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Surgical unroofing of the optic canal and visual outcome in basal meningiomas

Acta Neurochirurgica volume 155, pages 77–84 (2013)Cite this article

An Erratum to this article was published on 07 October 2012

Abstract

Background

To define from a series of surgically treated suprasellar, anterior clinoid, and sphenoid wing meningiomas, an unequivocal criterion for performing optic canal deroofing in patients with basal meningiomas with deteriorated vision.

Methods

One hundred-fifty consecutive patients with suprasellar and parasellar meningiomas (44 tuberculum sellae, 46 clinoidal, and 60 spheno-orbital) who underwent surgery between 1988 and 2008 are retrospectively analyzed. The rate of preoperative visual deficit, the incidence of optic canal involvement, the related surgical management, and its influence on visual outcome are reviewed in all tumor localizations.

Results

All 44 patients with tuberculum sellae meningiomas had variable preoperative visual impairment. All were operated on by transcranial approach. Unroofing of the optic canal was performed in the two cases with intracanalar tumor extension. Postoperatively, the visual function improved in 27 patients (61.4 %) and was unchanged in 17 (25 %).

Among 46 patients with clinoidal meningiomas, visual dysfunction was found in 30 (65.2 %). The first 32 patients were operated on by classical pterional approach, with selective opening of the optic canal in six cases (group A), whereas all the last 14 underwent routine anterior clinoidectomy and opening of the optic canal (group B). The visual function improved postoperatively in 17 among 30 patients (56.7 %), with a significantly higher rate in group B cases (80 % versus 45 %).

Among 60 patients with spheno-orbital meningiomas, 36 (60 %) had visual dysfunction and 43 (71.6 %) involvement of the optic canal. The visual function improved in 18 cases (50 %), was unchanged in 13 (36 %), and worsened in 5 (14 %). Lateral tumors had the lowest rate of optic canal involvement and a 100 % rate of visual improvement; on the other hand, all orbital apex and diffuse tumors had concentric invasion of the optic canal with a 18.6 % rate of visual worsening.

Conclusions

UOC seems to be a safe procedure not associated with immediate postoperative impairment of the vision. We recommend routine deroofing of the optic canal coupled with extradural anterior clinoidectomy in all clinoidal meningiomas in order to obtain early and complete exposure of both intradural and extradural segments of the optic nerve. For tuberculum sellae meningiomas, we advise to open the optic canal only in cases with intracanalar tumor extension. Finally, for spheno-orbital meningiomas, we recommend UOC through a cranio-orbital approach in almost all cases, except for lateral meningiomas, where the involvement of the lateral wall of the optic canal is rare and may be successfully managed through a lateral orbitotomy without craniotomy.

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References

  1. Al-Mefty O (1987) Supraorbital-pterional approach to skull base lesions. Neurosurgery 21:474–477

    PubMed  Article  CAS  Google Scholar 

  2. Al-Mefty O (1990) Clinoidal meningiomas. J Neurosurg 73:840–849

    PubMed  Article  CAS  Google Scholar 

  3. Al-Mefty O, Ayoubi S (1991) Clinoidal meningiomas. Acta Neurochir (Wien) 53(suppl):92–97

    Article  CAS  Google Scholar 

  4. Arai H, Sato K, Okuda M, Miyajima M, Hishii M (2000) Transcranial transsphenoidal approach for tuberculum sellae meningiomas. Acta Neurochir (Wien) 142:751–756

    Article  CAS  Google Scholar 

  5. Bassiouni H, Asgari S, Sandalcioglou E, Seifert V, Stolke D, Marquardt G (2009) Anterior clinoidal meningiomas: functional outcome after microsurgical resection in a consecutive series of 106 patients. J Neurosurg 111:1078–1090

    PubMed  Article  Google Scholar 

  6. Bikmaz K, Mrak R, Al-Mefty O (2007) Management of bone-invasive, hyperostotic sphenoid wing meningiomas. J Neurosurg 107:905–912

    PubMed  Article  Google Scholar 

  7. Cannon PS, Rutherford SA, Richardson PL, King A, Leatherbarrow B (2009) The surgical management and outcomes for spheno-orbital meningiomas: a 7-year review of multi-disciplinary practice. Orbit 28:371–376

    PubMed  Article  Google Scholar 

  8. de Divitiis E, Esposito F, Cappabianca P, Cavallo LM, de Divitiis O (2008) Tuberculum sellae meningiomas: high route or low route? A series of 51 consecutive cases. Neurosurgery 62:556–563

    PubMed  Article  Google Scholar 

  9. Dolenc VV (1983) Direct microsurgical repair of intracavernous vascular lesions. J Neurosurg 58:824–831

    PubMed  Article  CAS  Google Scholar 

  10. Goel A, Gupta S, Desai K (2000) New grading system to predict respectability of anterior clinoid meningiomas. Neurol Med Chir 40:610–617

    Article  CAS  Google Scholar 

  11. Lee JH, Sade B, Park BJ (2006) A surgical technique for the removal of clinoidal meningiomas. Neurosurgery 59(ONS suppl 1):108–114

    Google Scholar 

  12. Mahmoud M, Nader R, Al-Mefty O (2010) Optic canal involvement in tuberculum sellae meningiomas: influence on approach, recurrence, and visual recovery. Neurosurgery 66(ONS suppl 1):108–119

    Google Scholar 

  13. Mariniello G, Cappabianca P, Buonamassa S, de Divitiis E (2004) Surgical treatment of intracavernous trigeminal schwannomas via a fronto-temporal epidural approach. Clin Neurol Neurosurg 106:104–109

    PubMed  Article  Google Scholar 

  14. Mariniello G, Maiuri F, Strianese D, Donzelli R, Iuliano A, Tranfa F (2008) Spheno-orbital meningiomas: surgical approaches and outcome according to the intraorbital tumor extent. Zentralbl Neurochir 69:175–181

    PubMed  Article  CAS  Google Scholar 

  15. Mariniello G, Maiuri F, de Divitiis E, Bonavolontà G, Tranfa F, Iuliano A (2010) Lateral orbitotomy for removal of sphenoid wing meningiomas invading the orbit. Neurosurgery 66(ONS suppl 6):287–292

    PubMed  Google Scholar 

  16. Mathiesen T, Kihlstrom L (2006) Visual outcome of tuberculum sellae meningiomas after extradural optic nerve decompression. Neurosurgery 59:570–576

    PubMed  Article  Google Scholar 

  17. McDermott MW, Durity FA, Rootman J, Woodhurst WB (1990) Combined frontotemporal-orbitozygomatic approach for tumors of the sphenoid wing and orbit. Neurosurgery 26:107–116

    PubMed  Article  CAS  Google Scholar 

  18. Nakamura M, Roser F, Jacobs C, Vorkapic P, Samii M (2006) Medial sphenoid wing meningiomas: clinical outcome and recurrence rate. Neurosurgery 58:626–639

    PubMed  Article  Google Scholar 

  19. Newman SA, Jane JA (1991) Meningiomas of the optic nerve, orbit and anterior visual pathways. In: Al Mefty O (ed) Meningiomas. Raven, New-York, pp 461–494

    Google Scholar 

  20. Nozaki K, Kikuta K, Takagi Y, Mineharu Y, Takahashi JA, Hashimoto N (2008) Effect of early optic canal unroofing on the outcome of visual function in surgery for meningiomas of the tuberculum sellae and planum sphenoidale. Neurosurgery 62:839–844

    PubMed  Article  Google Scholar 

  21. Pamir MN, Ozduman K, Belirgen M, Kilic T, Ozek MM (2005) Outcome determinants of pterional surgery for tuberculum sellae meningiomas. Acta Neurochir (Wien) 147:1121–1130

    Article  CAS  Google Scholar 

  22. Ringel F, Cedzich C, Schramm J (2007) Microsurgical technique and results of a series of 63 spheno-orbital meningiomas. Neurosurgery 60(ONS suppl 2):214–222

    PubMed  Google Scholar 

  23. Risi P, Uske A, de Tribolet N (1994) Meningiomas involving the anterior clinoid process. Br J Neurosurg 8:295–305

    PubMed  Article  CAS  Google Scholar 

  24. Sade B, Lee JH (2008) High incidence of optic canal involvement in clinoidal meningiomas: rationale for aggressive skull base approach. Acta Neurochir (Wien) 150:1127–1132

    Article  Google Scholar 

  25. Sade B, Lee JH (2009) High incidence of optic canal involvement in tuberculum sellae meningiomas: rationale for aggressive skull base approach. Surg Neurol 72:118–123

    PubMed  Article  Google Scholar 

  26. Sandalcioglu IE, Gasser T, Mohr C, Stolke D, Wiedemayer H (2005) Spheno-orbital meningiomas: interdisciplinary surgical approach, resectability and long-term results. J Craniomaxillofac Surg 33:260–266

    PubMed  Article  Google Scholar 

  27. Schick U, Hassler W (2005) Surgical management of tuberculum sellae meningiomas: involvement of the optic canal and visual outcome. J Neurol Neurosurg Psychiatry 76:977–983

    PubMed  Article  CAS  Google Scholar 

  28. Schick U, Bleyen J, Bani A, Hassler W (2006) Management of meningiomas en plaque of the sphenoid wing. J Neurosurg 104:208–214

    PubMed  Article  Google Scholar 

  29. Shrivastava RK, Sen C, Costantino PD, Della Rocca R (2005) Sphenoorbital meningiomas: surgical limitations and lessons learned in their long-term management. J Neurosurg 103:491–497

    PubMed  Article  Google Scholar 

  30. Simpson D (1957) The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20:22–39

    PubMed  Article  CAS  Google Scholar 

  31. Yasargil MG (1996) Meningiomas. In: Yasargil MG (ed) Microneurosurgery. Georg Thieme Verlag, Stuttgart, pp 134–165

    Google Scholar 

  32. Yonekawa Y, Ogata N, Imhof HG, Olivecrona M, Strommer K, Kwak TE (1997) Selective extradural anterior clinoidectomy for supra- and parasellar processes. J Neurosurg 87:636–642

    PubMed  Article  CAS  Google Scholar 

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Affiliations

  1. Department of Neurological Sciences, Section of Neurosurgery, “Federico II” University School of Medicine, Naples, Italy

    Giuseppe Mariniello, Oreste de Divitiis & Francesco Maiuri

  2. Department of Ophthalmology, Section of Orbital Pathology, “Federico II” University School of Medicine, Naples, Italy

    Giulio Bonavolontà

  3. Università degli Studi di Napoli “Federico II”, Cattedra di Neurochirurgia, 5 Via S. Pansini, Naples, 80131, Italy

    Giuseppe Mariniello

Authors
  1. Giuseppe Mariniello
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  2. Oreste de Divitiis
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  3. Giulio Bonavolontà
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  4. Francesco Maiuri
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Correspondence to Giuseppe Mariniello.

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Mariniello, G., de Divitiis, O., Bonavolontà, G. et al. Surgical unroofing of the optic canal and visual outcome in basal meningiomas. Acta Neurochir 155, 77–84 (2013). https://doi.org/10.1007/s00701-012-1485-z

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  • DOI: https://doi.org/10.1007/s00701-012-1485-z

Keywords

  • Tuberculum sellae meningioma
  • Anterior clinoid meningioma
  • Spheno-orbital meningioma
  • Skull base
  • Meningioma
  • Optic canal