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

Objective: To review patterns of clinical presentation, radiological features, and outcomes of surgical excision of anterior fossa meningioma.

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

Results: Of these patients, 18% were men, and 82% were women, and the median age was 44 years; 40% 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. The 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 three patients, visual deterioration in three patients, diabetes insipidus in two patients EDH in one patient, and DVT in one patient. The 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 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.