Article
Anterior clinoid meningiomas: Outcome in a consecutive series of 72 patients treated by microsurgery
Vordere Clinoid-Fortsatz-Meningeome: Mikrochirurgische Ergebnisse in einem konsekutiven Kollektiv von 72 Patienten
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Authors
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H. Bassiouni
- Neurochirurgische Klinik, Universitätsklinikum Essen
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S. Asgari
- Neurochirurgische Klinik, Universitätsklinikum Essen
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D. Stolke
- Neurochirurgische Klinik, Universitätsklinikum Essen
| Published: | April 11, 2007 |
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Outline
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Objective: We conducted a retrospective analysis in a consecutive series of patients treated by microsurgery for an anterior clinoid meningioma with regard to long-term follow-up results.
Methods: Clinical, radiological and surgical data were reviewed in a consecutive series of 72 patients treated with microsurgery for an anterior clinoid meningioma in the period from June 1987 till June 2005.
Results: The main presenting symptoms in the 64 women and 8 men (mean age 55 yrs, range 24 to 74 yrs) were visual impairment in 59% and headache in 34% of the patients. Mean duration of preoperative symptoms prior to hospital admission was 19 months, with a wide range from 10 days to 11 years. Ophthalmological examination revealed diminished visual acuity in 63% and a visual field deficit in 28% of the cases. Preoperative magnetic resonance imaging (MRI) demonstrated tumor extension into the cavernous sinus in 45% of patients. Extent of tumor resection, usually via the pterional approach, was grade I in 4% and grade II in 58% of the cases according to Simpson’s classification system. The intracavernous tumor portion was left in situ in 37% of cases (grade IV). Impaired visual acuity improved postoperatively in 47%, remained unchanged in 47% and deteriorated in 6% of patients. The surgical mortality and the permanent morbidity rates were 3% and 23%, respectively. The Karnofsky performance score improved from 84 before operation to 88 after surgery. After a mean follow-up period of 7.3 years (range 1.5 yrs to 17 yrs) with clinical and MRI examination, we observed a tumor recurrence in 16% after a Simpson grade I and II removal and clinical progression of known residual tumor in a further 38% of patients.
Conclusions: Although acceptable early results can be achieved in this challenging skull base meningioma group with microsurgical resection, long-term functional outcome is less favourable due to a high recurrence rate after an apparently complete resection or progression of residual tumor due to the involvement of the cavernous sinus.
