Surgical treatment of anterior clinoidal meningiomas

Abstract

Objective To investigate the surgical strategies and microsurgical techniques for anterior clinoidal meningiomas(ACMs).Methods A retrospective analysis of the clinical,radiographic,operative,and follow - up data was performed in 49 patients with ACMs who underwent surgical resection in our department between January 2000 to June 2011.Results The mean size of the tumors was 4.4 cm (range 2 ～7 cm).Simpson grade Ⅰ resection was achieved in 3 cases(6％ ),grade Ⅱ in 25(51％ ),grade Ⅲ in 12(25％ )and grade Ⅳ in 9 (18％).The mean follow- up period was 31.1months (ranged from 3 to 111months).Among the 30 patients with preoperative visual impairment,the visual acuity was improved in 12 cases (40％),unchanged in 15 ( 50％ ) and worsened in 3 ( 10％ ).New permanent postoperative neurological deficits were observed in 10 cases:1patient with new visual deficit,3 worsening of preexisting visual deficits,4 hemiparesis and 2 partial oculomotor nerve paresis.Conclusions ACMs consistently involve the unilateral arteries of the anterior cerebral circulation and optic apparatus.Constant microsurgical surveillance of the arterial tree and maintenance of the cerebrospinal fluid interface between the tumor and involved arteries and nerves are the most important operative nuances for safe tumor resection. Key words: Meningioma; Sphenoid wing; Anterior clinoidal process; Microsurgery