Surgery for Clinoidal Meningiomas: Case Series and Meta-Analysis of Outcomes and Complications.

Details

Serval ID
serval:BIB_3EF21E15E1F7
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Surgery for Clinoidal Meningiomas: Case Series and Meta-Analysis of Outcomes and Complications.
Journal
World neurosurgery
Author(s)
Giammattei L., Starnoni D., Levivier M., Messerer M., Daniel R.T.
ISSN
1878-8769 (Electronic)
ISSN-L
1878-8750
Publication state
Published
Issued date
09/2019
Peer-reviewed
Oui
Volume
129
Pages
e700-e717
Language
english
Notes
Publication types: Journal Article ; Meta-Analysis
Publication Status: ppublish
Abstract
Clinoidal meningiomas present specific characteristics related to their peculiar site of anatomic origin. Clinical series focusing on pure clinoidal meningiomas are not numerous. We performed a systematic review and meta-analysis, including our own case series, of the available literature to better identify the specific features of these tumors.
A systematic review and meta-analysis were performed for surgically treated pure clinoidal meningiomas using PubMed, Cochrane, and Embase databases. A retrospective review of a cohort of 18 consecutive patients treated between 2010 and 2018 in our department was also included in this meta-analysis.
A total of 1208 patients were included in the analysis. With a weighted mean follow-up of 48.1 months, the pooled rate of gross total resection was 64.2% (95% confidence interval [CI], 57.3%-71.0%) in the overall population, 11.8% (95% CI, 2.4%-21.1%) in the Al-Mefty I subgroup, 92.6% (95% CI, 88.9%-96.3%) in the Al-Mefty II subgroup, and 84.2% (95% CI, 70.8%-97.6%) in the Al-Mefty III subgroup. Overall visual improvement after treatment was found in 48% (95% CI, 38.6%-57.4%) of patients with a pooled deterioration rate of 4.5% (95% CI, 3%-6%). Pooled overall recurrence was observed in 8.9% of patients (95% CI, 6.0%-11.8%) and mortality occurred in 1.2% (95% CI, 0.6%-1.8%).
The rate of gross total resection is proportional to the dural origin of these tumors, which is intimately related to critical neurovascular structures. Complementary radiosurgery could represent a valid treatment strategy. Postoperative visual improvement remains less satisfying compared with other suprasellar meningiomas. The introduction of skull-base techniques, such as extradural anterior clinoidectomy, has enabled improvements in visual outcome without any increase in approach-related morbidity.
Keywords
Adult, Aged, Female, Humans, Male, Meningeal Neoplasms/pathology, Meningeal Neoplasms/surgery, Meningioma/pathology, Meningioma/surgery, Middle Aged, Neurosurgical Procedures/methods, Postoperative Period, Retrospective Studies, Sphenoid Bone/pathology, Sphenoid Bone/surgery, Treatment Outcome, Anterior clinoid process, Clinoidal meningiomas, Extradural anterior clinoidectomy, Skull base
Pubmed
Web of science
Create date
24/06/2019 8:34
Last modification date
24/01/2020 7:19
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