الفهرس 
SURGICAL ANATOMYOnly 14 pages are availabe for public view
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Abstract
D
espite the recent advances in skull base surgery, microsurgical techniques, and neuroimaging, yet surgical resection of clinoidal meningiomas is still a major challenge. In this study, we present our surgical experience in the treatment of clinoidal meningiomas at our institution highlighting the role of extradural anterior clinoidectomy in improving the visual outcome and the extent of tumor resection.
This is a prospective cohort study conducted on 33 patients with anterior clinoidal meningioma. The surgical approach utilized consisted of extradural anterior clinoidectomy, optic canal deroofing with falciform ligament opening in all patients. The primary outcome assessment was visual improvement and secondary outcomes were extent of tumor resection, recurrence, and postoperative complications.
The study included 5 males and 28 females with mean age 49.48±11.41 years. Preoperative visual deficit was present in 30 (90.9%) patients. Optic canal involvement was present in 24 (72.7%) patients, ICA encasement was in 16 (48.5%), cavernous sinus invasion in 8 (24.2%). Gross total resection was achieved in 24 patients (72.7%), subtotal and partial resections were achieved in 6 (18.2%) and 3 (9.1%) patients, respectively. The main factors precluding total removal was cavernous sinus involvement and ICA encasement. Vision improved in 21 patients (70%), while 6 patients (20%) had stationary course and 1 patient suffered postoperative new visual deterioration (3%), mortality rate was 6.1%, mean follow-up period was 27±13 months.
In this series, the use of extradural anterior clinoidectomy provided a favorable visual outcome and improved extent of resection in patients with clinoidal meningiomas.