Management of anterior clinoid meningiomas: Results and complications in 45 patients

nterior clinoid meningiomas (ACM) are frequently associated with failure of complete removal, recurrence and significant mortality and morbidity. We present our experience in 45 patients (pts). We use two skull base approaches for the management of these tumors: a) the cranio orbital zygomatic approach and b) the frontotemporal craniotomy followed by orbital osteotomy. The approach that we select depends on the size of the tumor. For large or giant tumors we use the craniorbital zygomatic approach and for small tumors we use the frontotemporal craniotomy with orbital osteotomy. Both techniques provide certain advantages: minimal brain retraction and shortening of the distance to the lesion. Total resection was achieved in 43 pts. In 2 pts the tumor was directly adhering to the adventitia of the carotid artery and for this reason the tumor was partially removed. There were no operative deaths in this series. Cerebrospinal fluid leak was the most common complication: 3 of 45 pts. Follow up time ranges from 1 to 8 years. There was no recurrence in our pts.