The Frontotemporal Epidural Approach Combined with Temporal Polectomy for Surgical Resection of Clinoidal Meningiomas
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- Category: Vol. 81, June 2013
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The Frontotemporal Epidural Approach Combined with Temporal Polectomy for Surgical Resection of Clinoidal Meningiomas,AHMED HEGAZY
Abstract
Objective: The objective of this study is to examine the effects of combining pealing of the outer layer of the lateral wall of the cavernous sinus with temporal pole resection on the safety, radicality and operative time when used for the surgical resection of clinoidal meningiomas.
Patients and Methods: 12 patients with clinoidal menin-giomas were operated at Cairo University Hospital in the period between January 2009 and December 2011 using this technique. Patients were followed-up for a period ranging between six months and one and a half years. The technique comprises of epidural devascularization followed by a temporal pole resection in all patients. All patients were prepared for by pass in case inadvertent rupture of the internal carotid artery would take place. This was followed by resection of the part of the tumor in the middle fossa all the way up to the free border of the tentorium. The Sylvian fissure was then split and neurovascular dissection was done provided there is a good arachnoid plane.
Results: The epidural approach resulted in a complete devascularization of the tumor in all except one case 8.3%. A good arachnoid plane was found in 75% of cases which allowed for a radical resection in these cases. No mortalities and no intraoperative carotid artery injury took place in the present series. 41% of cases developed a postoperative communicating hydrocephalus. However, only 16.6% required C.S.F diversion. 8.3% of cases developed diabetes incipidus, third cranial nerve paralysis or internal jugular vein throm-bosis.
Conclusion: The absence of intraoperative carotid artery or major neurovascular structure injury together with an incidence of radical resection comparable to other series using other approaches indicates that the present approach described, renders clinoidal meningioma resection safer and less time consuming.