Abstract
Clinical and radiological features or characteristics of posterior clinoid process (PCP) meningiomas have rarely been described because of their extreme scarcity and terminological confusion. Therefore, the strategies in the surgical intervention for PCP meningiomas have not been well established. Moreover, the presence of deep and critical neuroanatomical structures and relatively high morbidity, which can be difficult to predict preoperatively, make their surgical excision more challenging. We report two surgical cases of PCP meningioma and discuss the appropriate assessment of preoperative features and surgical strategies with review of the literature. Our study suggests that PCP meningioma may be characterized by the anterior displacement of internal carotid artery, and infero-laterally shifted posterior communicating arteries, and homonymous hemianopsia, a distinctive clinical feature. One of the key issues in PCP meningioma surgery is preservation of the optic nerve. Unlocking the optic nerve by anterior clinoidectomy and dissection, the falciform ligament is the important step to preserve vision for larger tumors. Complication with the perforators is also hazardous of these challenging surgeries than anterior clinoid meningiomas for their specific neuroanatomical structures and might not be feasible to avoid even with additional techniques and critical monitoring. A combination and multi-staged-surgical approach can be options of tailor-made surgical strategy in cases with tumor adhesion to the perforators.
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References
Drake CG (1961) Bleeding aneurysms of the basilar artery. Direct surgical management in four cases. J Neurosurg 18:230–238. doi:10.3171/jns.1961.18.2.0230
Fujitsu K, Kuwabara T (1985) Zygomatic approach for lesions in the interpeduncular cistern. J Neurosurg 62(3):340–343. doi:10.3171/jns.1985.62.3.0340
Geng SM, Zhang JT, Zhang LW, Wu Z, Wang ZC (2009) Optimal microsurgical treatment of dorsum sellae meningioma. Chin Med J (Engl) 122(16):1857–1861
Goto T, Ohata K (2009) Posterior clinoidal meningiomas. Meningiomas 399–402
Hakuba A, Liu S, Nishimura S (1986) The orbitozygomatic infratemporal approach: a new surgical technique. Surg Neurol 26(3):271–276
Hakuba A, Nishimura S, Inoue Y (1985) Transpetrosal-transtentorial approach and its application in the therapy of retrochiasmatic craniopharyngiomas. Surg Neurol 24(4):405–415
Hakuba A, Nishimura S, Jang BJ (1988) A combined retroauricular and preauricular transpetrosal-transtentorial approach to clivus meningiomas. Surg Neurol 30(2):108–116
Horiguchi T, Yoshida K, Kawase T (2008) Posterior clinoid meningioma (abstract). AANS:Article ID: 51587
Nakamura M, Samii M (2003) Surgical management of a meningioma in the retrosellar region. Acta Neurochir 145(3):215–219. doi:10.1007/s00701-002-1053-z, discussion 219–220
Ohba S, Sasaki H, Kimura T, Ikeda E, Kawase T (2010) Clear cell meningiomas: three case reports with genetic characterization and review of the literature. Neurosurgery 67(3):E870–E871. doi:10.1227/01.NEU.0000374857.06732.CD, discussion E871
Oya S, Kim SH, Sade B, Lee JH (2011) The natural history of intracranial meningiomas. J Neurosurg 114(5):1250–1256. doi:10.3171/2010.12.JNS101623
Shukla D, Gangadharan J, Kakati A, Devi BI (2013) Posterior clinoid process meningioma. Clin Neurol Neurosurg 115(8):1517–1519. doi:10.1016/j.clineuro.2012.12.007
Sodhi HB, Singla N, Gupta SK (2015) Posterior clinoid meningioma: a case report with discussion on terminology and surgical approach. Surg Neurol Int 6:21. doi:10.4103/2152-7806.151261
Sughrue ME, Rutkowski MJ, Aranda D, Barani IJ, McDermott MW, Parsa AT (2010) Treatment decision making based on the published natural history and growth rate of small meningiomas. J Neurosurg 113(5):1036–1042. doi:10.3171/2010.3.JNS091966
Yano S, Kuratsu J, Kumamoto Brain Tumor Research G (2006) Indications for surgery in patients with asymptomatic meningiomas based on an extensive experience. J Neurosurg 105(4):538–543. doi:10.3171/jns.2006.105.4.538
Yasargil MG, Antic J, Laciga R, Jain KK, Hodosh RM, Smith RD (1976) Microsurgical pterional approach to aneurysms of the basilar bifurcation. Surg Neurol 6(2):83–91
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Conception and design: Takase, Kawahara. Acquisition of data: Takase, Kawasaki, Tateishi, Yokoyama, Kawahara. Analysis and interpretation of data: Takase. Drafting the article: Takase. Critically revising the article: Kawahara. Reviewed submitted version of manuscript: Kawasaki, Tateishi, Yokoyama, Murata, Kawahara. Study supervision: Kawahara.
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The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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Nobutaka Kawahara is deceased.
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Takase, H., Kawasaki, T., Tateishi, K. et al. Characteristics and surgical strategies for posterior clinoid process meningioma: two case reports and review of the literature. Neurosurg Rev 40, 163–169 (2017). https://doi.org/10.1007/s10143-016-0774-z
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DOI: https://doi.org/10.1007/s10143-016-0774-z