Aim: The purpose of this article is to advocate standard skull base technique for removing the clinoidal meningioma and to delineate the technique's advantages that aid in achieving an improved extent of tumor res...Aim: The purpose of this article is to advocate standard skull base technique for removing the clinoidal meningioma and to delineate the technique's advantages that aid in achieving an improved extent of tumor resection and enhancing the patients' overall outcome, specially their visual outcome. Methods: A retrospective analysis was performed on 10 consecutive patients with clinoidal meningiomas who underwent surgical resection at the Bangabandhu Sheikh Mujib Medical University and other private clinics between May 2013 and July 2016. A standard pterional craniotomy technique consisting of extradural anterior clinoidectomy, coupled with optic canal unroofing and optic nerve sheath opening was used in all patients. All patients had thorough preoperative and postoperative ophthalmological evaluations. The follow-up period ranged from 6 to 42 months. Results: Total resection was achieved in 5 (50.0%) of the 10 patients in this series. The majority of the patients with preoperative visual impairment experienced significant visual improvement 7 of 10 patients;70.0%). Conclusion: In the majority of patients with clinoidal meningiomas, total resection may be achieved with minimal complications. For large tumors encasing the optic nerve and internal carotid artery, or for those tumors causing preoperative visual impairment, use of the cranial base technique delineated in this study may lead to significant improvement in the patients' visual and overall outcomes.展开更多
Background Large and giant medial sphenoid wing meningiomas that are located deeply in the skull base where they are closely bounded by cavernous sinus,optic nerve,and internal carotid artery make the gross resection ...Background Large and giant medial sphenoid wing meningiomas that are located deeply in the skull base where they are closely bounded by cavernous sinus,optic nerve,and internal carotid artery make the gross resection hard to achieve.Also,this kind of meningiomas is often accompanied by a series of severe complications.Therefore,it was regarded as a formidable challenge to even the most experienced neurosurgeons.This study aimed to investigate the clinical features and management experience of patients with large and giant medial sphenoid wing meningiomas.Methods In this study,53 patients （33 female and 20 male,mean age of 47.5 years） with large and giant medial sphenoid wing meningiomas were treated surgically between April 2004 to March 2012,with their clinical features analyzed,management experience collected,and treatment results investigated retrospectively.Results In this study,gross total resection （Simpson Ⅰ and Ⅱ） was applied in 44 patients （83％）.Fifty-three patients had accepted the routine computed tomography scan and magnetic resonance imaging scan as postoperative neuroradiological evaluation.Their performance showed surgical complications of vascular lesions and helped us evaluate patients＇ conditions,respectively.Meanwhile,the drugs resisting cerebral angiospasm,such as Nimodipine,were infused in every postoperative patient through vein as routine.As a result,11 patients （21％） were found to have secondary injury of cranial nerves Ⅱ,Ⅲ,and Ⅳ,and nine patients got recovered during the long-term observing follow-up period.Temporary surgical complications of vascular lesions occurred after surgery,such as cerebral angiospasm,ischemia,and edema;24 patients （45％） appeared to have infarction and dyskinesia of limbs.Overall,visual ability was improved in 41 patients （77％）.No patient died during the process.Conclusions Microsurgical treatment may be the most effective method for the large and giant medial sphenoid wing meningiomas.The surgical strategy should focus on survival and postoperative living quality.展开更多
文摘Aim: The purpose of this article is to advocate standard skull base technique for removing the clinoidal meningioma and to delineate the technique's advantages that aid in achieving an improved extent of tumor resection and enhancing the patients' overall outcome, specially their visual outcome. Methods: A retrospective analysis was performed on 10 consecutive patients with clinoidal meningiomas who underwent surgical resection at the Bangabandhu Sheikh Mujib Medical University and other private clinics between May 2013 and July 2016. A standard pterional craniotomy technique consisting of extradural anterior clinoidectomy, coupled with optic canal unroofing and optic nerve sheath opening was used in all patients. All patients had thorough preoperative and postoperative ophthalmological evaluations. The follow-up period ranged from 6 to 42 months. Results: Total resection was achieved in 5 (50.0%) of the 10 patients in this series. The majority of the patients with preoperative visual impairment experienced significant visual improvement 7 of 10 patients;70.0%). Conclusion: In the majority of patients with clinoidal meningiomas, total resection may be achieved with minimal complications. For large tumors encasing the optic nerve and internal carotid artery, or for those tumors causing preoperative visual impairment, use of the cranial base technique delineated in this study may lead to significant improvement in the patients' visual and overall outcomes.
文摘Background Large and giant medial sphenoid wing meningiomas that are located deeply in the skull base where they are closely bounded by cavernous sinus,optic nerve,and internal carotid artery make the gross resection hard to achieve.Also,this kind of meningiomas is often accompanied by a series of severe complications.Therefore,it was regarded as a formidable challenge to even the most experienced neurosurgeons.This study aimed to investigate the clinical features and management experience of patients with large and giant medial sphenoid wing meningiomas.Methods In this study,53 patients （33 female and 20 male,mean age of 47.5 years） with large and giant medial sphenoid wing meningiomas were treated surgically between April 2004 to March 2012,with their clinical features analyzed,management experience collected,and treatment results investigated retrospectively.Results In this study,gross total resection （Simpson Ⅰ and Ⅱ） was applied in 44 patients （83％）.Fifty-three patients had accepted the routine computed tomography scan and magnetic resonance imaging scan as postoperative neuroradiological evaluation.Their performance showed surgical complications of vascular lesions and helped us evaluate patients＇ conditions,respectively.Meanwhile,the drugs resisting cerebral angiospasm,such as Nimodipine,were infused in every postoperative patient through vein as routine.As a result,11 patients （21％） were found to have secondary injury of cranial nerves Ⅱ,Ⅲ,and Ⅳ,and nine patients got recovered during the long-term observing follow-up period.Temporary surgical complications of vascular lesions occurred after surgery,such as cerebral angiospasm,ischemia,and edema;24 patients （45％） appeared to have infarction and dyskinesia of limbs.Overall,visual ability was improved in 41 patients （77％）.No patient died during the process.Conclusions Microsurgical treatment may be the most effective method for the large and giant medial sphenoid wing meningiomas.The surgical strategy should focus on survival and postoperative living quality.
