Early postoperative results of surgical treatment of patients with anterior clinoidal meningiomas

Abstract

Resection of anterior clinoidal meningiomas is a challenging task due to their localization, frequent involvement of the major cerebral arteries and cranial nerves, a high risk of postoperative neurological deficits, and low radicalness of surgery. Objective. To evaluate the radicalness of microsurgical removal and a neurological deficit in the early postoperative period in patients with anterior clinoidal meningiomas. Material and methods. A total of 35 patients with anterior clinoidal meningiomas underwent surgery at the Department of Neurooncology of the Novosibirsk Federal Neurosurgical Center in the period from 2013 to July 2016. There were 29 (82.9%) females and 6 (17.1%) males. The mean patient age was 50.1 years (31-72 years). According to the Al-Mefty classification (1990), type 1 tumors occurred in 10 (28.6%) patients, type 2 tumors were in 22 (62.8%) patients, and type 3 tumors were in 3 (8.6%) patients. Twenty four (68.6%) patients had large (greater than 4.0 cm) tumors, 7 (20.0%) patients had medium (2.0-4.0 cm) tumors, and 4 (11.4%) patients had small (less than 2.0 cm) meningiomas. The tumor involved the major arteries in 21 (60.0%) patients. Results. The lateral supraorbital approach was used in 26 (74.3%) patients, and the pterional approach was used in 9 (25.7%) cases. The tumor was resected totally (Simpson II) in 25 (71.4%) cases and subtotally (Simpson IV, subtype A and B) in 10 (28.6%) patients. In the early postoperative period, cerebral symptoms regressed in 20 (57.1%) patients; visual acuity improved in 2 of 13 (15.4%) patients. Four (11.4%) patients developed IIIrd nerve palsy; 2 (5.7%) patients developed severe hemiparesis. The mortality rate was 2.9%. Conclusion. The completeness of resection directly depends on the tumor consistency: soft meningiomas can be totally resected (Simpson II) with a good functional outcome. In the case of solid tumors, total resection may lead to serious ischemic disorders with a high risk of death.