Surgical management of clinoidal meningiomas: 10 cases analysis

Abstract

The purpose of this article is to advocate standard skull base technique for removing the clinoidal meningioma and to delineate the technique's advantages that aid in achieving an improved extent of tumor resection and enhancing the patients' overall outcome, specially their visual outcome. Methods: A retrospective analysis was performed on 10 consecutive patients with clinoidal meningiomas who underwent surgical resection at the Bangabandhu Sheikh Mujib Medical University and other private clinics between May 2013 and July 2016. A standard pterional craniotomy technique consisting of extradural anterior clinoidectomy, coupled with optic canal unroofing and optic nerve sheath opening was used in all patients. All patients had thorough preoperative and postoperative ophthalmological evaluations. The follow-up period ranged from 6 to 42 months. Results: Total resection was achieved in 5 (50.0%) of the 10 patients in this series. The majority of the patients with preoperative visual impairment experienced significant visual improvement 7 of 10 patients; 70.0%). Conclusion: In the majority of patients with clinoidal meningiomas, total resection may be achieved with minimal complications. For large tumors encasing the optic nerve and internal carotid artery, or for those tumors causing preoperative visual impairment, use of the cranial base technique delineated in this study may lead to significant improvement in the patients' visual and overall outcomes.

Extradural anterior clinoidectomy in surgical management of clinoidal meningiomas

“…In our study, visual improvement was reported in 70% of our patients. In previously published case series in which extradural anterior clinoidectomy was used [2,11,13,[16][17][18][19][20][21][29][30][31], visual improvement ranged from 10 to 77% as shown in Table 4. Preoperative visual status is an important prognostic factor affecting the visual outcome [4,34]; Verma and colleagues reported a 20.7% improvement in visual outcome; however, this study had a higher percentage of patients with long-lasting severe visual deficit (32%) or patients who were already blind (15%) with a mean duration 21.5 months [19].…”

“…Various surgical approaches were advocated in the management of clinoidal meningiomas; the optimum surgical approach to improve the visual outcome and the extent of resection is still debatable. Many studies reported the use of the extradural cranial base technique through pterional approach or FTOZ and anterior clinoidectomy [2,11,13,[16][17][18][19][20][21]. Pterional approach with intradural anterior clinoidectomy [4,[22][23][24][25], lateral supraorbital approach [25][26][27], and lateral sub-frontal approach [13] were also performed in many studies.…”

Surgical management of anterior clinoidal meningiomas: consensus statement on behalf of the EANS skull base section

“…An extradural anterior clinoidectomy (EAC) is the most common procedure in most published series [1,2,4,10,12,19,30,34,37,42,48,62,65,68,73,75], and its variant, the intradural anterior clinoidectomy (IAC), has been performed in selected cases by a few authors [5,49,50,55,63,64,70]. EAC also allows the skeletonization of 270° of the optic canal allowing safer removal of the tumor in this region.…”

Cranio-Cervical Junction Meningioma: A Rare Case Report

“…Meningiomas were named by Harvey Cushing in 1922 and described as common tumors that arise from arachnoid cap cells which form the outer lining of the arachnoid membrane and from related cells such as arachnoid fibroblasts and the meningoblast [1][2][3]. These tumors are generally benign tumors and carry good prognosis.…”