Anterior Cranial Fossa Meningioma, Outcome of Surgery Using Different Surgical Approaches

Objective: The aim of the work is to review patterns of clinical presentation, radiological features, and outcome of surgical excision of anterior fossa meningioma patients treated at King Khalid University Hospital (KKUH), College of Medicine, King Saud University.

Patients and Methods: Three hundred consecutive meningioma patients were treated at KKUH between 1990 and December 2010. Data of clinical presentation, radiological features, surgical procedure, and outcome of surgery were collected and analyzed.

Results: The patient population was 18% men and 82% women; the median age was 44 years. Forty percent of patients had olfactory groove, 32% had suprasellar, 20% had sphenoid wing, 6% had cranio-orbital, and 2% had multiple meningiomas. The tumor was <3 cm in 12%, 3–5 cm in 58%, and >5 cm in 30% of patients. Pterional approach was used in 52%, bifrontal approach in 32%, supraorbital approach in 6%, and combined approaches in 10% of patients. Total resection (Simpson I) was achieved in 74% of patients. Postoperative complications included CSF leak in two patients, severe brain swelling in two patients, infection in two patients, postoperative seizures in two patients, loss of vision two patients, visual deterioration in two patients, diabetes insipidus in two patients, EDH in one patient, and DVT in one patient. Follow-up period ranged from 6 months to 10 years (mean, 43 months), the outcome was 71% improved, 12% the same, 12% deteriorated, and 2% died. Tumor recurrence was seen in 10% of patients.

Conclusion: Surgical approach is tailored to tumor's size, location, and extension. Combined with microsurgical cranial base techniques, it allows complete removal with excellent neurosurgical outcome, minimal permanent morbidity, and low recurrence rates.