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Surgical nuances for safe resection of anterior clinoid meningiomas
EANS Academy. Voznyak O. Sep 27, 2019; 275939; EP04023
Dr. Oleksandr Voznyak
Dr. Oleksandr Voznyak

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Abstract
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Background: Radical surgical resection of anterior clinoid process (CM) frequently is difficult due to tumor bone and cavernous sinus (CS) invasion, encasement of arteries and veins, adhesions with brain and cranial nerves. Optimal surgical approach is a cornerstone for successful and safe CM excision.
Objectives: Evaluate advantages and disadvantages of frontolateral and ptarional approaches for CM resection.
Methods: Overall 64 patients with CM were operated on from 2009 to 2017yy. Ratio F/M was - 49/15. Mean age-53 y. (26-70). Preoperative symptoms included visual imparament, proptosis, intracranial hypertention, hemiparesis, oculomotor nerves pulsy, seizers. Tumors extended to CS in 32 cases. Patients were operated on via pterional (31) and frontolateral (33) approaches. Clinoidectomy was key procedure for CM surgery. All the CM were histologically verified. Follow up time was 12- 92 months.
Result: Tumors were totally removed in 28 (43,8%) cases, subtotally in 22 (34,4%), partially in 14 (21,8%). Visual improvement was documented after 61 procedures and deterioration after 3. Complications: brain infarction-2, permanent III-rd nerve palsy - 1, CSF leakage-1. Three patients were re-operated on due to meningioma prolonged growth. In 3 patient tumor resection was followed by radiation therapy. There were no lethal cases.
Conclusion: Frontolateral approach was applied for CM without remarkable bone invasion and extension to CS. Pterional approach provided effective excision of CM extended to cavernous sinus and invaded to bone structures.
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