Microsurgical Treatment Of Meningiomas In The Central Region Of Skull Base

The meningiomas of the central skull base include the innersphenoid ridge meningiomas, tubereulum sellae meningiomas,anterior process meningiomas, diaphragm sellae meningiomas,cavernous sinus meningiomas, petrous apex and clival meningiomas.The operations are complex and the postoperative complications aremore because the deep situation, the complicated anatomy and theinvolved cranial nerves and blood vessels. It is a neurosurgicalproblem in the operations involving the central region of the skullbase. 74 patients were hospitalized during 2002.1-2005.4 withmeningiomas of the central region of the skull base. All patientsunderwent the microsurgical resections.Of the patients, there were 31 men and 43 women. The mean ageis 46 years (from 13 to 76 years). All cases underwent MR imaging.Of these meningiomas, there were 35 inner sphenoid ridge andtubereulum sellae meningiomas, 19 diaphragm sellae and tubereulumsellae meningiomas, 9 parasellae and cavernous sinus meningiomas,11 petrous apex and clival meningiomas.According to the situations and directions of tumor growth, thesurgical technique adopted disubfrontal approach, subtemporalapprpach, pterional approach, subtemporal-anterior sigmoidalapproach and suboccipito-retrosigmoidal approach. For the innersphenoid ridge meningiomas, frontal-temporal approach which isaround the pterion is adopted, but if the tumor is a small one,subfrontal approach is receivable. For tubereulum sellae meningiomas,according to the position and the direction of growth, differentsubfrontal approach is adopted, in which if tumors is huge,disubfrontal-pterional approach is often adopted. For cavernous sinusmeningiomas, pterional approach is adopted.For petrous apex andclival meningiomas, subtemporal approach, subtemporal-anteriorsigmoidal approach and suboccipito-retrosigmoidal appr-oach arechosen. 59 patients underwent gross total tumor resection, the rates are asfollows: 89% (17/19) in diaphragm sellae meningiomas, 86% (30/35)in anterior process meningiomas and the inner sphenoid ridgemeningiomas, 64% (7/11) in petroclival meningiomas and 55% (5/9)in cavernous sinus meningiomas. 15 patients underwent subtotaltumor resection, there were postoperative deaths for 2 patients (onecase involved acute renal failure, the other suffered pulmonaryinfection). Postoperative morbidity consisted of oculomotor nervepalsies for 2 patients, intracranial haemorrhage for 1 patient whichresolved with the second operation, cerebrospinal fluid leak for 1patient, meningitis for 1 patient. The rate of serious postoperativemorbidity is 11%. The mean follow-up period was from 6 months to 2years. 5 patient experienced tumor recurrence after subtotal tumorremoval. By the management of microsurgical technique, the therapy ofmeningiomas of the central skull base is satisfying. The conclusionsare as follows:...