Clinoidal Meningiomas: Clinical and Functional Benefits of Minimally Invasive Approaches

 

Introduction: Extradural anterior clinoidectomy (eAC) via the minipterional craniotomy (MPT) approach (MPT + eAC) has been recently introduced into the neurosurgical armamentarium to improve access to anterior and middle fossa skull base structures using a minimally invasive approach (MIA). Despite its appealing, impact in clinical and functional outcomes are yet to be made. We aim to determine if MIA can be safely applied in the treatment of clinoidal meningiomas (CM) and whether this translates into a substantial benefit for the patient and/or the healthcare system.

Methods: A retrospective review of all ACP meningiomas operated by two surgeons on between January 2015 and July 2022 was conducted. Resection was typically performed via a frontotemporal (FT) or MPT craniotomy, followed by eAC, and intradural removal of the tumor. Through the analysis of several clinical and quality metrics, we compared outcomes of patients undergoing MPT + eAC as opposed those being treated through a more traditional approach.

Results: Eighteen individuals (3 males, median age: 67) were included in this study. GTR was achieved in all patients (100%). 8 patients underwent MPT + eAC, and 10 FT + eAC. MPT + eAC demonstrated to be associated to a shorter length of stay, time of operation, and functional independence at 6 months postoperatively. We did not observe differences in the preoperative tumor size/volume, improvement/worsening visual function, grade of resection, or infection rates.

Conclusions: Application of skull base techniques (middle fossa peeling, eAC) affords the successful implementation of MIA in the treatment of complex skull base meningiomas. In the case of CM, MPT renders a beneficial impact in patient's functional outcome

Publication History

Article published online:
01 February 2023

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