Anterior Clinoidal Meningiomas Research Articles

Resolution of Paroxysmal Hemicrania After Resection of Intracranial Meningioma

Paroxysmal hemicrania is a trigeminal autonomic cephalalgia first described in 1976, characterized by episodic attacks of excruciating unilateral periorbital and temporal stabbing, pulsatile, craw-like, or boring headaches lasting 2 – 30 minutes, accompanied by autonomic features, and alleviated by indomethacin. Paroxysmal hemicrania is divided into an episodic or chronic form, depending on the duration and frequency of the attacks. We describe a case of paroxysmal hemicrania in a patient with a contralateral anterior clinoid meningioma, which resolved after tumor resection. Most cases of autonomic cephalgias are primary headaches and not caused by underlying intracranial structural lesions. Based on our patient and a literature review of secondary causes of trigeminal autonomic cephalalgias, we recommend that all patients with trigeminal autonomic cephalalgias including paroxysmal hemicrania undergo neuroimaging studies. The preferred neuro-radiologic procedure should be a cranial MRI to exclude underlying structural intracranial lesions, particularly in the sellar and parasellar regions.

Anterior clinoidal meningiomas: functional outcome after microsurgical resection in a consecutive series of 106 patients

In this study, the authors' goal was to analyze a series of patients treated microsurgically for an anterior clinoid process (ACP) meningioma in regard to long-term functional outcome. The authors retrospectively analyzed clinical data in a consecutive series of 106 patients who underwent microsurgical treatment for an ACP meningioma at 2 neurosurgical institutions between 1987 and 2005. The main presenting symptoms of the 84 female and 22 male patients (mean age 56 years) were visual impairment in 54% and headache in 28%. Physical examination revealed decreased visual acuity in 49% and a visual field deficit in 26%. Tumors were primarily resected via a pterional approach. Meningioma extensions invading the cavernous sinus, present in 29% of the patients, were not removed. Complete tumor resection (Simpson Grade I and II) was achieved in 59% of the cases. Postoperatively, visual acuity improved in 40%, was unchanged in 46%, and deteriorated in 14%. A new oculomotor palsy was observed in 8 patients (8%). Clinical and MR imaging data were available in 95 patients for a mean postsurgical period of 6.9 years (1.5-18 years) and revealed tumor recurrence in 10% and tumor progression after subtotal resection in 38%. Clinical deterioration on long-term follow-up consisting primarily of ophthalmological deficits was observed in 14% of the cases. Acceptable functional results can be achieved after microsurgical resection of ACP meningiomas; however, long-term treatment remains challenging due to a high tumor recurrence and progression rate.

Anterior clinoidal meningiomas: analysis of 43 consecutive surgically treated cases

Anterior clinoidal meningiomas are considered different from meningiomas of the medial sphenoid wing, but there is still some confusion about identification. The current classification scheme only considers tumour origin and invasion pattern around the clinoid process as indicators of resectability. However, the size of the tumour has important effects on surgical outcome. The purpose of this study was to analyze our clinical experience with anterior clinoidal meningiomas and refine the current classification scheme. Forty-three consecutive cases of anterior clinoidal meningioma were retrospectively analyzed. All were surgically treated at the Marmara University Department of Neurosurgery, the Marmara University Institute for Neurological Sciences, and the Department of Neurosurgery at Acibadem Hospital between 1987 and 2006. A pterional approach was used in all cases. The mean tumour volume was 34.2 +/- 46.6 cc. Sixteen (37.2%) of the tumours were giant (largest diameter >4 cm). Total surgical removal was achieved in 39 cases (90.7%) and subtotal removal in 4 cases (9.3%). Eight patients (18.6%) developed early postoperative complications. The median and range of follow-up time was 39, R = 99 (3, 102) months. Four (9.3%) of the 43 tumours recurred during follow-up and were treated with radiosurgery. Anterior clinoidal meningioma is a separate disease entity from other meningiomas of the medial third of the sphenoid wing. Relatively good outcomes can be stated in this specific subgroup if growth criteria competable with true diagnosis are fulfilled. Size should be incorporated into any classification scheme for determining clinical and surgical risk. The standard pterional approach is sufficient for removing anterior clinoidal meningiomas.

Surgical management of anterior clinoidal meningiomas: a 26-case report

Background Resection of anterior clinoidal meningiomas remains a major neurosurgical challenge. We determine the surgical technique for removal of tumor and improvement of patient's outcome. Methods A retrospective analysis was performed on 26 consecutive patients with anterior clinoidal meningiomas who underwent surgical resection at the Department of Neurosurgery, Renji Hospital, from January 1999 to August 2006. All patients had surgery through the pterional or extended pterional approach. Microvascular Doppler probe was used to protect the internal carotid artery and its branching arteries during dissection of the tumor. Twenty-two of them had severe visual deficits preoperatively. The follow-up period ranged from 3 to 36 months (22.3 ± 8.8 months). Results In this series, Simpson grade II resection in 16 cases (61.5%), Simpson grade III resection in 4 cases (15.4%), Simpson grade IV resection in 6 cases (23.1%) were achieved. Sixteen of the patients with preoperative visual impairment experienced significant improvement. No patients died. There was no evidence of tumor recurrence during follow-up. Conclusions In the majority of patients, surgery is still the first choice for total resection of the tumors without major complications. Protection of nerves and blood vessels must be a priority concern during removal of tumors.

Anterior Clinoid Meningiomas: A Long-Term Follow-Up Study in a Consecutive Series of 72 Patients

Purpose: We conducted a retrospective analysis in a consecutive series of patients treated microsurgically for an anterior clinoid meningioma with regard to long-term follow-up results.

Anterior Clinoid Meningiomas: A Long-Term Follow-Up Study in a Consecutive Series of 72 Patients

Purpose: We conducted a retrospective analysis in a consecutive series of patients treated microsurgically for an anterior clinoid meningioma with regard to long-term follow-up results.

New grading system to predict resectability of anterior clinoid meningiomas.

Sixty patients with anterior clinoid meningiomas (mean age 48 years) were surgically treated. There was a slight female predominance. Headache and visual impairment were the commonest clinical symptoms at presentation. The patients were classified on the basis of extent of the visual impairment, size of the tumor, and the tumor relationship with the internal carotid artery. A grading system was designed using the total scores in these classifications on the scale of 2-10. The classifications and the grading system were assessed for planning of the operative strategy, anticipating the extent of resectability, possible difficulties in dissecting the carotid artery and optic nerve during the operation, and prognosis. Total resection was achieved in 42 cases (scores 4-8), subtotal resection in 17 cases (scores 7-10), and only partial resection in one case (score 10). Vision improved in 14 cases. Three patients died following surgery. Mean follow up was 26 months. There was one recurrence. Fifty-four patients are leading independent and active lives.

Anterior clinoidal meningiomas: Report of a series of 33 patients operated on through the pterional approach

Anterior clinoidal meningiomas: Report of a series of 33 patients operated on through the pterional approach

Anterior clinoidal meningiomas: Report of a series of 33 patients operated on through the pterional approach

Anterior clinoidal meningiomas: Report of a series of 33 patients operated on through the pterional approach

Anterior clinoidal meningiomas: report of a series of 33 patients operated on through the pterional approach.

Between 1985 and 1995, 33 cases of clinoidal meningioma were surgically treated by pterional approach. In 6 cases, according to the grading scale of Al-Mefty, the lesions were group I, having originated from the lower part of the clinoid; in 22 cases, the lesions were group II, having originated from the upper or lateral part of the clinoid process; and in 5 cases, the lesions were group III since they arose from the optic foramen. Postoperatively, 17 patients showed an improvement, 4 were unchanged, and 6 presented further deficits. Five patients died after surgery: two from pulmonary thromboembolism, one from myocardial infarction, one from hematoma of the operative field, and one from cerebral ischemia after severe vasospasm of the internal carotid artery (unresponsive to treatment). The mean follow-up was 53.7 months (range 12-108 months) and included 19 patients. During this period, there were five recurrences, and three patients underwent resection again and showed no signs of tumor regrowth 1 year later; one patient who did not undergo resection again due to his age and poor general conditions died 3 years after onset of the recurrence; the last patient has so far refused a second operation. The clinical, diagnostic, and therapeutic aspects of this not infrequent pathology are discussed in the light of our experience and the pertinent literature.

Surgical treatment of anterior basal meningiomas.

Meningiomas of the anterior skull base account for 40% of all intracranial meningiomas. Of these, almost half are sphenoid wing meningiomas; the other half are tuberculum sella tumors or olfactory groove tumors. Anterior clinoidal (medial sphenoid wing) meningiomas are a subcategory of the sphenoid wing meningiomas; they fall into one of three categories according to the presence of an interfacing arachnoidal membrane between the tumor and the cerebral vessels. Meningiomas of the tuberculum sella arise from the tuberculum sella, chiasmatic sulcus, limbus sphenoidale, and the diaphragma sella; they may extend into both optic canals. Olfactory groove meningiomas arise more anteriorly than do the tuberculum sella meningiomas and may be symmetrical around the midline or extend to one side or the other; at least 15% grow into the ethmoid sinuses. This paper addresses the clinical presentation, preoperative evaluation, and surgical procedures used for treating tumors of the tuberculum sella, the olfactory groove, and the anterior clinoid.

Compressive optic neuropathy from pituitary adenoma and intracranial meningioma

Abstract The simultaneous occurrence of a pituitary adenoma and an intracranial meningioma is extraordinary. Preoperative differentiation of these tumors is important since this alters the surgical approach. The authors report a patient with compressive optic neuropathy due to pituitary adenoma and an anterior clinoidal meningioma. The radiological characteristics of these tumors provided preoperative diagnosis by gadolinium-enhanced MRI, confirmed by histopathological examination.

Clinoidal meningiomas

Anterior clinoidal meningiomas are frequently grouped with suprasellar or sphenoid ridge meningiomas, masking their notorious association with a high mortality and morbidity rate, failure of total removal, and recurrence. To avoid injury to encased cerebral vessels, most surgeons are content with subtotal removal. Without total removal, however, recurrence is expected. Recent advances in cranial-base exposure and cavernous sinus surgery have facilitated radical total removal. The author reports 24 cases operated on with vigorous attempts at total removal of the tumor with involved dura and bone. This experience has distinguished three groups (I, II, and III) which influence surgical difficulties, the success of total removal, and outcome. These subgroups relate to the presence of interfacing arachnoid membranes between the tumor and cerebral vessels. The presence or absence of arachnoid membranes depends on the origin of the tumor and its relation to the naked segment of carotid artery lying outside the carotid cistern. Total removal was impossible in the three patients in Group I, with postoperative death occurring in one patient and hemiplegia in another. Total removal was achieved in 18 of the 19 patients in Group II, with one death from pulmonary embolism. In the two patients in Group III, total removal without complications was easily achieved.

Retinal Thinning and Regression of Neovascularization

To the Editor. —I read with interest the speculations of Dr Glaser 1 concerning the mechanism of action of scatter photocoagulation. Dr Glaser suggests that altered cellular interactions within laser scars may be central to involution of neovascularization. The following case is difficult to understand within the framework of Dr Glaser's theoretical constructs. Report of a Case. —A 41-year-old woman presented to the Department of Neurology at the University of Virginia, Charlottesville, with a 17-year history of insulin-dependent diabetes mellitus and a four-month history of seizures. Results of physical examination were remarkable only for disc neovascularization in both eyes. A computed tomographic scan demonstrated a left anterior clinoid meningioma. She was referred to the Department of Ophthalmology. Visual acuity was 20/20 OU, and results of examination were normal except for moderate background diabetic retinopathy and neovascularization on the disc (NVD), greater in the left eye than the right (Fig 1).

Vergleich der verschiedenen R�ntgen-Untersuchungen bei der Diagnostik von praesell�ren Meningeomen

Twenty-nine cases of presellar meningiomas were reviewed to determine the value of each of several radiological tests in the detection of these tumors. Tumor size was correlated with the test results. Skull films and brain scans were false negative in a significant number, particularly in the group of tumors of less than 2 cm in height. Pneumoencephalograms and carotid angiograms were positive in all cases studied except for one anterior clinoid meningioma detected only by sellar polytomography. Tumor stain was noted on 75% of angiograms and tumor vascular supply was analyzed. These high rates of detection were believed to be due to the use of stereoscopic subtractions of selective internal and external carotid angiograms and the use of tomography during pneumoencephalography.