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Suprasellar meningiomas: Overlooked diagnosis in the beginning
S236
Tumours of the eNS- Meningiomas
I p-s-s8SI Surgical management of meningiomas of the cavernous sinus: A review of 31 patients J.J. Acebes, J. Cabiol, L. Lopez-Obarrio, F. Isamat. Ciutat SanitariaI
Universitaria De Bel/vitge, Universityof Barcelona, Barcelona, Spain It is sometimes difficult 10 define the precise origin of some of the meningiomas in the region of the cavernous sinus, particularly so if the tumors are large. We have included in this series the pure intracavernous meningiomas, as well as, the juxtacavemous ones with an obvious invasion of the sinus, a subgroup with particular operative difficulties. This is a review of 31 meningiomas of the cavernous sinus surgically treated within the last 7 years, since the time we adopted the following technique. All the patients were operated using the fronto-temporal or the fronto-orbital approaches with zygomatic or orbito-zygomatic osteotomies. In some very large tumors the above was combined with a retromastoid craniotomy when so needed. The purpose of this review is to evaluate possible factors that may foresee the acceptable extent of resection and the outcome of cranial nerves function. Total resection was obtained in 14 of the 31 cases. There was no perioperative mortality. The carotid artery was encased by the tumor in 16 patients, and in only one of these cases the removal was considered to be complete. The preoperative involvement of the cranial nerves (CN) was as follow: CN II 13 patients , CN 11120, CN IV 10, CN V 11, CN V112. On the postoperative outcome the figures changed to: CN II 8, CN III 12, CN IV 5, CN V 5, CN VI 6. Most of these postoperative CN deficits were those of unrecovered/worsened preoperative involvements, though some others were newly created. Three patients had postoperative hemiparesis-plegia, but in 3 with preoperative motor deficits these subsided after surgery. It appears from this analysis that: 1.- Radical surgery should be the aim for tumors where the carotid artery is not encased; 2.- A negative outcome of CN function is related to the invasion of the cavernous sinus rather than to the size of the tumor; 3.- Invasive meningiomas surgery should be that of tumoral cytoreduction followed by Radiosurgery.
IP-S-S86!
Supras~lIa~ meningiomas: Overlooked diagnosis in thebegmnmg
M. .Jokovic, V. Antunovi6, M. Jani6ijevi6, D. Radulovic, Institutefor
Neurosurgery, Clinical Centre of Serbia, Belgrade, Yugoslavia
It is not rare for suprasellar masses to be misdiagnosed and treated by endocrinologist or ophthalmologist. We analyzed all supersellar meningiomas operated at our Institute during a 2 years period, excluding meningiomas of presellar region with suprasellar propagation. Suprasellar meningiomas numbered 15, 12% of all suprasellar tumors operated in that period. Of all 119 suprasellar tumors, 18 (15.1%) were meningioma. As usual, there was female predominance (89% -16 patients), mean 48 years old. The dominant symptoms were: visual problems, headache, endocrine problems, mental disorders. Three patients were treated as optic neuritis for more than 1 year, two as endocrine disorders and one was having psychological treatment, the rest were seen by neuroopthalmologist and sent to us. Total removal was achieved in 14, subtotal in 4 patients. There was no operative mortality. All patients were discharged from hospital in 9 days (15 in excellent condition, 2 transferred to endocrinologic department because of insipid diabetes, 1 had worsening of visual function after 24 h). Degree of visual damage is in correlation with duration of symptoms, meaning that early diagnosis and microsurgical operative techniques is the most important in treatment of suprasellar meningiomas.
Thursday, 10 July 1997
using the microneurosurgicaltechnique, whereas in 13% subtotal tumor resection was performed. Complete recovery of vision functions was recorded in 57%, unchanged finding in 30% and exacerebation in 13% of the patients operated on for removal 01 meningioma of the tuberculum sellae.
I P-S-S88I Visual outcome of planum sphenoidale and tuberculum sellaemeningiomas Teiii Uede, Masafumi Ohtaki, Sumiyoshi Tanabe, Kazuo Hash!. Department of
Neurosurgery, Sapporo MedicalUniversity, School of Medicine, Sapporo, Japan The visual outcome after the operation has been unacceptable in the planum sphenoidale and tuberculum sellae meningiomas. This paper discusses the strategy to secure the visual acuity in operation. Twelve cases are summarized. In six midline symmetrical meningiomas, the tumor compressed the nerves at the portion of optic chiasm, causing a typical bitemporal hemianopsia. Four large tumors were resected by the frontobasal interhemispheric approach to minimize the intraoperative damage to optic chiasm, and two small ones were removed by the pterional approach. Visual deficits recovered immediately after operations in all cases. Six meningiomas were attached to the lateral part of the planum sphenoidale or tuberculum sella. Although size was relatively small in all cases, ipsilateral severe visual loss by direct compression of the optic nerve was observed in five cases. The tumor extended into the optic canal in three cases on MRI. The ipsilateral pterional approach was selected in lour cases, the contralateral pterional approach in one case, and the frontobasal interhemispheric approach in one case, respectively. In three recent cases, we removed the anterior clinoid process and opened the optic canal before surgical manipulation of the tumor to avoid additional nerve damage. Visual symptoms were improved in all cases except one. Although the planum sphenoidale and tuberculum sellae meningiomas are still troublesome, appropriate preoperative management would allow us to expect a excellent visual outcome. Especially, selection of the surgical approach should be based on the anatomical analysis of the nerve displacement.
I P-S-S89I
Meningiomas of the peritorcular region: Surgical experience with two cases
F. Biroli, A. Signorelli, F. Degonda, C. Griffin!. NeurosurgicalDepartment, OspedaliRiuniti Bergamo, Italy
Introduction: Peritorcular Region Meningiomas represent a serious problem, since the infiltration of the venous sinuses wall often makes the complete removal risky or even impossible. It's still under discussion whether to remove them completely, with a heavy threat for the venous sinus flow, or leave a little fragment and check it periodically. Methods: Within a series of 100 meningiomas operated in our Department in the last 3 years (Sept. '93-Sept. '96), 9 were of the posterior falx, 7 of the posterior fossa, 5 tentorial and 2 of the peritorcutar region. Among the peritorcular ones, the first one arose from the tentorium, secondarily compressing the torcula, and the second one was of the sagittal transverse sinus junction. In diagnostic studies the venous flow was partially reduced, but still conserved. The first one was completely removed; the second one subtotally resected, leaving a small fragment which infiltrated the sinus wall. Results: After one year, patients only showed a little visual loss. No residual parts of tumour were visible at RMI. Only a small dural thickening was detected. Venous flow was normal. Conclusions and Discussions: Despite controversies, we preferred not to take on the risk of a venous thrombosis resulting from a complete removal. Up till now we prefer to check the patient with periodical MRI and, in the event of tumoural regrowth, use an adjuvant treatment.
I P-S-S87! Meningiomas of the tuberculum sellae 1 , V. Beros 1 , M. Ruzic 2. 1 Departmentof Neurosurgery, UniversityHospital Sisters of Mercy, Zagreb, Croatia, 2 Department of Anesthesiology, UniversityHospital Sisters of Mercy, Zagreb, Croatia
L. Negovetic 1 , V. Lupret 1 , V. Cerina
In the 1987-1995 period, 2676 patients with intracranial tumors were operated on at the Department of Neurosurgery, Sisters of Mercy University Hospital in Zagreb. There were 475 (18%) patients with meningiomas, 127, (26%) of them with the process localized at the base of the skull. In 69 patients with meningiomas of the tuberculum sellae, the initial clinical symptoms were visual deficits. The diagnosis of tumor was verified by CT and MRI. In most patients, preoperative cerebral panangiography was performed for proper neurosurgical planning. The frontotemporal pterional craniotomy was used in 65 patients. The frontotemporo-orbitozygomatic extradural approach was used in 4 patients. In 87% of the patients, the whole tumor was removed
I P-S-590 I Angiomatous meningioma of the middlecranial fossa
Binjie Zhang, Shugan Zhu, Hongwei He. Department of Neurosurgery, the
AffiliatedHospitalof Shandong, Medical University, Jinan, PR China Six cases of angiomatous meningioma of fossa media are reported. The early clinical manifestations of the tumors were due to the number 3, 4, 5, 6 cranial nerves involvement. The tumors often affect the structures nearby: sella turcica, cavernous sinus etc, which cause much bleeding during operation, so that total resection is difficult. Preoperative preparation, the surgical approach and techniques of operation are discussed.
Tumours of the eNS- Meningiomas
I p-s-s8SI Surgical management of meningiomas of the cavernous sinus: A review of 31 patients J.J. Acebes, J. Cabiol, L. Lopez-Obarrio, F. Isamat. Ciutat SanitariaI
Universitaria De Bel/vitge, Universityof Barcelona, Barcelona, Spain It is sometimes difficult 10 define the precise origin of some of the meningiomas in the region of the cavernous sinus, particularly so if the tumors are large. We have included in this series the pure intracavernous meningiomas, as well as, the juxtacavemous ones with an obvious invasion of the sinus, a subgroup with particular operative difficulties. This is a review of 31 meningiomas of the cavernous sinus surgically treated within the last 7 years, since the time we adopted the following technique. All the patients were operated using the fronto-temporal or the fronto-orbital approaches with zygomatic or orbito-zygomatic osteotomies. In some very large tumors the above was combined with a retromastoid craniotomy when so needed. The purpose of this review is to evaluate possible factors that may foresee the acceptable extent of resection and the outcome of cranial nerves function. Total resection was obtained in 14 of the 31 cases. There was no perioperative mortality. The carotid artery was encased by the tumor in 16 patients, and in only one of these cases the removal was considered to be complete. The preoperative involvement of the cranial nerves (CN) was as follow: CN II 13 patients , CN 11120, CN IV 10, CN V 11, CN V112. On the postoperative outcome the figures changed to: CN II 8, CN III 12, CN IV 5, CN V 5, CN VI 6. Most of these postoperative CN deficits were those of unrecovered/worsened preoperative involvements, though some others were newly created. Three patients had postoperative hemiparesis-plegia, but in 3 with preoperative motor deficits these subsided after surgery. It appears from this analysis that: 1.- Radical surgery should be the aim for tumors where the carotid artery is not encased; 2.- A negative outcome of CN function is related to the invasion of the cavernous sinus rather than to the size of the tumor; 3.- Invasive meningiomas surgery should be that of tumoral cytoreduction followed by Radiosurgery.
IP-S-S86!
Supras~lIa~ meningiomas: Overlooked diagnosis in thebegmnmg
M. .Jokovic, V. Antunovi6, M. Jani6ijevi6, D. Radulovic, Institutefor
Neurosurgery, Clinical Centre of Serbia, Belgrade, Yugoslavia
It is not rare for suprasellar masses to be misdiagnosed and treated by endocrinologist or ophthalmologist. We analyzed all supersellar meningiomas operated at our Institute during a 2 years period, excluding meningiomas of presellar region with suprasellar propagation. Suprasellar meningiomas numbered 15, 12% of all suprasellar tumors operated in that period. Of all 119 suprasellar tumors, 18 (15.1%) were meningioma. As usual, there was female predominance (89% -16 patients), mean 48 years old. The dominant symptoms were: visual problems, headache, endocrine problems, mental disorders. Three patients were treated as optic neuritis for more than 1 year, two as endocrine disorders and one was having psychological treatment, the rest were seen by neuroopthalmologist and sent to us. Total removal was achieved in 14, subtotal in 4 patients. There was no operative mortality. All patients were discharged from hospital in 9 days (15 in excellent condition, 2 transferred to endocrinologic department because of insipid diabetes, 1 had worsening of visual function after 24 h). Degree of visual damage is in correlation with duration of symptoms, meaning that early diagnosis and microsurgical operative techniques is the most important in treatment of suprasellar meningiomas.
Thursday, 10 July 1997
using the microneurosurgicaltechnique, whereas in 13% subtotal tumor resection was performed. Complete recovery of vision functions was recorded in 57%, unchanged finding in 30% and exacerebation in 13% of the patients operated on for removal 01 meningioma of the tuberculum sellae.
I P-S-S88I Visual outcome of planum sphenoidale and tuberculum sellaemeningiomas Teiii Uede, Masafumi Ohtaki, Sumiyoshi Tanabe, Kazuo Hash!. Department of
Neurosurgery, Sapporo MedicalUniversity, School of Medicine, Sapporo, Japan The visual outcome after the operation has been unacceptable in the planum sphenoidale and tuberculum sellae meningiomas. This paper discusses the strategy to secure the visual acuity in operation. Twelve cases are summarized. In six midline symmetrical meningiomas, the tumor compressed the nerves at the portion of optic chiasm, causing a typical bitemporal hemianopsia. Four large tumors were resected by the frontobasal interhemispheric approach to minimize the intraoperative damage to optic chiasm, and two small ones were removed by the pterional approach. Visual deficits recovered immediately after operations in all cases. Six meningiomas were attached to the lateral part of the planum sphenoidale or tuberculum sella. Although size was relatively small in all cases, ipsilateral severe visual loss by direct compression of the optic nerve was observed in five cases. The tumor extended into the optic canal in three cases on MRI. The ipsilateral pterional approach was selected in lour cases, the contralateral pterional approach in one case, and the frontobasal interhemispheric approach in one case, respectively. In three recent cases, we removed the anterior clinoid process and opened the optic canal before surgical manipulation of the tumor to avoid additional nerve damage. Visual symptoms were improved in all cases except one. Although the planum sphenoidale and tuberculum sellae meningiomas are still troublesome, appropriate preoperative management would allow us to expect a excellent visual outcome. Especially, selection of the surgical approach should be based on the anatomical analysis of the nerve displacement.
I P-S-S89I
Meningiomas of the peritorcular region: Surgical experience with two cases
F. Biroli, A. Signorelli, F. Degonda, C. Griffin!. NeurosurgicalDepartment, OspedaliRiuniti Bergamo, Italy
Introduction: Peritorcular Region Meningiomas represent a serious problem, since the infiltration of the venous sinuses wall often makes the complete removal risky or even impossible. It's still under discussion whether to remove them completely, with a heavy threat for the venous sinus flow, or leave a little fragment and check it periodically. Methods: Within a series of 100 meningiomas operated in our Department in the last 3 years (Sept. '93-Sept. '96), 9 were of the posterior falx, 7 of the posterior fossa, 5 tentorial and 2 of the peritorcutar region. Among the peritorcular ones, the first one arose from the tentorium, secondarily compressing the torcula, and the second one was of the sagittal transverse sinus junction. In diagnostic studies the venous flow was partially reduced, but still conserved. The first one was completely removed; the second one subtotally resected, leaving a small fragment which infiltrated the sinus wall. Results: After one year, patients only showed a little visual loss. No residual parts of tumour were visible at RMI. Only a small dural thickening was detected. Venous flow was normal. Conclusions and Discussions: Despite controversies, we preferred not to take on the risk of a venous thrombosis resulting from a complete removal. Up till now we prefer to check the patient with periodical MRI and, in the event of tumoural regrowth, use an adjuvant treatment.
I P-S-S87! Meningiomas of the tuberculum sellae 1 , V. Beros 1 , M. Ruzic 2. 1 Departmentof Neurosurgery, UniversityHospital Sisters of Mercy, Zagreb, Croatia, 2 Department of Anesthesiology, UniversityHospital Sisters of Mercy, Zagreb, Croatia
L. Negovetic 1 , V. Lupret 1 , V. Cerina
In the 1987-1995 period, 2676 patients with intracranial tumors were operated on at the Department of Neurosurgery, Sisters of Mercy University Hospital in Zagreb. There were 475 (18%) patients with meningiomas, 127, (26%) of them with the process localized at the base of the skull. In 69 patients with meningiomas of the tuberculum sellae, the initial clinical symptoms were visual deficits. The diagnosis of tumor was verified by CT and MRI. In most patients, preoperative cerebral panangiography was performed for proper neurosurgical planning. The frontotemporal pterional craniotomy was used in 65 patients. The frontotemporo-orbitozygomatic extradural approach was used in 4 patients. In 87% of the patients, the whole tumor was removed
I P-S-590 I Angiomatous meningioma of the middlecranial fossa
Binjie Zhang, Shugan Zhu, Hongwei He. Department of Neurosurgery, the
AffiliatedHospitalof Shandong, Medical University, Jinan, PR China Six cases of angiomatous meningioma of fossa media are reported. The early clinical manifestations of the tumors were due to the number 3, 4, 5, 6 cranial nerves involvement. The tumors often affect the structures nearby: sella turcica, cavernous sinus etc, which cause much bleeding during operation, so that total resection is difficult. Preoperative preparation, the surgical approach and techniques of operation are discussed.