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Best Abstract in Skull Base: Clinical course after operative resection of spheno-clinoidal meningioma: a single center retrospective study
EANS Academy. Flueh C. 09/26/19; 281696 Disclosure(s): I hereby declare that I have nothing to disclose.
Dr. Charlotte Flueh
Dr. Charlotte Flueh

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Removal of a spheno-clinoidal meningioma involving decompression of the optic canal is highly effective. As worsening of visual deficits postoperatively only occurred in patients who received extensive tumor resection, we conclude that careful planning and a case-oriented, individual selection of the operative procedure is crucial to achieve a good outcome.
Spheno-clinoidal meningioma remain a neurosurgical challenge, as they often involve the optic nerve, the ICA and cranial nerves III, IV and V. Extent of an operative resection, especially concerning bony decompression, is discussed controversially. We systematically analyzed the patients, who were operated on speno-clinoidal meningioma between April 2015 and January 2018 at our center.
A total of 42 patients was operated (80,9% female; median age 57,3 years, WHO °I in 92,7%). Extent of resection was graded using the Simpson classification (°I in 26,2%, °II in 23,8%, °III in 14,3%, °IV in 26,2%, °V in 9,5%). The optic canal was decompressed in 51,3%, anterior clinoidectomy was performed in 7,7%. Prior to the operation, 38,1% of the patients were diagnosed visual deficits, 16,7% double vision and 40,5% distortions of the visual field. In a course of 36 months postoperatively, deficits improved in 60,9%, and were unaltered in 26,1% of cases. Three patients showed intermittent postoperative worsening of visual deficits, and two patients developed further deficits 3 to 6 months after the operation. Double vision was unchanged in 4 cases, and improved in 2 cases. Concerning the visual field, 7 patient improved, 4 patients showed unaltered results and 2 patient worse results postoperatively. Two of three patients who were discharged with new visual or oculomotor deficits improved after 3 to 6 months. Interestingly, the patients whose visual and oculomotor deficits had improved postoperatively, were operated Simpson °II-V in 78,58%, whereas primarily asymptomatic patients who were discharged with new deficits were operated Simpson °I or °II in all cases.
In patients with preoperative ophthalmologic deficits, intraoperative complications related to the approach (bleeding, infection) occurred significantly more frequently than in patients without preoperative deficits. Patients with preoperative deficits received a bony decompression of the optic canal or an anterior clinoidectomy more frequently (p=0,03), and symptoms improved significantly after the operation. The frequency of a decreased postoperative ophthalmologic status did not differ significantly between both groups. Interestingly, the amount of tumor tissue which was removed, was significantly higher in patients without preoperative ophthalmologic deficits.
Removal of a spheno-clinoidal meningioma involving decompression of the optic canal is highly effective. As worsening of visual deficits postoperatively only occurred in patients who received extensive tumor resection, we conclude that careful planning and a case-oriented, individual selection of the operative procedure is crucial to achieve a good outcome.
Spheno-clinoidal meningioma remain a neurosurgical challenge, as they often involve the optic nerve, the ICA and cranial nerves III, IV and V. Extent of an operative resection, especially concerning bony decompression, is discussed controversially. We systematically analyzed the patients, who were operated on speno-clinoidal meningioma between April 2015 and January 2018 at our center.
A total of 42 patients was operated (80,9% female; median age 57,3 years, WHO °I in 92,7%). Extent of resection was graded using the Simpson classification (°I in 26,2%, °II in 23,8%, °III in 14,3%, °IV in 26,2%, °V in 9,5%). The optic canal was decompressed in 51,3%, anterior clinoidectomy was performed in 7,7%. Prior to the operation, 38,1% of the patients were diagnosed visual deficits, 16,7% double vision and 40,5% distortions of the visual field. In a course of 36 months postoperatively, deficits improved in 60,9%, and were unaltered in 26,1% of cases. Three patients showed intermittent postoperative worsening of visual deficits, and two patients developed further deficits 3 to 6 months after the operation. Double vision was unchanged in 4 cases, and improved in 2 cases. Concerning the visual field, 7 patient improved, 4 patients showed unaltered results and 2 patient worse results postoperatively. Two of three patients who were discharged with new visual or oculomotor deficits improved after 3 to 6 months. Interestingly, the patients whose visual and oculomotor deficits had improved postoperatively, were operated Simpson °II-V in 78,58%, whereas primarily asymptomatic patients who were discharged with new deficits were operated Simpson °I or °II in all cases.
In patients with preoperative ophthalmologic deficits, intraoperative complications related to the approach (bleeding, infection) occurred significantly more frequently than in patients without preoperative deficits. Patients with preoperative deficits received a bony decompression of the optic canal or an anterior clinoidectomy more frequently (p=0,03), and symptoms improved significantly after the operation. The frequency of a decreased postoperative ophthalmologic status did not differ significantly between both groups. Interestingly, the amount of tumor tissue which was removed, was significantly higher in patients without preoperative ophthalmologic deficits.
Removal of a spheno-clinoidal meningioma involving decompression of the optic canal is highly effective. As worsening of visual deficits postoperatively only occurred in patients who received extensive tumor resection, we conclude that careful planning and a case-oriented, individual selection of the operative procedure is crucial to achieve a good outcome.
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