Surgical Strategy and Clinical Outcome of Anterior and Middle Skull Base Meningiomas: 10 Years of Experience

Introduction: An extensive resection of meningiomas of the anterior and middle fossa still remains an operative challenge for neurosurgeons. Many surgical strategies for resection have been published, and a consensus of treatment has not been reached.

Materials and Methods: A retrospective study in 1 neurosurgical center in Germany was performed that included 140 patients treated from 1998 to 2007. The gender incidence and the age range were as follows: 91 men and 49 women whose ages ranged from 29 to 73 years (mean, 58.4 years). The clinical symptoms were headache and vertigo in 26 patients, cranial nerve impairment in 61 patients, convulsions in 15 patients and other symptoms in 38 patients. Magnetic resonance imaging was performed in all patients for diagnostic and surgical planning purposes. The patients were divided into 3 groups. The first group consisted of 28 patients presenting with meningiomas of the anterior fossa. The second group consisted of 83 patients presenting with meningiomas of the lateral middle skull base. The third group consisted of 29 patients presenting with meningiomas of the parasellar region. The pterional approach was chosen in 91.4% of the cases. The subfrontal and subtemporal surgical approach was used in 8.6% of cases. The postoperative follow-up period ranged from 1 month to 10 years.

Results: The degree of resection was evaluated using the well-known Simpson scale. In 112 cases, we found a resection classified as Simpson grade 1/2; in 27 cases, the resection was classified as Simpson grade 4. In the remaining 2 cases, a biopsy was performed, and the Simpson grade was 5.

Thirty-seven patients presented with new neurological deficits. In only 29 cases, a recurrent tumor was diagnosed.

Conclusion: Anterior and middle skull base meningiomas are difficult to resect completely, particularly due to involvement of vessels and nerves. Lesions of the skull base require a multivector planning approach for each patient with analysis of its anatomical variations and particularities.