Treatment outcomes after surgical resection of midline anterior skull base meningiomas at a single center |
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| Authors: | Ho-Young Park Ho Jun Seol Do-Hyun Nam Jung-Il Lee Doo-Sik Kong Jong Hyun Kim Kwan Park |
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| Affiliation: | 1. Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan;2. Mechanical Engineering Research Laboratory, Hitachi Ltd., Tsuchiura, Japan;1. Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Medical College PO, Trivandrum 695011, India;2. Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, India;1. Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, AZ, USA;2. Division of Neurological Surgery, University of São Paulo, São Paulo, Brazil;1. Department of Neurology, College of Medicine, Chung-Ang University, Heukseok-dong, Dongjak-gu, Seoul 156-755, South Korea;2. Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, South Korea;3. Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada;4. Department of Neurology, Seoul Medical Center, Seoul, South Korea;5. Department of Anatomy and Cell Biology, Chung-Ang University College of Medicine, Seoul, South Korea;6. Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, South Korea;1. Department of Neurosurgery, Dr. Achanta Lakshmipathi Neurosurgical Centre, Post Graduate Institute of Neurological Surgery, VHS Medical Centre, Taramani, TTTI Post, Chennai 600113, India;2. Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India |
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| Abstract: | Meningiomas of the midline anterior skull base (ASB) typically grow around the optic chiasm. These tumors can displace or adhere to the optic apparatus, resulting in visual abnormalities. For this reason, in most studies of surgically resected meningiomas, only surgical and visual outcomes have been evaluated. However, in this study, we assessed overall clinical outcomes and the effects of different surgical approaches on outcomes. Clinical data for 126 patients who were treated surgically for midline ASB meningiomas between 1994 and 2009 were collected and reviewed retrospectively. The mean follow-up duration was 39 months (range: 0.5–146 months). Most procedures were performed via a pterional approach and did not require an aggressive skull base approach. Clinical outcomes were evaluated using our own criteria, and potential predictive factors for visual and clinical outcomes were tested statistically. The tumor control rate was 83% (105/126). Immediate postoperative visual status and optic canal involvement were correlated with visual outcome. Of the patients who ultimately had improved visual status, only six were originally categorized as having severe visual impairment (all were only able to count fingers). In terms of clinical outcome, 41 patients were classified as “excellent”, 32 as “good”, 29 as “fair”, and 20 as “poor”. A symptom duration of less than six months, less severe preoperative visual symptoms of the affected eye, and the extent of resection were all correlated with improved clinical outcome. Involvement of the optic canal, adherence of the tumor to the optic nerve, and major arterial encasement by the tumor were associated with poor clinical outcome. We recommend that in patients with unilateral severe visual impairment, the focus should be on improving visual function in the contralateral eye. Preoperative and postoperative evaluation of several variables allows for the prediction of clinical and visual outcomes. |
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