MENINGIOMAS INVOLVING THE ANTERIOR CLINOID PROCESS

We report a series of 34 clinoidal meningiomas treated surgically and analyse the results according to cavernous sinus involvement. Fifteen tumours extended into the cavernous sinus. Only four of these could be resected completely, and global outcome was improved or stable in 10 cases. Overall, 20 tumours had a total resection and 14 had a partial resection. Complete removal of the sphenoid wing, including the anteri or clinoid and part of the planum sphenoidale, allows early devascular ization of the tumour and minimizes brain retraction when associated w ith resection of the zygomatic arch. The most frequent postoperative c omplication was transient CSF leak, occurring in three patients. Two p atients died postoperatively, and three suffered permanent complicatio ns. There was no recurrence after total removal, but five patients sho wed signs of progressive tumour growth after partial removal, treated by radiotherapy in three and by surgery in two cases. Twenty patients showed preoperative visual impairment. Outcome of vision was improved or stable in 13 (68%) and worse in six cases (32%). Wes suggest that p rogressive visual impairment should lead to aggressive surgical treatm ent, especially when complete resection of cavernous sinus involvement can be performed.