SURGICAL-MANAGEMENT OF MENINGIOMAS ORIGINATING IN MECKELS CAVE

OBJECTIVE: To define the difference of meningiomas that originate in t he area of Meckel's cave (MC) (primary MC meningiomas) in regard to th e different surgical approaches and postoperative results. METHODS: A retrospective analysis of all meningiomas involving the cranial base d isplayed 21 cases of meningiomas originating in MC (primary MC meningi omas). These cases were classified according to the tumor extension in four different types: Type I, tumors mainly confined to MC; Type II, MC meningiomas with extension into the middle fossa; Type III, MC meni ngiomas with extension into the posterior fossa; and Type IV, MC menin giomas with extension into both middle and posterior fossae. RESULTS: Trigeminal neuralgia resolved in all cases in this series, despite tum or type. Trigeminal hypesthesia showed postoperative improvement only in Type III MC meningiomas. In Types I and III, total removal without further morbidity was frequently achieved. Cavernous sinus infiltratio n, especially in Types II and IV, limited (in some cases) the extent o f tumor extirpation. CONCLUSION: Types I, II, and III MC meningiomas h ave a good prognosis. In most cases, very good outcomes are achieved. Radical tumor removal can usually be achieved without further morbidit y and with postoperative improvement of the preexisting symptoms, espe cially in Types I and III MC meningiomas. On the contrary, Type IV MC meningiomas are usually only subtotally resected. Surgery in such case s may carry a high risk of additional morbidity, especially with regar d to the IIIrd, IVth, and VIth cranial nerves. The postoperative outco me regarding facial pain in cases of all tumor types is usually very g ood. Trigeminal hypesthesia may persist after tumor removal in the maj ority of cases.