Parasellar spaces remain particularly singular, comprising most important neurovascular structures as internal carotid artery, optic, oculomotor and trigeminal nerves. Meningiomas are one of the most frequent tumors arising from parasellar spaces. In this location, meningiomas remain mostly benign tumors with WHO grade I and meningothelial subtype. Progestin intake should be investigated and leads mostly to conservative strategy. In case of benign non-symptomatic tumor, observation should be proposed. Tumor growth will lead to propose surgery or radiosurgery. In case of uncertain diagnosis and aggressive pattern, a precise diagnosis is required. For cavernous sinus and Meckel’s cave lesions, complete removal is rarely considered leading to propose endoscopic endonasal or transcranial biopsy. Optic nerve decompression could also be proposed via these both approaches. A case by case discussion about the best approach is recommended. Transcranial approach remains necessary for tumor removal in most cases. Vascular injury could lead to severe complications. CSF leak, meningitis, venous sacrifice, visual impairment and cranial nerves palsies are more frequent complications. Pituitary dysfunctions are rare in preoperative assessment as in postoperative follow-up but should be assessed in case of meningiomas located close to the pituitary axis. Long-term follow-up is required given the frequent incomplete tumor removal and the risk of delayed recurrence. Radiosurgery is relevant for small and well-limited meningiomas or intra-CS postoperative residue, whereas RT and proton beam therapy are indicated for large extended non-operable meningiomas. The place of the peptide receptor radionuclide therapy needs to be defined. Targeted therapy should be considered in rare recurrent and aggressive parasellar meningiomas.


中文翻译：

---

鞍旁脑膜瘤。

鞍旁间隙仍然特别奇异，包括最重要的神经血管结构，如颈内动脉，视神经，动眼神经和三叉神经。脑膜瘤是由鞍旁间隙引起的最常见的肿瘤之一。在这个位置，脑膜瘤大多数仍是世卫组织I级和脑膜内皮亚型的良性肿瘤。孕激素的摄入应进行调查，并主要导致采取保守策略。对于良性非症状性肿瘤，应建议观察。肿瘤生长将导致建议手术或放射手术。在不确定的诊断和攻击性模式的情况下，需要进行精确的诊断。对于海绵窦和Meckel's洞穴病变，很少考虑完全切除，因此建议进行内窥镜鼻内或经颅活检。也可以通过这两种方法提出视神经减压。建议逐案讨论最佳方法。在大多数情况下，经颅入路仍是切除肿瘤的必要方法。血管损伤可能导致严重的并发症。脑脊液漏，脑膜炎，静脉牺牲，视力障碍和颅神经麻痹是更常见的并发症。垂体功能障碍在术前评估中和术后随访中一样罕见，但是如果脑膜瘤位于垂体轴附近，则应进行评估。考虑到频繁的不完全切除肿瘤和延迟复发的风险，需要长期随访。放射外科手术与小而局限的脑膜瘤或CS术后残留有关，而RT和质子束治疗则适用于较大范围的不可手术的脑膜瘤。肽受体放射性核素治疗的位置需要确定。在罕见的复发性和侵袭性鞍旁脑膜瘤中应考虑靶向治疗。