gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Skull base meningiomas with compression of the anterior optic system – Clinical presentation, surgical treatment and results with regard to the site of tumor origin

Meeting Abstract

  • M. Nakamura - Klinik für Neurochirurgie, Medizinische Hochschule Hannover
  • M.P. Peyravi-Chasnasar - Klinik für Neurochirurgie, Medizinische Hochschule Hannover
  • J.K. Krauss - Klinik für Neurochirurgie, Medizinische Hochschule Hannover

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocSA.03.09

DOI: 10.3205/12dgnc329, URN: urn:nbn:de:0183-12dgnc3291

Published: June 4, 2012

© 2012 Nakamura et al.
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Outline

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Objective: Meningiomas involving the anterior visual system may originate from different anatomical sites of the anterior or middle fossa. The direction of tumor growth and site of tumor origin determines the form of compression of the optic nerve or chiasm. We report on a series of 79 patients with 81 meningiomas, which were operated because of compression of the anterior visual system, present the surgical management and results with subject to the mode of visual impairment.

Methods: All patients were operated through the frontolateral or pterional approach using microsurgical technique between January 2006 and August 2011. Clinical data were collected prospectively including preoperative medical history, radiological, operative and histological findings and follow-up records.

Results: Our series includes 61 women and 18 men with a mean age of 56.8 years (35–79 years). There were 15 sphenoorbital, 14 tuberculum sellae, 13 planum sphenoidale, 11 medial sphenoid wing, 10 olfactory groove, 9 supra-parasellar (with cavernous sinus infiltration), 6 anterior clinoid meningiomas and 3 optic nerve sheath meningioma. Fourteen meningiomas presented as a recurrent tumor. Surgical decompression of the optic nerve or chiasm was performed in all cases. Total tumor resection was achieved in 51 tumors, a subtotal resection in 19 and partial resection in 11 tumors. Intracanalicular tumor growth was observed during surgery in 19 cases. Opening of the optic canal was accomplished in 16 cases. In patients with preoperative functional vision (n=73), visual function improved in 67.1%, remained stable in 27.4% and was worse in 5.5%. In 8 patients with preoperative complete loss of vision, vision did not recover. There was 1 tumor with recurrent optic nerve compression 27 months after surgery. The mean follow-up time was 27.6 months (3–60 months).

Conclusions: The majority of patients with anterior and middle skull base meningiomas compressing the optic nerve or chiasm benefit from surgical decompression except those with preoperative complete loss of vision. Best results were observed in patients with frontobasal, planum sphenoidale or tuberculum sellae meningiomas, where decompression of the anterior optic system may lead to immediate visual improvement.