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World Neurosurg. 2019 Jun 6. pii: S1878-8750(19)31530-X. doi: 10.1016/j.wneu.2019.05.253. [Epub ahead of print]

Surgery For Clinoidal Meningiomas: Case Series And Meta-Analysis Of Outcomes And Complications.

Author information

1
Neurosurgery Service and Gamma Knife Center, University Hospital of Lausanne (CHUV).
2
Neurosurgery Service and Gamma Knife Center, University Hospital of Lausanne (CHUV); Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
3
Neurosurgery Service and Gamma Knife Center, University Hospital of Lausanne (CHUV); Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland. Electronic address: roy.daniel@chuv.ch.

Abstract

OBJECTIVE:

Clinoidal meningiomas present specific characteristics related to their peculiar site of anatomical origin. Clinical series focusing on pure clinoidal meningiomas are not numerous. We performed a systematic review and meta-analysis, including our own case series, of the available literature in order to better identify the specific features of these tumors.

METHODS:

A systematic review and meta-analysis was performed for surgically treated pure clinoidal meningiomas using Pubmed, Cochrane and EMBASE databases. A retrospective review of a cohort of 18 consecutive patients treated between 2010 and 2018 in our Department, was also included in this meta-analysis..

RESULTS:

1208 patients were included in the analysis. With a weighted mean follow-up of 48.1 months, the pooled rate of gross total resection(GTR) was 64.2%(95% C.I.57.3-71.0%) in the overall population, 11.8%(95% C.I.2.4-21.1%) in the Al-Mefty I subgroup, 92.6%(95%C.I. 88.9-96.3%) in the Al-Mefty II subgroup and 84.2%(95% C.I.70.8-97.6%) in the Al-Mefty III subgroup. Overall visual improvement after treatment was found in 48%(95% C.I.38.6-57.4%) of patients with a pooled deterioration rate of 4.5%(95% C.I.3-6%). Pooled overall recurrence was observed in 8.9% of patients(95% CI6.0%-11.8%) and mortality occurred in 1.2%(95% CI0.6%-1.8%).

CONCLUSION:

The rate of GTR is proportional to the dural origin of these tumors that is intimately related to critical neurovascular structures. Complementary radiosurgery could represent a valid treatment strategy. Post-operative visual improvement remains less satisfying when compared to other suprasellar meningiomas. The introduction of skull-base techniques like, extradural anterior clinoidectomy, has enabled improvements in visual outcome without any increase in approach related morbidity.

KEYWORDS:

anterior clinoid process; clinoidal meningiomas; extradural anterior clinoidectomy; skull base

PMID:
31176836
DOI:
10.1016/j.wneu.2019.05.253

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