Advertisement

Acta Neurochirurgica

, 150:625 | Cite as

Anterior clinoidal meningiomas: analysis of 43 consecutive surgically treated cases

  • M. N. Pamir
  • M. Belirgen
  • K. Özduman
  • T. Kılıç
  • M. Özek
Clinical Article

Summary

Background. Anterior clinoidal meningiomas are considered different from meningiomas of the medial sphenoid wing, but there is still some confusion about identification. The current classification scheme only considers tumour origin and invasion pattern around the clinoid process as indicators of resectability. However, the size of the tumour has important effects on surgical outcome. The purpose of this study was to analyze our clinical experience with anterior clinoidal meningiomas and refine the current classification scheme.

Method. Forty-three consecutive cases of anterior clinoidal meningioma were retrospectively analyzed. All were surgically treated at the Marmara University Department of Neurosurgery, the Marmara University Institute for Neurological Sciences, and the Department of Neurosurgery at Acibadem Hospital between 1987 and 2006. A pterional approach was used in all cases.

Findings. The mean tumour volume was 34.2 ± 46.6 cc. Sixteen (37.2%) of the tumours were giant (largest diameter >4 cm). Total surgical removal was achieved in 39 cases (90.7%) and subtotal removal in 4 cases (9.3%). Eight patients (18.6%) developed early postoperative complications. The median and range of follow-up time was 39, R = 99 (3, 102) months. Four (9.3%) of the 43 tumours recurred during follow-up and were treated with radiosurgery.

Conclusion. Anterior clinoidal meningioma is a separate disease entity from other meningiomas of the medial third of the sphenoid wing. Relatively good outcomes can be stated in this specific subgroup if growth criteria competable with true diagnosis are fulfilled. Size should be incorporated into any classification scheme for determining clinical and surgical risk. The standard pterional approach is sufficient for removing anterior clinoidal meningiomas.

Keywords: Classification; clinoidal; meningioma; sphenoid wing; surgery. 

References

  1. Abdel-Aziz, KM, Froelich, SC, Dagnew, E, Jean, W, Breneman, JC, Zuccarello, M, van Loveren, HR, Tew, JM,Jr 2004Large sphenoid wing meningiomas involving the cavernous sinus: conservative surgical strategies for better functional outcomesNeurosurgery5413751383discussion 1383–1374PubMedCrossRefGoogle Scholar
  2. Al-Mefty, O 1990Clinoidal meningiomasJ Neurosurg73840849PubMedGoogle Scholar
  3. Bonnal, J, Thibaut, A, Brotchi, J, Born, J 1980Invading meningiomas of the sphenoid ridgeJ Neurosurg53587599PubMedGoogle Scholar
  4. Chang, JH, Chang, JW, Choi, JY, Park, YG, Chung, SS 2003Complications after Gamma-knife radiosurgery for benign meningiomasJ Neurol Neurosurg Psychiatry74226230PubMedCrossRefGoogle Scholar
  5. Cushing, H, Eisenhardt, L 1938Meningiomas: their classification, regional behaviour, life history and surgical end resultsCharles C ThomasSpringfield, ILGoogle Scholar
  6. Eustacchio S, Trummer M, Fuchs I, Schrottner O, Sutter B, Pendl G (2002) Preservation of cranial nerve function following Gamma-knife radiosurgery for benign skull base meningiomas: experience in 121 patients with follow-up of 5 to 9.8 years. Acta Neurochir (Suppl 84): 71–76Google Scholar
  7. Fahlbusch, R, Schott, W 2002Pterional surgery of meningiomas of the tuberculum sellae and planum sphenoidale: surgical results with special consideration of ophthalmological and endocrinological outcomesJ Neurosurg96235243PubMedGoogle Scholar
  8. Goel, A, Gupta, S, Desai, K 2000New grading system to predict resectability of anterior clinoid meningiomasNeurol Med Chir (Tokyo)40610616discussion 616–617CrossRefGoogle Scholar
  9. Goel, A, Muzumdar, D, Desai, K 2002Tuberculum sellae meningioma: a report on management on the basis of a surgical experience with 70 PatientsNeurosurgery5113581364PubMedCrossRefGoogle Scholar
  10. Hodes, JE, Sanders, M, Patel, P, Patchell, RA 1996Radiosurgical management of meningiomasStereotact Funct Neurosurg661518PubMedCrossRefGoogle Scholar
  11. Jaaskelainen, J 1986Seemingly complete removal of histologically benign intracranial meningioma: late recurrence rate and factors predicting recurrence in 657 patients. A multivariate analysisSurg Neurol26461469PubMedCrossRefGoogle Scholar
  12. Kobayashi, T, Kida, Y, Mori, Y 2001Long-term results of stereotactic Gamma radiosurgery of meningiomasSurg Neurol55325331PubMedCrossRefGoogle Scholar
  13. Kondziolka, D, Lunsford, LD, Coffey, RJ, Flickinger, JC 1991Gamma-knife radiosurgery of meningiomasStereotact Funct Neurosurg571121PubMedCrossRefGoogle Scholar
  14. Kondziolka, D, Lunsford, LD, Coffey, RJ, Flickinger, JC 1991Stereotactic radiosurgery of meningiomasJ Neurosurg74552559PubMedGoogle Scholar
  15. Lee, JH, Jeun, SS, Evans, J, Kosmorsky, G 2001Surgical management of clinoidal meningiomasNeurosurgery4810121019discussion 1019–1021PubMedCrossRefGoogle Scholar
  16. Lee, JH, Sade, B, Park, BJ 2006A surgical technique for the removal of clinoidal meningiomasNeurosurgery59ONS108ONS114discussion ONS108–ONS114PubMedCrossRefGoogle Scholar
  17. Mathiesen, T, Kihlstrom, L 2006Visual outcome of tuberculum sellae meningiomas after extradural optic nerve decompressionNeurosurgery59570576discussion 570–576PubMedCrossRefGoogle Scholar
  18. Mathiesen, T, Lindquist, C, Kihlstrom, L, Karlsson, B 1996Recurrence of cranial base meningiomasNeurosurgery3927discussion 8–9PubMedCrossRefGoogle Scholar
  19. Mirimanoff, RO, Dosoretz, DE, Linggood, RM, Ojemann, RG, Martuza, RL 1985Meningioma: analysis of recurrence and progression following neurosurgical resectionJ Neurosurg621824PubMedCrossRefGoogle Scholar
  20. Pamir, MN, Kilic, T, Bayrakli, F, Peker, S 2005Changing treatment strategy of cavernous sinus meningiomas: experience of a single institutionSurg Neurol64S58S66PubMedCrossRefGoogle Scholar
  21. Pamir, MN, Ozduman, K, Belirgen, M, Kilic, T, Ozek, MM 2005Outcome determinants of pterional surgery for tuberculum sellae meningiomasActa Neurochir (Wien)14711211130discussion 1130CrossRefGoogle Scholar
  22. Pendl, G, Eustacchio, S, Unger, F 2001Radiosurgery as alternative treatment for skull base meningiomasJ Clin Neurosci81214PubMedCrossRefGoogle Scholar
  23. Puzzilli, F, Ruggeri, A, Mastronardi, L, Agrillo, A, Ferrante, L 1999Anterior clinoidal meningiomas: report of a series of 33 patients operated on through the pterional approachNeuro-oncology1188195PubMedCrossRefGoogle Scholar
  24. Risi, P, Uske, A, de Tribolet, N 1994Meningiomas involving the anterior clinoid processBr J Neurosurg8295305PubMedCrossRefGoogle Scholar
  25. Samii, M, Ammirati, M 1993Medial sphenoid wing meningiomasSpringer-VerlagBerlin3541Google Scholar
  26. Shrivastava, RK, Sen, C, Costantino, PD, Della Rocca, R 2005Sphenoorbital meningiomas: surgical limitations and lessons learned in their long-term managementJ Neurosurg103491497PubMedGoogle Scholar
  27. Tobias, S, Kim, CH, Kosmorsky, G, Lee, JH 2003Management of surgical clinoidal meningiomasNeurosurg Focus14e5PubMedCrossRefGoogle Scholar
  28. Yasargil, M 1996MicroneurosurgeryThieme VerlagStuttgart-NewYorkGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • M. N. Pamir
    • 1
    • 2
  • M. Belirgen
    • 1
  • K. Özduman
    • 1
  • T. Kılıç
    • 1
  • M. Özek
    • 1
  1. 1.Department of NeurosurgeryMarmara University Faculty of MedicineIstanbulTurkey
  2. 2.Department of NeurosurgeryAcibadem University Faculty of MedicineIstanbulTurkey

Personalised recommendations