title: Management of surgical clinoidal meningiomas.
abstract: OBJECTIVE
  Clinoidal meningiomas remain a major neurosurgical challenge. Surgery-related outcome has been less than desirable in the past, and little attention has been directed toward improving visual deficits. The authors advocate a skull base technique for the removal of these difficult tumors and describe its advantages in terms of improving extent of resection and enhancing overall outcome, particularly visual function.
  
  
  METHODS
  A retrospective analysis was performed on data obtained in 26 consecutive patients with clinoidal meningiomas (including one patient with hemangiopericytoma) who underwent resection between June 1995 and January 2003. In 24 cases the skull base procedure involved extradural anterior clinoidectomy, optic canal unroofing, and optic sheath opening; in two cases a standard pterional craniotomy was performed. Fourteen of the 26 patients suffered significant preoperative visual deficits. All patients underwent thorough pre- and postoperative ophthalmological evaluations. The follow-up period ranged from 3 to 91 months (mean 42.3 months). Total resection was achieved in 20 patients (77%), and the majority (76.9%) of patients with preoperative visual impairment experienced significant improvement.
  
  
  CONCLUSIONS
  With the use of the skull base technique, total resection and excellent visual outcome may be achieved with minimal morbidity in most patients with clinoidal meningiomas.
authors.affiliation: Brain Tumor Institute, Department of Neurosurgery and Cole Eye Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Tobias
authors.forename: Chang-Hyun
authors.initials: CH
authors.lastname: Kim
authors.forename: Gregory
authors.initials: G
authors.lastname: Kosmorsky
authors.forename: Joung H
authors.initials: JH
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008579:Meningioma / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies; D019291:Skull Base / Q000000981:diagnostic imaging / Q000601:surgery; D014786:Vision Disorders / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*