Surgical management of anterior clinoidal meningiomas: consensus statement on behalf of the EANS skull base section

Abstract

Background The optimal management of clinoidal meningiomas (CMs) continues to be debated. Methods We constituted a task force comprising the members of the EANS skull base committee along with international experts to derive recommendations for the management of these tumors. The data from the literature along with contemporary practice patterns were discussed within the task force to generate consensual recommendations. Results and conclusion This article represents the consensus opinion of the task force regarding pre-operative evaluations, patient’s counselling, surgical classification, and optimal surgical strategy. Although this analysis yielded only Class B evidence and expert opinions, it should guide practitioners in the management of patients with clinoidal meningiomas and might form the basis for future clinical trials.

Surgery for clinoidal meningiomas with cavernous sinus extension: Near-total excision and chiasmopexy

“…CS involvement and adventitial involvement of the ICA are the main factors limiting the extent of resection with gross total resection (GTR) achieved in only 11.8% [3,7].…”

“…CS involvement and adventitial involvement of the ICA are the main factors limiting the extent of resection with gross total resection (GTR) achieved in only 11.8% [ 3 , 7 ]. A recurrence rate of 60% after less-than-total resection has been reported, compared to a rate of about 5–10% in cases of GTR.…”

“…A recurrence rate of 60% after less-than-total resection has been reported, compared to a rate of about 5–10% in cases of GTR. In less than total resections, adjuvant radiosurgery represents an excellent method of treatment, to ensure local tumor control [ 7 ]. A delay of 3 months seems to be ideal based on our experience to maximize the benefit of the fat graft before its possible reabsorption.…”

Neoplasms and tumor-like lesions of the sellar region: imaging findings with correlation to pathology and 2021 WHO classification

“…Clinoidal meningiomas (CLM), frequently centered on the anterior clinoid processes, rapidly invade the optic canal compressing the nerve with unilateral progressive visual loss and headache. Large CLMs may secondarily extend to the superior orbital fissure and cavernous sinus, leading to additional cranial neuropathies such as diplopia and facial hypoesthesia [ 94 ]. Cavernous sinus meningiomas (CSM) originate from the lateral dural wall of cavernous sinus and slowly extent within the sinus, leading to stenosis of the intracavernous segment of the internal carotid artery and cranial nerve disjunctions.…”

Management of Recurrent Meningiomas: State of the Art and Perspectives

“…In this case, maximal safe tumor resection, as well as complete removal of the dural tail, is advocated [ 1 , 2 ]. Depending on size, location, and anatomical relationship with the surrounding structures, achieving a gross total resection (GTR) can be challenging [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ] and may not even be worth the risk of surgery-related morbidity and functional impairment [ 5 , 11 ]. This is particularly true for skull base meningiomas (SBMs), where a radical excision may represent a challenge and sometimes even be detrimental, especially when cranial nerve and vascular structures are involved [ 5 , 7 , 8 , 12 , 13 , 14 , 15 ].…”