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Minimally Invasive Thumb-sized Pterional Craniotomy for Surgical Clip Ligation of Unruptured Anterior Circulation Aneurysms
Published on: August 11, 2015
Mini-Pterional Craniotomy for Resection of Parasellar Meningiomas
Hurtis J Tullos1, Andrew K Conner1, Cordell M Baker1
1Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Background:
Surgical resection of parasellar meningiomas is a challenging operation that traditionally has been performed with a large pterional or orbitozygomatic craniotomy. In this study, we report patient outcomes and detail our surgical approach when resecting these tumors with a smaller, less invasive "mini-pterional" craniotomy.
Methods:
We performed a retrospective review on all patients undergoing a mini-pterional craniotomy for resection of parasellar meningiomas from 2012 to 2016. We describe the technical aspects of the mini-pterional craniotomy and provide the outcomes of patients who received an operation with this approach.
Results:
Twenty-four patients were treated with a mini-pterional craniotomy for resection of parasellar meningiomas. Median tumor volume was 6.2 cm3. Twenty-two of 24 (92%) patients had a World Health Organization grade I meningioma, and 2 of 24 (8%) patients had a World Health Organization grade II meningioma. Tumors were located at the medial sphenoid wing (60%), anterior clinoid (24%) and spheno-cavernous junction (12%). Nineteen of 24 (79%) patients had a Simpson Grade I resection and 5 of 24 (21%) a Simpson Grade IV resection. Median length of the operations was 242 minutes. Neurosurgical complications occurred in 2 patients who had a surgical-site infection and cerebrospinal fluid leak; one of these patients also developed postoperative hydrocephalus. In this series, no deaths, parenchymal contusions, or repeat operations occurred.
Conclusions:
The mini-pterional craniotomy can be used to resect parasellar meningiomas with good results and a low complication profile. This approach provides an efficacious method of resecting these tumors without sacrificing Simpson grade or patient safety.
Insights
The mini-pterional craniotomy offers a less invasive surgical option for resecting parasellar meningiomas. This approach yields good patient outcomes with a low complication rate, preserving tumor resection quality.
Area of Science:
- Neurosurgery
- Oncology
Background:
- Parasellar meningiomas traditionally require extensive pterional or orbitozygomatic craniotomies.
- Minimally invasive surgical techniques are sought to improve patient outcomes.
Purpose of the Study:
- To evaluate patient outcomes and surgical approach using a mini-pterional craniotomy for parasellar meningioma resection.
- To assess the efficacy and safety of this less invasive technique.
Main Methods:
- Retrospective review of patients who underwent mini-pterional craniotomy for parasellar meningiomas (2012-2016).
- Detailed description of the mini-pterional craniotomy technique.
- Analysis of patient outcomes including resection grade and complications.
Main Results:
- Twenty-four patients with parasellar meningiomas were treated.
- Most tumors were World Health Organization grade I (92%).
- High rates of Simpson Grade I resection (79%) were achieved with a low complication profile (surgical-site infection, CSF leak in 2 patients).
Conclusions:
- The mini-pterional craniotomy is an effective and safe approach for resecting parasellar meningiomas.
- This technique allows for good tumor resection without compromising patient safety.
