Stratification of predictive factors to assess resectability and surgical outcome in clinoidal meningioma
Introduction
Meningiomas arising from the anterior cranial fossa floor constitute about 40% of all intracranial meningiomas [10]. Such tumors may involve and extend along the dura of the olfactory groove, planum sphenoidale, anterior clinoid process, diaphragma sellae, orbital roof and tuberculum sellae. In reported series of sphenoidal meningiomas, the incidence of clinoidal meningiomas constitutes 34–43.9% [3], [24] of cases. Surgical resection of clinoidal meningiomas is challenging due to the close association of the tumor with critical neurovascular structures such as the internal carotid artery, the anterior cerebral artery, the anterior communicating artery complex and associated perforators, the optic apparatus and the pituitary gland and infundibulum. The objective of this study was to critically analyze our series of 36 surgically treated clinoidal meningiomas and assess the predictive factors individually as well as collectively for extent of resection.
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Materials and methods
After obtaining local institutional review board approval, and in compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations, we retrospectively reviewed the medical records, neuroimaging studies, and pathology reports of all patients who underwent resection of clinoidal meningiomas from 1995 to 2015 in our institute. There were 36 patients identified with clinoidal meningiomas. All patients were evaluated with gadolinium-enhanced MRI of the brain prior to surgery.
Results
A total of 36 consecutive patients of clinoidal meningioma were recruited for outcome analysis. The mean age at surgery was 61 years (range 33–82 years). Twenty-six patients were female and 10 patients were male. Twenty-one meningiomas were located on the left and 15 were on the right. Presenting symptoms included visual impairment (89%), headache (72%), memory deficits (<1%) and seizures (<1%) (Table 2). The mean volume of a tumor was 16.99 cm3. The most commonly utilized surgical approaches
General
Clinoidal meningiomas by definition are ambiguous, and its management protocol for large lesions is also still debatable. In 1938, Cushing and Eisenhardt broadly classified this group as “deep inner or clinoidal third sphenoid ridge meningiomas” and this marked the first use of “clinoidal” to distinguish these tumors [7]. Al-Mefty’s more detailed system [2], introduced in 1990, classified clinoidal meningiomas into three separate groups depend on interfacing arachnoid membranes between the
Conclusions
Clinoidal meningiomas are the unique subset of tumors due to its close proximity to neurovascular structures and extension into the cavernous sinus and optic canal. They can be safely excised with minimal morbidity and mortality using microsurgical techniques. We recommend considering all possible clinical, radiological and intraoperative findings to predict the extent of resection for clinoidal meningiomas. This grading system will help to tailor the management plan and prognosticate in an
Conflicts of interest
None.
Approval from Institutional review board (IRB: H13-019) was obtained prior to this study.
Disclosure
A portion of this manuscript was presented during the scientific session at the annual meeting of the Congress of Neurological Surgeons held in October, 2015 at New Orleans, Louisiana.
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