Mini-Pterional Craniotomy for Resection of Parasellar Meningiomas

Abstract

Surgical resection of parasellar meningiomas is a challenging operation that traditionally has been performed with a large pterional or orbitozygomatic craniotomy. In this study, we report patient outcomes and detail our surgical approach when resecting these tumors with a smaller, less invasive "mini-pterional" craniotomy. We performed a retrospective review on all patients undergoing a mini-pterional craniotomy for resection of parasellar meningiomas from 2012 to 2016. We describe the technical aspects of the mini-pterional craniotomy and provide the outcomes of patients who received an operation with this approach. Twenty-four patients were treated with a mini-pterional craniotomy for resection of parasellar meningiomas. Median tumor volume was 6.2 cm3. Twenty-two of 24 (92%) patients had a World Health Organization grade I meningioma, and 2 of 24 (8%) patients had a World Health Organization grade II meningioma. Tumors were located at the medial sphenoid wing (60%), anterior clinoid (24%) and spheno-cavernous junction (12%). Nineteen of 24 (79%) patients had a Simpson Grade I resection and 5 of 24 (21%) a Simpson Grade IV resection. Median length of the operations was 242 minutes. Neurosurgical complications occurred in 2 patients who had a surgical-site infection and cerebrospinal fluid leak; one of these patients also developed postoperative hydrocephalus. In this series, no deaths, parenchymal contusions, or repeat operations occurred. The mini-pterional craniotomy can be used to resect parasellar meningiomas with good results and a low complication profile. This approach provides an efficacious method of resecting these tumors without sacrificing Simpson grade or patient safety.