Predictors of visual function after resection of skull base meningiomas with extradural anterior clinoidectomy

Baucher, Guillaume; Troude, Lucas; Roux, Alexandre; Loundou, Anderson; Meling, Torstein R.; Roche, Pièrre-Hugues

doi:10.1007/s10143-021-01716-w

Cited by 4 publications

(8 citation statements)

References 35 publications

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“…As discussed in a recent meta-analysis,[ 8 ] the most used surgical technique was the pterional craniotomy associated or not orbital wall, anterior clinoid, and optic canal removal. [ 2 , 18 ] Since 2008, orbitotomy through supraciliary or trans-eyelid approach started to be used. Recently, the use of endoscope for lateral orbitotomy and tumor resection is increasing allowing minimally invasive approaches for specific cases, in which there is an invasion of the lateral portion of the orbit.…”

Section: Discussionmentioning

confidence: 99%

Spheno-orbital meningiomas: Is orbit reconstruction mandatory? Long-term outcomes and exophthalmos improvement

Santos¹,

Paiva²,

Róz³

et al. 2022

Surgical Neurology International

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Background: Meningiomas correspond to one-third of all primary central nervous system tumors. Approximately 9% of them are spheno-orbital meningiomas (SOMs), presenting significant clinical symptoms as visual impairment and orbital esthetics. This article aims to evaluate exophthalmos’ improvement in a surgical series without orbital reconstruction. Methods: We consecutively included all patients diagnosed with SOM, admitted to a single institution for 10 years. Surgical resection was the standard of care, associated or not with adjuvant radiation therapy. The radiological investigation included preoperative and postoperative head CT or MRI. We quantified proptosis through imaging. Results: Forty patients composed this series, 87.5% were female. Proptosis was the most common presentation (90%), followed by decreased visual acuity (65%), motility deficit (20%), and headache (20%). Gross total resection was achieved in 65% of the procedures. In late outcomes, 78% of the patients maintained or improved visual acuity and 85% maintained or improved headache. Proptosis significantly improved after surgery and along with the follow-up (P < 0.001). Ten patients were submitted to adjuvant RT, six of them after a subtotal resection. All patients of this subgroup had proptosis. It was observed a higher frequency of worse in visual acuity in patients submitted to RT (71% vs. 28%, P = 0.038). Conclusion: Resection of SOM was sufficient to stop the evolution of visual deficit and allowed the improvement of proptosis. Orbital reconstruction does not seem to be an essential step in reducing enophthalmos.

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Section: Discussionmentioning

confidence: 99%

Spheno-orbital meningiomas: Is orbit reconstruction mandatory? Long-term outcomes and exophthalmos improvement

Santos¹,

Paiva²,

Róz³

et al. 2022

Surgical Neurology International

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“…Anterior clinoidectomy can improve the exposure of structures in the central skull base including the optic nerve and the ICA, while promoting access to lesions around these structures ( 17 , 24 , 30 , 34 – 36 ). The optic nerve can be visualized and decompressed earlier in the extradural anterior clinoidectomy by optic canal unroofing, which can reduce the probability of intraoperative injury to neurovascular structures during tumor manipulation ( 22 , 23 , 37 , 38 ). In addition, extradural anterior clinoidectomy allows the devascularization of the tumor before resection by controlling dural feeding vessels ( 33 , 39 ).…”

Section: Discussionmentioning

confidence: 99%

“…The step involving identification and unroofing of the optic canal is key to safe and successful anterior clinoidectomy in the ETOA. This allows early decompression of the optic nerve during surgery, which can minimize the possible damage to the optic nerve during the subsequent steps ( 22 , 38 , 56 , 57 ). The optic canal could be readily confirmed from below after detaching the periorbita from the orbital roof, while the grove whit the optic canal can be detected using a blunt hook dissector.…”

Section: Discussionmentioning

confidence: 99%

“…The anterior clinoid process (ACP) is an important landmark in anterior skull base surgeries (14)(15)(16). In classic transcranial surgeries, anterior clinoidectomy is a vital procedure to remove tumors in the skull base region, and various methods are undergoing research (17)(18)(19)(20)(21)(22)(23)(24). However, anterior clinoidectomy through the ETOA remains challenging due to technical difficulties and structural complexity.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic transorbital extradural anterior clinoidectomy: A stepwise surgical technique and case series study [SevEN-013]

et al. 2022

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BackgroundAnterior clinoidectomy is an important procedure for approaching the central skull base lesions. However, anterior clinoidectomy through the endoscopic transorbital approach (ETOA) still has limitations due to technical difficulties and the structural complexity of the anterior clinoid process (ACP). Therefore, the authors designed a stepwise surgical technique of extradural anterior clinoidectomy through the ETOA. The purpose of this study was to evaluate the feasibility of this technique.MethodsAnatomical dissections were performed in 6 cadaveric specimens using a neuroendoscope and neuro-navigation system. The extradural anterior clinoidectomy through the ETOA was performed stepwise, and based on the results, this surgical technique was performed in the 7 clinical cases to evaluate its safety and efficiency.ResultsEndoscopic extradural anterior clinoidectomy was successfully performed in all cadaveric specimens and patients using the proposed technique. This 5-step technique enabled detachment of the lesser wing of sphenoid bone from the ACP, safe unroofing of the optic canal, and resection of the optic strut without injuring the optic nerve and internal carotid artery. Since the sequential resection of the 3 supporting roots of the ACP was accomplished safely, anterior clinoidectomy was then successfully performed in all clinical cases. Furthermore, no complications related to the anterior clinoidectomy occurred in any clinical case.ConclusionWe designed a stepwise surgical technique that allows safe and efficient anterior clinoidectomy through the ETOA. Using this technique, extradural anterior clinoidectomy can be accomplished under direct endoscopic visualization with low morbidity. Since this technique is applicable to the central skull base surgery where anterior clinoidectomy is necessary, it expands the application of the ETOA.

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“…Visual impairment typically begins with mono-ocular symptoms and extends to the second eye if the tumor grows 5 ; therefore, surgical excision may be unavoidable despite the risk of iatrogenic injury to the ON and optic chiasma (OCH) posed by direct manipulation of the tumor near the ON and OCH. 6 ON is trapped in the OC between the bony segment of the canal and the falciform ligament, and this situation could be a potential cause of ischemic injury of ON during manipulation. This explains why OC decompression may be required before tumor resection.…”

mentioning

confidence: 99%

Visual Outcomes after Suprasellar Meningioma Resection: A Retrospective Cohort Study and a Machine Learning-Based Predictive Model

Iranmehr,

Chavoshi,

Zeinalizadeh

2024

J Neurol Surg B Skull Base

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Objectives In this research, the authors provide a retrospective cohort study of 82 patients with suprasellar meningiomas to identify predictors of the visual outcome following surgery. We also conducted a matched retrospective case–control analysis. Methods This retrospective cohort study included all patients who underwent craniotomy for surgical excision of suprasellar meningiomas at our institution between January 2016 and March 2022. We designed a matched case–control study for patients with and without early intradural optic canal decompression (IOCD). We also developed a machine learning model to have the best possible sensitivity for the prediction of visual recovery after surgery. Results The visual acuity score (VAS) improved in 46.3% of our cases and decreased in 7.4% of the 82 included cases postoperatively. The VAS did not change in 46.3% of the patients after surgery. Statistically, visual complaints, optic atrophy, tuberculum sella involvement, and olfactory groove involvement were associated with lower preoperative VAS and visual field index (VFI). Only intracavernous sinus (ICS) extension and intraoperative vascular involvement were significantly associated with lower postoperative mean VAS correction. The outcome analysis revealed that the improvement in VAS and VFI after surgery was not statistically different between the groups with and without early IOCD (p-value = 1). Conclusion ICS extension was the only location-related factor associated with increased tumor recurrence or regrowth, which makes postoperative radiotherapy more valuable in patients with cavernous sinus extension. Our study results did not support the efficacy of early IOCD in increasing postoperative VAS and VFI.

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Predictors of visual function after resection of skull base meningiomas with extradural anterior clinoidectomy

Cited by 4 publications

References 35 publications

Spheno-orbital meningiomas: Is orbit reconstruction mandatory? Long-term outcomes and exophthalmos improvement

Spheno-orbital meningiomas: Is orbit reconstruction mandatory? Long-term outcomes and exophthalmos improvement

Endoscopic transorbital extradural anterior clinoidectomy: A stepwise surgical technique and case series study [SevEN-013]

Visual Outcomes after Suprasellar Meningioma Resection: A Retrospective Cohort Study and a Machine Learning-Based Predictive Model

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