2. 1938- Cushing and Eisenhardt published : The
Meningiomas, Their Classification, Regional
Behaviour, Life History, Surgical End Results.
Reported 313 pts operated for meningioma b/w 1903-
1932
10/10/16 2
3. There is today nothing
in the whole realm of
surgery more gratifyng
than the succeessful
removal of meningioma
with perfect functional
recovery
10/10/16 3
4. Cells of origin are believed to be arachnoid cap cells
Usually globular encapsulated tumor
Attached to the dura and compressing the underlying
brain
May invade the dural sinuses and dura and bone
May also occur as a falttened sheath of tumor taking
shape of a bone- meningioma en plaque
Intratumoral hemmorhage is rare and necrosis is absent
10/10/16 4
6. Who 2000 classified the meningioma as
under heading “ tumors of meninges” and
subheading “ tumors of meningothelial
cells”
10/10/16 6
7. First performed by Francesco Durante in 1895
Cushing operated on 28 cases mostly with large
olfactory groove meningiomas with mortality rates of
19 %
10/10/16 7SW / OLFACTORY GROOVE MENINGIOMA
8. Account for 8-13% for all meningiomas
May arise from anterior cranial fossa , cribiform palte or
crista galli or planum sphenoidale
May be symmetric around midline or may predominate
more on one side
Principally supplied by anterior ethmoidal, meningeal,
ophthalmic arteries
Large tumors may be involving anterior cerebral arteries
Olfactory nerve is usually splayed out by tumor and optic
chiasma may be pushed away
10/10/16 8SW / OLFACTORY GROOVE MENINGIOMA
10. Clinical feature
Slow growing tumors ,no female preponderance
unlike other meningiomas
These tumors can grow to large size before
developing the symptoms
Long standing headache(75%)
Seizures(12.5%)
Visual dysfunction(8.3%)
Anosmia seen in 85-90% but never a presenting
symptom
Neuropsychiatric menifestations like excitement ,
restlessness, indifference or apathy
10/10/16 10SW / OLFACTORY GROOVE MENINGIOMA
11. Anterior tumors can cause central scotoma/
papilloedema
Growth posteriorly can cause u/l blindness,
bitemporal hemianopia with optic atrophy
Foster kennedy syndrome( neither common nor
diagnostic, roughly noted in 8.3% of pts)
Eroding through cribiform plate or orbital wall may
cause proptosis.
10/10/16 11SW / OLFACTORY GROOVE MENINGIOMA
12. Neuroradiology
On CT scan there is a
well defined mass lesion
of uniform density with
hyperdensity on contrast
enhancement
Calcification may be
seen
Increased thickness of
bone due to hyperostosis
Bony detruction by
tumor
10/10/16 12SW / OLFACTORY GROOVE MENINGIOMA
15. ON T 1 images tumor is
usually isointense to
grey matter but may
have variable signals
On post contrast there
is intense signal noted in
tumors
Dural tail may be seen
10/10/16 15SW / OLFACTORY GROOVE MENINGIOMA
19. (A) 3D-CTA clearly demonstrated the relationship between the tumor and ACA.
(B) 3D-CTA clearly demonstrate the relationship between the tumor and ICA.
(C) 3D-CTA clearly demonstrated the relationship between the tumor, drain vein and
cranium.
(D) The observation during the operation was consistent with the 3D-CTA image. ACA,
anterior cerebral artery; ICA, internal carotid artery; 3D-CTA, 3-dimensional computed
tomographic angiograph
10/10/16 19SW / OLFACTORY GROOVE MENINGIOMA
20. AJNR Am J Neuroradiol. 2014
Preoperative embolization of intracranial meningiomas: efficacy,
technical considerations, and complications. Abstract
BACKGROUND AND PURPOSE:
Preoperative embolization for intracranial meningiomas offers potential advantages for
safer and more effective surgery. However, this treatment strategy has not been
examined in a large comparative series. The purpose of this study was to review our
experience using preoperative embolization to understand the efficacy, technical
considerations and complications of this technique.
MATERIALS AND METHODS:
We performed a retrospective review of patients undergoing intracranial meningioma resection at our institution (March 2001
to December 2012). Comparisons were made between embolized and nonembolized patients, including patient and tumor
characteristics, embolization method, operative blood loss, complications, and extent of resection. Logistic regression analyses
were used to identify factors predictive of operative blood loss and extent of resection.
RESULTS:
Preoperatively, 224 patients were referred for embolization, of which 177
received embolization. No complications were seen in 97.1%. There were no significant
differences in operative duration, extent of resection, or complications. Estimated blood
loss was higher in the embolized group (410 versus 315 mL, P=.0074), but history
of embolization was not a predictor of blood loss in multivariate analysis. Independent
predictors of blood loss included decreasing degree of tumor embolization (P=.037),
skull base location (P=.005), and male sex (P=.034). Embolization was not an
independent predictor of gross total resection.
CONCLUSIONS:
Preoperative embolization is a safe option for selected meningiomas. In our
series, embolization did not alter the operative duration, complications, or
degree of resection, but the degree of embolization was an independent
predictor of decreased operative blood loss.
10/10/16 20SW / OLFACTORY GROOVE MENINGIOMA
21. Clin Neuroradiol. 2014 .
Necrosis score, surgical time, and transfused blood volume in patients treated
with preoperative embolizationof intracranial meningiomas. Analysis of a single-
centre experience and a review of literature.
PURPOSE:
Several authors have demonstrated that preoperative embolization of meningiomas
reduces blood loss during surgery. However,preoperative embolization is still under
debate. Aim of this study is the retrospective evaluation of necrosis score, surgical time,
and transfused blood volume, on patients affected by intracranial meningiomas treated
with preoperative embolization before surgery, compared with a control group treated
only with surgery.
METHOD:
Twenty-eight patients with meningiomas were subjected to a preoperative embolization with polyvinyl alcohol (PVA). These patients were divided into two groups: group 1,
patients with preoperative embolization performed at least 7 days before surgery; and group 2, patients withpreoperative embolization performed less than 7 days before
surgery. A statistical evaluation was made by comparing necrosis score, surgical time, and transfused blood volume of these groups. Then, we compared these parameters also
with group 3, which included patients with surgically treated meningioma who did not undergo preoperative embolization.
RESULTS:
Surgery time and transfused blood volume were significantly lower in patients who had
been embolized at least 7 days before definitive surgery. Furthermore, large confluent
areas of necrosis were significantly more frequent in patients with a larger time span
between embolizationand surgery.
CONCLUSION:
Preoperative embolization with PVA in patients with intracranial meningiomas is safe
and effective, as it reduces the volume of transfused blood during surgical operation.
However, patients should undergo surgery at least 7 days after embolization, as a
shorter time interval has been correlated with a longer surgical time and a higher
transfused blood volume.
10/10/16 21SW / OLFACTORY GROOVE MENINGIOMA
22. Surgery
Goal should be always to perform total excision all
the dural attchment should be excised
The involved bones should also be excised
In all cases bicoronal incision used
Various surgical approaches are
1. Craniotomy
2.Unilateral subfrontal approach
3. pterional approach
4.Fronto orbital craniotomy
5.Subcranial approach
10/10/16 22SW / OLFACTORY GROOVE MENINGIOMA
25. Meticulous repair of cranial base is necessary to
prevent CSF leak
Extensive resection of all suspicious bone is necessary
Recurrence is common in late follow ups( 28%)
Causes of recurrences are direct tumor extension to
neural tissues and incomplete bony excision,
recurrence at the previous margins
10/10/16 25SW / OLFACTORY GROOVE MENINGIOMA
26. Complications
1. CSF leakage: folowing frontal sinus breach, meticulous
repair with vascularised graft be ubdertaken
2. Vascular injury: injury of ACA can result in post
operative ACA territory infarct, sacrifice of smaller br.
Such as frontopolar may be well tolerated
3. Seizures:” around 6% in reported series
4. Visual loss: usually due to rough handling of optic nerve
or chiasma or interference with vessels of chiasma. Finn
& Mount reported a 12% rate of visual loss.
5. Mortality: low in most series.. Ojemann had 1 death in
17 operated patients.
10/10/16 26SW / OLFACTORY GROOVE MENINGIOMA
27. Neurosurgery. 2009
Lateral supraorbital approach applied to olfactory groove meningiomas:
experience with 66 consecutive patients. Abstract
OBJECTIVE:
The lateral supraorbital approach for safely and completely removing olfactory groove meningiomas
was assessed.
METHODS:
Between September 1997 and June 2008, a total of 656 meningiomas were operated on by the senior author (JH) at
the Department of Neurosurgery, Helsinki University Central Hospital; 66 were olfactory meningiomas. We
retrospectively analyze the clinical data, radiological findings, surgical treatment, histology, and outcome of all the
olfactory groove meningioma patients and discuss the operative techniques used.
RESULTS:
Sixty-six patients were operated on by the lateral supraorbital approach. The median preoperative
Karnofsky Performance Scale score was 80 (range, 40-100). Three patients were redo cases in which
the primary operation had been performed elsewhere. Seemingly complete tumor removal was
achieved in 60 patients (91%); there was no surgical mortality. Postoperatively, 6 patients (9%) had
cerebrospinal fluid leakage, 5 (8%) had new visual deficits, 4 (6%) had wound infections, 4 (6%) had
cotton granulomas, and 1 (2%) had a postoperative hematoma. The median Karnofsky score at
discharge was 80 (range, 40-100). Six patients had recurrent tumors; 3 underwent reoperations after
an average of 21 months (range, 1-41 months); 1 was treated with radiosurgery, and 2 were only
followed. During the median follow-up time of 45 months (range, 2-128 months), there were 4
recurrences (6%) diagnosed on average 32 months (range, 17-59 months) after surgery.
CONCLUSION:
The lateral supraorbital approach can be used safely for olfactory groove meningiomas of all sizes
with no mortality and relatively low morbidity. Surgical results and tumor recurrence with this fast
and simple approach are similar to those obtained with more extensive, complex, and time-10/10/16 27SW / OLFACTORY GROOVE MENINGIOMA
28. Turk Neurosurg. 2016.
Results with Expanded Endonasal Resection of Skull Base Meningiomas
Technical Nuances and Approach Selection Based on an Early Experience.
Abstract
AIM:
Reconstruction technique advances have created renewed enthusiasm for the
expanded endonasal approach (EEA). However, as with any new technique, early experiences
inevitably lead to more selective use of these techniques. We reviewed our experience of the
expandedendonasal endoscopic approach for skull base meningiomas and place it in context of the
literature.
MATERIAL AND METHODS:
We performed retrospective review of all endonasal cases performed at our center for histologically
provenmeningioma. Tumor locations in 26 patients included the olfactory groove (n=9), tuberculum
sellae (n=7), optic nerve sheath (n=1), planum sphenoidale (n=2), clival (n=1) petroclival (n=3),
cavernous sinus (n=2) and extensive pan-basal meningioma (n=1).
RESULTS:
The median follow-up was 38.6 months. Excluding 3 patients with tumors found incidentally, pre-
operative symptoms improved in 14 of 23 (61%), were the same in 8 of 23 (35%) and worsened in one
of 23 patients (4%) at time of last follow-up. Of all 26 patients, 16 (62%) had complete macroscopic
resection of their tumor, 5 (19%) underwent at least 90% resection, and 5 (19%) underwent subtotal
resection. There were two neurological complications and one cerebrospinal fluid leak.
CONCLUSION:
This study presents outcomes of patients treated with endonasal endoscopic meningioma surgery.
We believe that very low rates of morbidity can be achieved in carefully selected patients, thus
avoiding brain manipulation.10/10/16 28SW / OLFACTORY GROOVE MENINGIOMA
29. World Neurosurg. 2014
Indications and limitations of the endoscopic endonasal approach for anterior cranial base
meningiomas. OBJECTIVE:
To describe the decision-making and the surgical strategy in the resection of anterior skullbase
meningiomas.
RESULTS:
Small and midsize olfactory groove, planum sphenoidale, and tuberculum sellae meningiomas
can be removed via an endonasalendoscopic approach, an alternative option to the transcranial
microsurgical approach. The choice of approach depends on tumor size and location,
involvement of important neurovascular structures, and, most importantly, the surgeon's
preference and experience. In my opinion, in most meningiomas, the endonasal approach has
no advantage compared with the transcranial approach. Disadvantages of
the endonasalapproach are the discomfort after surgery and the prolonged recovery phase
because of the nasal morbidity, which requires intensive nasal care. Compared with the
eyebrow approach, the trauma to the nasal cavity, paranasal sinuses, and skull base is greater,
and the risk of cerebrospinal fluid leak is higher.
CONCLUSION:
For most skull base meningiomas, I usually prefer the endoscope-assisted microsurgical
transcranial approach which combines the advantages of the operating microscope with the
advantages of the endoscope. The endonasal approach is beneficial for small tumors located
below or behind the chiasm.
10/10/16 29SW / OLFACTORY GROOVE MENINGIOMA
30. Skull base surgery. 2000
Presentation and Patterns of Late Recurrence of Olfactory Groove
Meningiomas Abstract
The objective of this article is to present the recurrence pattern of olfactory groove
meningiomas after surgical resection. Four patients, one female and three males, with
surgically resected olfactory groove meningiomas presented with tumor recurrence. All patients
underwent resection of an olfactory groove meningioma and later presented with recurrent
tumors. The mean age at initial diagnosis was 47 years. All presented initially with vision
changes, anosmia, memory dysfunction, and personality changes. Three patients had a
preoperative MRI scan. All patients had a craniotomy, with gross total resection achieved in
three, and 90% tumor removal achieved in the fourth. Involved dura was coagulated, but not
resected, in all cases. Three patients were followed with routine head CT scans postoperatively,
and none was followed with MRI scan. The mean time to recurrence was 6 years. Three
patients presented with recurrent visual deterioration, and one presented with symptoms of
nasal obstruction. Postoperative CT scans failed to document early tumor recurrence, whereas
MRI documented tumor recurrence in all patients. Tumor resection and optic nerve
decompression improved vision in two patients and stabilized vision in two. Complete
resection was not possible because of extensive bony involvement around the anterior clinoid
and inferior to the anterior cranial fossa in all cases. Evaluation of four patients with
recurrent growth of olfactory groove meningiomas showed the epicenter of recurrence to
be inferior to the anterior cranial fossa, with posterior extension involving the optic
canals, leading to visual deterioration. This location led to a delay in diagnosis in patients
who were followed only with routine CT scans. Initial surgical procedures should include
removal of involved dura and bone, and follow-up evaluation should include formal 10/10/16 30SW / OLFACTORY GROOVE MENINGIOMA
31. Neurosurgery. 2003
Recurrence of olfactory groove meningiomas.
Obeid F, Al-Mefty O.
Abstract
OBJECTIVE:
DESPITE APPARENT GROSS TOTAL RESECTION, OLFACTORY GROOVE MENINGIOMAS HAVE A HIGH
RATE OF LATE RECURRENCE (AVERAGE, 23%). IN THIS RETROSPECTIVE STUDY, WE CONFIRMED
THAT THE SITES OF THESE RECURRENCES ARE THE CRANIAL BASE AND PARANASAL SINUSES. WE
POSTULATED THAT THESE RECURRENCES STEM FROM CONSERVATIVE HANDLING OF THE
UNDERLYING INVADED BONE. THEREFORE, WE ANALYZED PATIENT OUTCOMES ACCORDING TO THE
RADICALITY OF SURGICAL RESECTION.
METHODS:
Fifteen consecutive patients with a diagnosis of olfactory groove meningioma were treated surgically between 1992 and 2001 (nine new cases, six
recurrent). Only patients with benign meningiomas were included; atypical and malignant meningiomas were excluded. Surgical resection included the
dura and drilling of the underlying bone and resection of involved mucosa. We reviewed each patient's clinical records, radiological studies, sites of
recurrence, grade of previous resection, and complications.
RESULTS:
Olfactory groove meningiomas invaded the underlying bone in 13 cases. All patients with recurrence had previously undergone a surgical resection
corresponding only to Simpson Grade 2, which does not include the removal of underlying invaded bone. The sites of recurrence were in the cranial base
or adjacent paranasal sinuses. The time to recurrence varied from 1 to 12 years (average, 7 yr; mean, 8 yr). Three patients had undergone one previous
resection, two had undergone two previous resections, and one had undergone four previous operations. The ethmoid sinus was involved in all cases of
recurrence, either with the sphenoid sinus or with an intracranial recurrence. Thirteen patients underwent complete resection of underlying bone and the
invaded paranasal sinuses, then reconstruction of the anterior fossa. No patient died. There were three instances of cerebrospinal fluid leakage (one
requiring operative repair), one case of delayed worsening vision after initial improvement, and two cases of transient cranial nerve palsy (Cranial
Nerves III and IV). There was no recurrence at follow-up (average, 3.7 yr; range, 1-7.3 yr).
CONCLUSION:
The cranial base and paranasal sinuses are sites of predilection for recurrence
of olfactory groove meningiomas. Recurrence is the result of a direct extension attributable to
incomplete resection of involved bone and regrowth at the edge of a previous surgical field. Extensive
resection of all suspicious underlying bone is a complement to radical removal of these lesions.
Reconstruction with a vascularized pericranial flap to prevent cerebrospinal fluid leakage is crucial.
10/10/16 31SW / OLFACTORY GROOVE MENINGIOMA
34. Definition
Meningiomas :arachnoid cap cells
SWM : bony crest formed by wings (lesser and greater) the sphenoid bone.
sphenoid ridge(lesser wing : internal 2/3 & greater wing its external 1/3)
10/10/16 34SW / OLFACTORY GROOVE MENINGIOMA
35. Comprise approx 14-20% of all meningiomas
Involve the anterior circulation and the anterior
visual pathways and optic nerve early
Higher morbidity, mortality and recurrence rates are
observed
Medial 1/3 spehnoid wing( SW) have highest rates of
recurrence in all meningiomas
10/10/16 35SW / OLFACTORY GROOVE MENINGIOMA
37. Two Main Tumor Types Have Been Described
1. Globoid Tumor Withy Nodular Shape
2. En Plaque Tumors
Nodular Type: Encapsulated That Displaces Or Encases
The Arteries And The Cranial Nerves. Has A Dural Site Of
Implantation That Has A Blood Supply Through It
En Plaque Variety: The Tumor Fills The Haversian Canals
And Infilterates Other Bones Such As Pterion, Orbital
Wall, Malar Bones, Zygomatic , Temporal Bones.
These Produce A Hyperostotic Reaction And Induces
Exophthalmos And Temporal Bowing
10/10/16 37SW / OLFACTORY GROOVE MENINGIOMA
38. Epidemiology
Race( Caucasians, Africans, African Americans, and
Asians)
Sex(Caucasians:75%women & 25% men.Africans show
an equal gender ratio).
Age(onset is 50 years increases thereafter)
Mortality(5years:87% & 10 years :58%)
10/10/16 38SW / OLFACTORY GROOVE MENINGIOMA
40. Histologic findings
According to the World Health Organization (WHO)
in 1993, :
Benign (grade I) 6.9%: do not invade the brain
parenchyma.
Atypical (grade II) 34.6%: mitosis & increased
nuclear-cytoplasmic ratio.
Malignant (grade III and IV) 72.7%: greater mitosis,
necrosis, and invasion of brain parenchyma.
10/10/16 40SW / OLFACTORY GROOVE MENINGIOMA
42. Clinical presentation
1. Inner 1/3 SW meningiomas
Progressive diminuation of vision with I/L nasal hemianopia
Superior temporal field defect
Later on I/L blidness
Foster Knennedy syndrome
In sphneocavernous type Abducens palsy is the first
menifestation
Total ophthalmoplegia with hypoesthesia in ophthalmic
division of nerve
Nakamura sbclassified it into
a) Tumors with CS involvement
b) Tumors without CS involvment
10/10/16 42SW / OLFACTORY GROOVE MENINGIOMA
43. Middle 1/3 or Alar meningiomas
1. Features of raised ICP
2.Headche, papilloedema
3. Anosmia, personality changes
4.Contralateral homonymous hemianopia
5.Visual and olfactory hallucinations
6.Contralateral facial palsy and hemiparesis
10/10/16 43SW / OLFACTORY GROOVE MENINGIOMA
44. Outer 1/3 or Pterional
meningiomas
En plaque varient presents with ptosis and chronic
palpebral edema
Skull deformity
Loss of visual acuity and blindness, diplopia,
epiphora, photophobia
Globoid type varient present with headche, seizures,
contralateral hemiparesis, features of raised ICP.
10/10/16 44SW / OLFACTORY GROOVE MENINGIOMA
52. MRI In SW meningiomas
Dural based intracranial extraaxial mass
Homogenous enhancement on post contrast imaging
En plaque meningiomas may be seen
Arterial encasement or displacement
ICA encasement commonly seen with tumor
involving CS
10/10/16 52SW / OLFACTORY GROOVE MENINGIOMA
60. Surgery
Indications:
size of the lesion >2.5cm
presence of signs or symptoms
patient’s condition
changes in the adjacent cerebral tissue (edema) on
imaging studies
surgeon’s experience.
10/10/16 60SW / OLFACTORY GROOVE MENINGIOMA
61. Goal of surgery
Radical Excision Of The Tumor
Resection Of The Lesion + The Dural Implant (2-cm
Margin) + All Hyperostotic Bone.
10/10/16 61SW / OLFACTORY GROOVE MENINGIOMA
63. Positioning
Supine Decubitus Position
The Head Fixed In A Three-pin Head Holder
Head Is Slightly Extension
Rotated Toward The Contralateral Side Of The
Tumor
Clinoidal Tumors (Between 30- 40 degree)
Alar And Pterional Lesions(between 40-50 degree)
10/10/16 63SW / OLFACTORY GROOVE MENINGIOMA
64. Skin incision
A Frontotemporal(pterional) Curvilinear
Starting At The Root Of The Zygomatic Arch, Just 5
Mm In Front Of The Tragus
Runs Vertically Upward
Once It Passes The Ear, It Is Curved Rostrally And
Superiorly Toward The Ipsilateral Frontal Region.
10/10/16 64SW / OLFACTORY GROOVE MENINGIOMA
65. Variation in skin incision
The midportion of incision can be extended
backward, especially in cases of pterional
meningiomas with large infiltration of the pterion.
If an orbitozygomatic (OZ) approach is required, it is
necessary to extend the incision vertically down to the
level of the ear lobe.
10/10/16 65SW / OLFACTORY GROOVE MENINGIOMA
66. Dissection of epicranial planes
superficial temporal artery preserved
a posterior branch may be coagulated
Dissection continues until the temporal fascia is
identified
Avoid wide separation between the temporal fascia
and the skin to avoid injury to the frontotemporal
branch of the facial nerve
10/10/16 66SW / OLFACTORY GROOVE MENINGIOMA
67. retrograde direction
two epicranial planes are created
skin and temporal fascia (fasciocutaneous flap)
temporal muscle alone (muscle flap)
10/10/16 67SW / OLFACTORY GROOVE MENINGIOMA
68. Craniotomy & tumor resection
anatomic variety of the meningioma
Pterional
Alar
Clinoidal
En-plaque
10/10/16 68SW / OLFACTORY GROOVE MENINGIOMA
69. Pterional
If hyperstosis:around the bone infiltration,bone flap
of around 5cm
If hyperstosis is absent:standard craniotomy
Section the tumor to elevate/remove the bone flap
Craneictomy:osseous tumor
10/10/16 69SW / OLFACTORY GROOVE MENINGIOMA
71. Alar
frontotemporal craniotomy
extradural resection of the lesser wing of the
sphenoid bone.
Bone removal is continued until complete exposure of
the superior orbital fissure
The dura mater is then opened following a curvilinear
frontotemporal incision, reflecting the dural flap
forward
10/10/16 71SW / OLFACTORY GROOVE MENINGIOMA
73. Clinoidal meningiomas
Al Mefty classification
1. Group 1: those encasing or attaching the ICA
adventitia, without definable plane between the
tumor and ICA
2.Group2: tumors with a separate arachnoid palne b/w
the tumor and ICA
3. Group 3 : tumors are actually optic nerve sheath or
optic foramen meningiomas not truly clinoidal.
10/10/16 73SW / OLFACTORY GROOVE MENINGIOMA
74. Formidable tumors to resect due to large size and
involvement of ICA and optic nerves 3rd
nerves
Grading is done to plan the surgical stretegies and
resectability and possible difficulties in dissecting the
ICA and optic nerves during surgery
Unilateral vision loss and headache with diplopia and
facial pain , proptosis are the menifestation
10/10/16 74SW / OLFACTORY GROOVE MENINGIOMA
75. Clinoidal
A Frontotemporal
Resection Of The Sphenoid Ridge
The Superior Orbital Fissure Is Also Completely
Opened
The Posterolateral Wall Of The Orbit Is Also
Removed In Case Of Orbital Part Of Tumor
Anterior Clinoidectomy:high Speed Drill+irrigation
Tumor Involving Optic Nerve:curvillenier Incision
10/10/16 75SW / OLFACTORY GROOVE MENINGIOMA
76. Cont..
wide splitting the sylvian fissure
Retractors are placed on the frontal and temporal
lobes
10/10/16 76SW / OLFACTORY GROOVE MENINGIOMA
79. En-plaque
It Is Easier To Expose The Entire Hyperostosis
Pterional Craniotomy Is Combined With An OZ
Osteotomy,particularly When The Lesion Extends
Into The Inferior Orbital Fissure, Infratemporal Fossa,
Or Orbit
10/10/16 79SW / OLFACTORY GROOVE MENINGIOMA
82. Reconstruction & closure
Resect A Free Dural Margin
Closure Of The Dura Mater Necessarily Implies
Application Of A Graft
Local Tissue: Aponeurotic Galea, Pericranium,or
Temporal Fascia
Distant Tissues Fascia lata Or Abdominal Fascia
Synthetic & Biologic Materials, But With A Slightly
Higher Risk Of Infection.
Watertight Closure Is Mandatory
10/10/16 82SW / OLFACTORY GROOVE MENINGIOMA
83. Cont…
reconstruction of the pterional defect:
Autologous materials : split calvarial bone graft or
ribs
synthetic materials : methylmethacrylate and
titanium
10/10/16 83SW / OLFACTORY GROOVE MENINGIOMA
84. Complications
Postoperative EDH: due To Wide Dural Detachment
CSF Leak
Seizures: If Grow Near Epileptogenic Areas
Cosmetic Problems : Inadequate Reconstruction
Infection : Prosthetic Material/sinus Opened
10/10/16 84SW / OLFACTORY GROOVE MENINGIOMA
85. Results
In general, the short- and midterm follow-up results
after SWM resection are excellent
In the majority of cases,gross total resection is
accomplished with minimal morbidity.
However, the critical point is in long-term follow-up
because of the high risk of recurrence, which is
inversely proportional to the degree of tumor
resection
10/10/16 85SW / OLFACTORY GROOVE MENINGIOMA
86. Medial sphenoid wing meningiomas: Experience with microsurgical resection over 5 years and a
review of literature
Satish Kumar Verma, Sumit Sinha, Dattaraj Parmanand Sawarkar, Pankaj Kumar
Singh, Deepak Gupta, P Sarat Chandra, Shashank Sharad Kale, Bhawani Shankar
Sharma
Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences,
New Delhi, India
Background: Medial sphenoid wing meningiomas are medially located tumors on the
sphenoid wing with attachment over the anterior clinoid process. They represent a
distinct entity. These medial sphenoid wing meningiomas present a more difficult
problem for the neurosurgeons because in a majority of cases, they involve the anterior
visual pathways and arteries of the anterior circulation and may invade the cavernous
sinus (CS). Higher morbidity, mortality and recurrence rates have been observed in these
tumors compared with meningiomas in other locations. The rate of recurrence for medial
sphenoid wing meningiomas is reported as being one of the highest amongst intracranial
meningiomas. Material and Methods: The authors retrospectively analyzed 78 consecutive
patients with the diagnosis of medial sphenoid wing meningioma who were operated in our
department from January 2008 to December 2012. Results: These patients, having a
meningioma of the medial sphenoid ridge, were divided into two types depending on the
involvement of CS. Diplopia, internal carotid artery encasement, and postoperative visual
deterioration were more common in Type 2 tumors. Similarly, extent of resection and
postoperative morbidity were greater in Type 2 patients. Conclusions: CS invasion confers an
added risk to the surgical morbidity and outcomes. However, with proper surgical
techniques, optimum outcomes can be achieved and overall surgical results at our center
are found to be comparable to that of the current literature.
10/10/16 86SW / OLFACTORY GROOVE MENINGIOMA
87. En plaque sphenoid wing meningiomas: recurrence factors and surgical strategy in a series of 71
patients.
Mirone G1
, Chibbaro S, Schiabello L, Tola S, George B.
Abstract
OBJECTIVE:
En plaque sphenoid wing meningiomas are complex tumors involving the sphenoid wing, the orbit,
and sometimes the cavernous sinus. Complete removal is difficult, so these tumors have high rates of
recurrence and postoperative morbidity. The authors report a series of 71 patients
with sphenoid wing meningiomas that were managed surgically.
METHODS:
The clinical records of 71 consecutive patients undergoing surgery for sphenoid wing meningiomas at
Lariboisière Hospital, Paris, were prospectively collected in a database during a 20-year period and
analyzed for presenting symptoms, surgical technique, clinical outcome, and follow-up.
RESULTS:
Among the 71 patients (mean age, 52. 7 years; range, 12-79 years), 62 were females and 9 were males. The
most typical symptoms recorded were proptosis in 61 patients (85.9%), visual impairment in 41 patients
(57.7%), and oculomotor paresis in 9 patients (12.7%). Complete removal was achieved in 59 patients
(83%). At 6 months of follow-up, magnetic resonance imaging scans revealed residual tumor in 12 patients
(9 in the cavernous sinus and 3 around the superior orbital fissure). Mean follow-up was 76.8 months
(range, 12-168 months). Tumor recurrence was recorded in 3 of 59 patients (5%) with total macroscopic
removal. Among the patients with subtotal resection, tumor progression was observed in 3 of 12 patients
(25%; 2 patients with grade III and 1 patient with grade IV resection). Mean time to recurrence was 43.3
months (range, 32-53 months).
CONCLUSION:
Surgical management of patients with sphenoid wing meningiomas cannot be uniform; it must be tailored
on a case-by-case basis. Successful resection requires extensive intra- and extradural surgery. We
recommend optic canal decompression in all patients to ameliorate and/or preserve visual function.10/10/16 87SW / OLFACTORY GROOVE MENINGIOMA
