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Cranial base surgical techniques for large sphenocavernous meningiomas: technical note.

J D Day1

  • 1House Neurological and Skull Base Surgery Associates, House Ear Clinic, St. Vincent's Hospital, Los Angeles, California, USA.

Neurosurgery
|March 17, 2000
PubMed
Summary

Cranial base surgery offers a safe and effective approach for large sphenoid ridge meningiomas, minimizing complications and avoiding preoperative embolization. This technique ensures good patient outcomes and functional recovery.

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Area of Science:

  • Neurosurgery
  • Surgical Oncology
  • Skull Base Surgery

Background:

  • Large sphenoid ridge meningiomas pose significant surgical challenges due to proximity to critical neurovascular structures.
  • Traditional surgical approaches often involve extensive brain retraction and risk to vital structures like the carotid artery and optic nerve.

Purpose of the Study:

  • To evaluate the efficacy and safety of cranial base surgical techniques for large sphenoid ridge meningiomas.
  • To minimize surgical morbidity by isolating major blood supply and protecting neurovascular elements.

Main Methods:

  • A retrospective review of six patients with large sphenoid ridge meningiomas treated with cranial base approaches.
  • Surgical strategies included frontotemporal, transzygomatic, and orbitozygomatic approaches with extensive bone removal.

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  • Tumors measured at least 5 cm and involved the cavernous sinus to varying degrees.

    • Main Results:

    • Gross total resection was achieved in four patients; subtotal resection in two due to tumor invasion.
    • No permanent cranial nerve deficits occurred; transient IIIrd nerve paresis was noted in two patients.
    • All six patients achieved good outcomes with independent activity within 3 months.

    Conclusions:

    • Contemporary cranial base surgical techniques are effective for managing large sphenoid ridge meningiomas.
    • These approaches allow for safe resection with low morbidity and reduce the need for preoperative embolization.
    • The anatomical basis for these successful surgical strategies is discussed.