Surgical management of clinoidal meningiomas

OBJECTIVE: Surgical outcome has been less than desirable in the management of patients with clinoidal meningiomas in the past, and little attention ha s been directed at improving their visual function. The purpose of this art icle is to advocate an available cranial base technique for removing these difficult tumors and to delineate the technique's advantages that aid in ac hieving an improved extent of tumor resection and enhancing the patients' o verall outcome, particularly their visual outcome. METHODS: A retrospective analysis was performed on 15 consecutive patients with clinoidal meningiomas (including a patient with hemangiopericytoma) wh o underwent surgical resection at the Cleveland Clinic Foundation between l une 1995 and January 2000. A cranial base technique consisting of extradura l anterior clinoidectomy, coupled with optic canal unroofing and optic shea th opening, was used in 13 patients, and standard pterional craniotomy was used in 2. Eight of 15 patients had significant visual deficits preoperativ ely. All patients had thorough preoperative and postoperative ophthalmologi cal evaluations. The follow-up period ranged from 6 to 60 months (mean, 37. 2 mo). RESULTS: Total resection was achieved in 13 (86.7%) of the 15 patients in t his series, and the majority of the patients with preoperative visual impai rment experienced significant improvement (6 of 8 patients; 75%). CONCLUSION: In the majority of patients with clinoidal meningiomas, total r esection may be achieved with minimal complications. For large tumors encas ing the optic nerve and internal carotid artery, or for those tumors causin g preoperative visual impairment, use of the cranial base technique delinea ted in this study may lead to significant improvement in the patients' visu al and overall outcomes.