Microsurgical Management and Clinical Outcome by Meningiomas of Central Region Skull Base

• Main Authors: Remenez, V., Terzis, A. J. A., Weber, F.
• Format: Conference Proceeding
• Language: English
• ISSN: 1531-5010; 1532-0065
• DOI: 10.1055/s-2011-1274274

Introduction: Surgical treatment of skull base meningiomas is difficult and interesting. Some regions of the skull base are especially difficult to access because of the anatomy and special morphology of the tumor. Surgical procedures in this region are often characterized by a higher complication and residual rate. Our study is a retrospective and prospective analysis of the results of meningeoma surgery in the central region of the skull base, which depends on the extension of the resection and the localization and pathomorphology of the tumor. Materials and Methods: The study is based on clinical data obtained in the Department for Neurosurgery of the Cologne-Merheim Hospital. We included data for 122 patients who were treated from 1998 to 2008. In 88 cases, the meningiomas were located in the pre- and parasellar (72%), and in 34 cases from the dorsum sella to the porus acusticus internus (27.9%). Criteria of observation were neurological examinations and pre- and postoperative MRI scans. Results: The median age of the patients was 59.9 years, with 73.8% female and 26.2% male. In 88 cases of meningiomas in the pre- and parasellar region, a pterional approach, either frontolateral or subtemporal, was chosen for surgery. The most common approach in posterior fossa was the retrosigmoidal approach. The degree of resection was evaluated using the well-known Simpson scale. In 101 cases, we found a resection classified as Simpson 1/2, 4 cases were classified as Simpson 3, and 16 cases were classified as Simpson 4, leaving 2 cases in which only a biopsy was performed. Concerning early postoperative complications, we had six cases of intracerebral bleedings and brain edema in four cases. Twenty-three patients showed new neural deficits. In 33 cases, we found a recurrent or progressive tumor postoperatively. One of the recurrent/progressive tumors showed a histopathological upgrading when resected again. Conclusion: Surgery of central skull base meningiomas is difficult to resect completely, particularly due to involvement of cranial nerves and vessels. These highly depend on the anatomical position and the morphological structure of the tumor, with both aspects influencing the technical possibility of a total or nearly total resection. Skull base meningiomas should be controlled closely, but a recurrence of the tumor is not considered likely in every case.