Surgical Resection of Clinoidal Meningiomas without Routine Use of Clinoidectomy

Area of Science:

• Neurosurgery
• Oncology
• Ophthalmology

Background:

• Meningiomas of the anterior clinoid process (ACP) pose significant surgical challenges due to their proximity to critical neurovascular structures.
• Routine anterior clinoidectomy is a common surgical step for ACP meningiomas, aiming to reduce recurrence and improve visual outcomes.
• The risks associated with anterior clinoidectomy are not fully understood, and its benefits require clearer delineation.

Purpose of the Study:

• To evaluate the outcomes of surgically managed anterior clinoid process meningiomas where anterior clinoidectomy was not routinely performed.
• To compare the efficacy and safety of a non-routine anterior clinoidectomy approach for ACP meningiomas against existing literature.

Main Methods:

• A retrospective review of 29 patients with anterior clinoid process meningiomas operated on between August 1997 and March 2019.
• Tumor resection was primarily performed via frontotemporal craniotomy with intradural removal.
• Anterior clinoidectomy was selectively employed only in cases of ACP hyperostosis causing optic nerve compression.

Main Results:

• Gross total resection was achieved in 75.9% of patients.
• Of 21 patients with visual deficits, 85.7% experienced improvement.
• Tumor recurrence occurred in 17.2% of patients, with a perioperative morbidity rate of 10.3% and no mortality.

Conclusions:

• Resection of anterior clinoid process meningiomas without routine anterior clinoidectomy is a viable surgical strategy.
• This approach achieves rates of gross total resection, recurrence, and visual improvement comparable to series employing routine clinoidectomy.
• Minimizing surgical risk through selective anterior clinoidectomy is achievable while maintaining favorable patient outcomes.