Surgical techniques for the dissection of encased perforators in giant clinoidal meningiomas

Yoshimoto, Koji; Nakamizo, Akira; Sasaki, Tatsuya

doi:10.1007/s00701-013-1750-9

Cited by 6 publications

(3 citation statements)

References 9 publications

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“… 26) Most recent clinical articles have emphasized the importance of early optic canal unroofing for preservation of optic function. 28 – 32) Table 3 summarizes recent clinical outcomes for clinoid meningiomas.…”

Section: Resultsmentioning

confidence: 99%

Surgical Resectability of Skull Base Meningiomas

Goto

Ohata

2016

Neurol. Med. Chir.(Tokyo)

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With recent advances in surgical technology such as preoperative imaging, neuro-monitoring, and surgical instruments, the surgical resectability of intracranial meningiomas has increased over the last two decades. This study reviewed clinical articles regarding the surgical treatment of meningiomas to clarify the role of surgical excision, with a focus on skull base meningiomas. We sub-classified clinical articles about skull base meningiomas into two categories (anterior and middle fossa meningiomas; and posterior fossa meningiomas) and reviewed papers in each category. In cases with anterior and middle fossa meningiomas, surgical resectability has reached a sufficient level to maximize functional preservation. In cases of posterior fossa meningioma, however, surgical respectability remains insufficient even with full use of recent surgical modalities. Continuous refining of operative procedures is required to obtain more satisfactory outcomes, especially for posterior fossa meningioma. In addition, recent long-term outcomes of stereotactic radiosurgery (SRS) were acceptable for controlling the skull base meningiomas. Therefore, combination with surgical excision and SRS should be considered in complicated skull base meningiomas.

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Section: Resultsmentioning

confidence: 99%

Surgical Resectability of Skull Base Meningiomas

Goto

Ohata

2016

Neurol. Med. Chir.(Tokyo)

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“…Within the case series reported in the literature on clinoidal meningiomas and the clinical outcome of patients undergoing microsurgical resection, the following preoperative predictive factors have been found: tumor size, patient age, invasion of the cavernous sinus, and previous visual deficit [ 3 , 6 - 7 , 10 - 17 , 19 - 27 ]. The objective of this article is to describe the relationship between tumor and patient characteristics, as well as the percentage of resection and clinical outcome of patients with clinoidal meningiomas in a third-level institution in Latin America.…”

Section: Introductionmentioning

confidence: 99%

“…First, it is of paramount importance to design the best approach for each tumor. Second, deciding which is the best management strategy for the intracavernous portion of the tumor if present [6,[8][9][10]. Since clinoidal meningiomas tend to grow dorsally, true invasion of the cavernous sinus is rare, with rates of invasion ranging from 0 to 44.1% [3].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors in the Surgery of Clinoidal Meningiomas

Valencia-Ramos,

Arroyo Del Castillo,

Aragon

et al. 2023

Cureus

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Introduction: Clinoidal meningiomas are currently among the intracranial meningiomas with the greatest neurosurgical complexity, morbidity, and mortality associated with their resection. The worldwide literature has described tumor size (>4 cm 3 ), patient age (>60 years), and invasion of the cavernous sinus as factors associated with a worse clinical outcome following surgery. Methods: We describe the series of cases of patients with clinoidal meningiomas who underwent microsurgical resection at our institution between January 2014 and March 2019. The intention was to analyze the multiple preoperative variables, such as the patient's demographic, tumor, and surgical characteristics, such as the Al-Mefty Classification to find a relationship with the patient's clinical outcome during their postoperative follow-up. Results: Death occurred in 4.8% of the cases. Postoperative morbidity was documented in 42.9%, the most frequent being ophthalmoparesis, followed by worsening of visual acuity, and new onset motor deficits. Radiological characteristics were assessed based on preoperative MRI. The maximum diameter, midline shift, invasion of the cavernous sinus, arterial encasement, and peritumoral edema were evaluated. Average intraoperative bleeding was 1.3 L. The most frequent histological grade was World Health Organization (WHO) grade 1 in 85.6% of the cases. Complete resection was obtained in 52.4% of the cases; 42.8% received fractionated stereotactic radiotherapy after surgery for disease control, and one received radiosurgery. Recurrence occurred in 33.3%. The average follow-up in months was 23.8. Conclusions: Demographic factors and tumor characteristics in clinoidal meningioma surgery are related to the subtype of meningioma according to the Al-Mefty Classification and impact directly the degree of resection, progression of the disease, and degree of postoperative complications. To achieve maximal resection while minimizing morbidity and mortality, these factors must be considered to decide on an appropriate approach and specific plan for each case.

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Long-term follow-up after surgical removal of meningioma of the inner third of the sphenoidal wing: outcome determinants and different strategies

et al. 2018

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Meningioma arising in the inner third of the sphenoidal wing has been well recognized since the origin of neurosurgery, yet it still poses a formidable challenge for the surgeon. Treatment strategies can be optimized through a tailored approach to surgical timing and use of a non-surgical armamentarium. The aim of this study was to evaluate the long-term effect of different strategies on progression-free survival and overall survival. We examined the clinical records of brain tumor patients to assess determinants for surgery (extent of tumor removal, postoperative complications) and for progression-free survival and overall survival in relation to timing of surgery eventually followed by stereotactic radiosurgery (SRS). The records of 60 patients were retrospectively reviewed, from preoperative assessment to a median follow-up of 104 months. All were symptomatic with prevalently visual symptoms (42.2%), large tumors (median diameter 3.44 cm), extension into the cavernous sinus (38.3%), and severe vascular involvement of one or more encased or narrowed vessels (50%). Subtotal removal was achieved in 40% of cases, mainly determined by cavernous sinus and vascular involvement; neurological complications occurred in 18.3% (persistent in 6.7% due to oculomotor and vascular injury). The overall rate of symptom improvement was 32.3% at 3 months and 49.5% at 12 months. Radiological monitoring prevented clinical progression; tumor progression occurred in 11.7% of cases. There were significant differences in progression-free survival between patients with (median 46 months) and those without (median 104 months) recurrence (p = 0.002): 12.5% after total removal, 6.2% after subtotal removal and adjuvant SRS, and 28.5% after subtotal removal and observation. The related Kaplan-Meier survival curve showed no significant difference between the three strategies. Further, disease progression after recurrence was noted in 28.6% of cases, but overall survival was not influenced by either tumor recurrence or type of treatment. Treatment failure was recorded in four cases (6.7%): one perioperative death and three later on. Surgery is the mainstay for the treatment of symptomatic meningioma and to restore neurological function; however, resectability is limited by vascular and cavernous sinus involvement. Careful postoperative monitoring prevented clinical progression and adjuvant or adjunctive SRS proved effective in tumor control. A low surgical complication rate and excellent long-term outcomes were achieved with this strategy.

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Surgical techniques for the dissection of encased perforators in giant clinoidal meningiomas

Abstract: The surgical techniques described in this article will aid in achieving maximum tumor resection while preserving encased perforators.

Cited by 6 publications

References 9 publications

Surgical Resectability of Skull Base Meningiomas

Surgical Resectability of Skull Base Meningiomas

Prognostic Factors in the Surgery of Clinoidal Meningiomas

Long-term follow-up after surgical removal of meningioma of the inner third of the sphenoidal wing: outcome determinants and different strategies

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