Surgery for Clinoidal Meningiomas: Case Series and Meta-Analysis of Outcomes and Complications

Abstract

Clinoidal meningiomas present specific characteristics related to their peculiar site of anatomic origin. Clinical series focusing on pure clinoidal meningiomas are not numerous. We performed a systematic review and meta-analysis, including our own case series, of the available literature to better identify the specific features of these tumors. A systematic review and meta-analysis were performed for surgically treated pure clinoidal meningiomas using PubMed, Cochrane, and Embase databases. A retrospective review of a cohort of 18 consecutive patients treated between 2010 and 2018 in our department was also included in this meta-analysis. A total of 1208 patients were included in the analysis. With a weighted mean follow-up of 48.1 months, the pooled rate of gross total resection was 64.2% (95% confidence interval [CI], 57.3%-71.0%) in the overall population, 11.8% (95% CI, 2.4%-21.1%) in the Al-Mefty I subgroup, 92.6% (95% CI, 88.9%-96.3%) in the Al-Mefty II subgroup, and 84.2% (95% CI, 70.8%-97.6%) in the Al-Mefty III subgroup. Overall visual improvement after treatment was found in 48% (95% CI, 38.6%-57.4%) of patients with a pooled deterioration rate of 4.5% (95% CI, 3%-6%). Pooled overall recurrence was observed in 8.9% of patients (95% CI, 6.0%-11.8%) and mortality occurred in 1.2% (95% CI, 0.6%-1.8%). The rate of gross total resection is proportional to the dural origin of these tumors, which is intimately related to critical neurovascular structures. Complementary radiosurgery could represent a valid treatment strategy. Postoperative visual improvement remains less satisfying compared with other suprasellar meningiomas. The introduction of skull-base techniques, such as extradural anterior clinoidectomy, has enabled improvements in visual outcome without any increase in approach-related morbidity.