is normal. Where no cause is found in the eye, and particularly where the visual field shows loss respecting the vertical midline, imaging is warranted.
Common Reasons for Evaluation
- Gradual loss of vision, especially in one eye
- Loss of peripheral vision or difficulty seeing objects to the side
- Changes in color vision or visual sharpness
- Persistent headaches
- Visual symptoms that continue to progress despite a new glasses prescription
Symptoms That Need Prompt Evaluation
- Sudden or rapidly worsening vision loss
- New severe headache with vomiting or marked visual change
- New confusion, weakness, speech difficulty, or other neurologic symptoms
- A first-time seizure
Diagnosis
MRI with contrast shows a tumor centered above the sella with a broad attachment to the skull base and a dural tail, sitting apart from the pituitary gland, which remains identifiable beneath it. That separation is often the key distinction from a pituitary tumor. Thin-slice imaging through the optic canals shows whether the tumor extends into them, which affects the operation.
Formal visual field testing is essential, both to establish the extent of loss and as the baseline against which recovery is measured. Optical coherence tomography of the retinal nerve layer is increasingly used and helps predict how much vision is likely to recover — nerves that have already thinned recover less.
A full pituitary hormone panel is performed even though results are usually normal, because a tumor this close to the stalk can occasionally affect it, and because an abnormal result would raise the possibility of a different diagnosis.
WHY LOCATION MATTERS
Why Location Matters in Tuberculum Sellae and Planum Sphenoidale Meningioma
These tumors arise directly beneath the optic nerves and chiasm, making vision the defining clinical issue and often the key reason treatment is recommended.
Where it sits
At the central anterior skull base, immediately below the optic nerves and optic chiasm.
What it can affect
Visual sharpness, color perception, and peripheral vision—often beginning gradually in one eye.
Why it matters for treatment
The relationship to the optic nerves, carotid arteries, and surrounding bone helps determine the safest route for decompression and tumor removal.
Treatment
Vision that has been compromised for a shorter time recovers more completely. This is the main reason these tumors are generally treated rather than watched once they are causing visual loss, and the reason evaluation is not deferred.
Vision improves in a majority of patients, often beginning within days, and continues to improve over months. Recovery is less complete where loss has been present for a long time. Hormone function is checked afterward, and follow-up imaging with repeat visual fields continues for years.
At Atlantic Brain and Spine, these cases are reviewed by a multidisciplinary skull base and brain tumor team to determine the approach that offers the best balance of tumor control and preservation of neurological function. Our Skull Base Surgery Center has been designated a Multidisciplinary Team of Distinction by the North American Skull Base Society, recognizing an established multidisciplinary approach to skull base care.
TREATMENT PLANNING
How Treatment Is Planned for Tuberculum Sellae and Planum Sphenoidale Meningioma
The safest strategy depends on the tumor’s exact anatomy, the structures it involves, and the goals of treatment.
01
Endoscopic Endonasal Surgery
Endoscopic endonasal surgery reaches these tumors from directly below the skull base through the nose. Its principal advantage is that the tumor is removed from beneath the optic nerves without touching or retracting them, and the bone of the optic canals can be opened from below to decompress the nerves directly. Its limits are anatomical: tumors extending well to either side beyond the optic nerves, or wrapping around the carotid or anterior cerebral arteries, cannot be safely reached this way. It also requires careful reconstruction of the skull base afterward to separate the nose from the fluid space around the brain.
02
Transcranial Surgery
An orbitozygomatic or pterional craniotomy reaches the tumor from above and to the side. This microsurgical approach is preferred for larger tumors, for those extending laterally, and for those involving the arteries. It gives direct control of the blood vessels and a wide view of the optic nerves from above, at the cost of working across or beside the nerves rather than beneath them.
03
Choosing the Route
The choice of approach depends on the tumor’s size, how far it extends to either side, whether it involves the optic canals, and its relationship to the arteries. Both are performed at Atlantic Brain and Spine. Having both available is what allows the decision to be made on the anatomy rather than on the technique the surgeon prefers.
The Diagnosis-to-Treatment Pathway
1. Confirm the diagnosis and location
MRI with contrast identifies a skull-base meningioma above the sella and distinguishes it from a pituitary-region tumor.
2. Define optic-canal involvement
Thin-slice imaging shows whether tumor extends into the optic canals and how closely it involves the optic nerves and chiasm.
3. Measure visual function
Formal visual fields and optical coherence tomography establish the degree of visual loss and help estimate recovery potential.
4. Check pituitary function
A pituitary hormone panel helps document baseline function and exclude other diagnoses when appropriate.
5. Choose the route to decompress the optic nerves
Tumor anatomy determines whether an endoscopic endonasal or transcranial approach offers the best access and visual protection.
6. Track vision and recurrence
Vision, hormone function, and MRI findings are followed after treatment, with repeat visual-field testing over time.
Frequently Asked Questions
These meningiomas arise from the central skull base near the optic nerves and optic chiasm, above the pituitary region.
Even relatively small tumors can compress the optic nerves or extend into the optic canals. Progressive loss of visual acuity or peripheral vision is therefore a common reason they are discovered.
Formal visual-field testing and optical coherence tomography can document the degree of optic-nerve injury and provide a baseline for judging recovery after treatment.
The tumor’s size, relationship to the optic nerves and arteries, optic-canal involvement, and direction of growth help determine whether an endoscopic endonasal or transcranial approach is the safer route.
Vision often improves when compression is relieved before permanent optic-nerve damage has occurred. The degree of recovery depends on how severe and how long-standing the visual loss was before treatment.
Specialists Who Treat Tuberculum Sellae and Planum Sphenoidale Meningiomas
Meningioma care at Atlantic Brain and Spine is provided by neurosurgeons with specialized expertise in brain and skull base tumors, with treatment tailored to the tumor’s location and nearby neurological structures.
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