Clinoidal Meningioma with Cavernous Sinus Invasion

Area of Science:

• Neurosurgery
• Skull Base Surgery
• Ophthalmology

Background:

• Clinoidal meningiomas are rare tumors that can cause significant visual impairment.
• Invasion of the cavernous sinus and internal carotid artery (ICA) presents surgical challenges.

Purpose of the Study:

• To describe a cranio-orbital surgical technique for large clinoidal meningiomas.
• To highlight methods for safe tumor resection and neurovascular structure preservation.

Main Methods:

• A 49-year-old female with headache and visual loss underwent MRI, revealing a large right clinoidal meningioma.
• A cranio-orbital approach was employed, involving extradural and intradural removal of the anterior clinoid process and optic strut.
• Techniques included retractorless dissection, sharp dissection, and intraoperative neurophysiological monitoring.

Main Results:

• Complete tumor removal was achieved using the described cranio-orbital approach.
• The surgical technique allowed for safe dissection of the internal carotid artery (ICA) and cavernous sinus.
• Postoperative recovery of cranial nerve function is possible even after surgical manipulation.

Conclusions:

• The cranio-orbital approach is effective for resecting large clinoidal meningiomas involving the cavernous sinus and ICA.
• Careful surgical technique, including neurophysiological monitoring, is crucial for minimizing cranial nerve injury.
• Postoperative recovery of neurological deficits is a potential outcome.