Anterior clinoidal meningiomas: functional outcome after microsurgical resection in a consecutive series of 106 patients

Object. In this study, the authors' goal was to analyze a series of patients treated microsurgically for an anterior clinoid process (ACP) meningioma in regard to long-term functional outcome. Methods. The authors retrospectively analyzed clinical data in a consecutive series of 106 patients who underwent microsurgical treatment for an ACP meningioma at 2 neurosurgical institutions between 1987 and 2005. The main presenting symptoms of the 84 female and 22 male patients (mean age 56 years) were visual impairment in 54% and headache in 28%. Physical examination revealed decreased visual acuity in 49% and a visual field deficit in 26%. Tumors were primarily resected via a pterional approach. Meningioma extensions invading the cavernous sinus, present in 29% of the patients, were not removed. Complete tumor resection (Simpson Grade I and II) was achieved in 59% of the cases. Results. Postoperatively, visual acuity improved in 40%, was unchanged in 46%, and deteriorated in 14%. A new oculomotor palsy was observed in 8 patients (8%). Clinical and MR imaging data were available in 95 patients for a mean postsurgical period of 6.9 years (1.5-18 years) and revealed tumor recurrence in 10% and tumor progression after subtotal resection in 38%. Clinical deterioration on long-term follow-up consisting primarily of ophthalmological deficits was observed in 14% of the cases. Conclusions. Acceptable functional results can be achieved after microsurgical resection of ACP meningiomas; however, long-term treatment remains challenging due to a high tumor recurrence and progression rate. (DOI: 10.3171/2009.3.17685)