Experience of resection large clinoidal meningiomas

Objective To investigate the clinical applied anatomy in the region of anterior clinoid process,and to improve the therapeutic efficacy of clinoidal tumors.Methods Twelve patients with large meningiomas located in clinoid were surgically treated via the extended anterior and middle fossa combined with epidural approach between January 1998 and August 2004.The surgical outcome and follow-up results were reviewed retrospectively.Supraorbital-poterional approach and cranioorbital zygomatic approach were used when tumors involved cavernous sinus.Anterior clinoid process was grinded with high-speed drilling.Supply of tumors were blocked extradurally.Tumors were resected intradurally.Results Of the 12 cases in large meningiomas located in clinoid,8 cases had total removal of tumors,3 patients had subtotal removal.Of the 10 patients with pre-operative severe visual deterioration,6 patients was markedly improved,one patient unchanged and one patient worsened post-operatively.No death was found in this group.Conclusions Using epidural approach for clinoidal meningiomas and grinding anterior clinoid process was advantageous to block tumors base blood supply and detach infraclinoidal tumors from internal carotid artery.Supraorbital-pterional approach could minimize brain retraction and was advantageous to expose superior pole of giant tumors.