Large sphenocavernous meningiomas: is there still a role for the intradural approach via the pterional-transsylvian route?
BACKGROUND
Large-sized sphenocavernous meningiomas represent a surgical challenge. Although the role of skull base techniques with combined extra- and intradural steps has been recently emphasized, pure intradural resection tactics via the pterional route constitute the traditional microsurgical approach for resection of such tumours.


METHODS
We report the application of the pterional-transsylvian approach in 13 patients with sphenocavernous meningiomas. This series is unique because it includes only patients with tumours exceeding 5 cm in their greatest dimension.


RESULTS
A gross total resection was accomplished in 10 patients (77%). Eight patients had a good outcome, one had a persistent mild hemiparesis, and one died. No recurrences occurred in this group. Three patients (23%) had subtotal resections owing to invasion of the cavernous sinus in one instance and encasement of the middle cerebral artery in the others. Two had a good outcome and one died. In these patients minimal asymptomatic tumour progression was seen 3 and 6 years after surgery. The overall surgical outcome was good in 10 patients (77%), fair in one, and death in two.


CONCLUSIONS
In our experience, large sphenocavernous meningiomas may be operated on adopting pure intradural resection tactics via the pterional-transsylvian route with rates of gross total removal and surgical complications related to brain retraction or vascular manipulation comparable to those of extensive skull base approaches. The traditional intradural pterional transsylvian approach continues to have a place in the treatment of these lesions.
Tomasello
F
F
Neurosurgical Clinic, Department of Neurosciences, Psychiatric and Anesthesiological Sciences University of Messina, Messina, Italy.
de Divitiis
O
O
Angileri
F F
FF
Salpietro
F M
FM
d'Avella
D
D
D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002426:Cavernous Sinus / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002535:Cerebral Aqueduct / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D004388:Dura Mater / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008866:Microsurgery / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013100:Sphenoid Bone / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*