Al-Mefty’s Meningiomas: Medicine & Health Science Books @ Al-Mefty’s Meningiomas Second Edition. Franco DeMonte, MD, FRCSC, FACS Professor of Neurosurgery and Head and Neck Surgery Mary. Al-Mefty O(1). Author information: (1)Department of Neurosurgery, University of Mississippi Medical Center, Jackson. Anterior clinoidal meningiomas are.

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To avoid injury to encased cerebral vessels, most surgeons are content with subtotal removal. The Role of Radiation Therapy The role of radiation therapy cannot be left unaddressed in a discussion of clinoidal meningiomas in which subtotal removal or recurrence are prominent features. The carotid, middle cerebral, and anterior cerebral arteries, as well as the optic apparatus, were all intimately involved with the tumor, being displaced, adherent, or totally engulfed.

This is an excellent book and a needed update. One patient developed delayed postoperative vasospasm 7 days postoperatively, which was confirmed by angiography, with a deteriorating ischemic neurological condition and eventual death 4 months later.

Four patients had previously undergone surgery on their tumors. Preservation of the superficial temporal artery is important since the artery may be needed for extracranial-intracranial EC-IC anastomosis.

Arachnoidal cleavage is present and careful dissection under the microscope is successful. I agree to the use and processing of my personal information for this purpose. One other patient had a pulmonary embolism.

Clinoidal meningiomas in: Journal of Neurosurgery Volume 73 Issue 6 Year

Particular attention is paid to spare the artery of Heubner and the vital branches of the striatum. An arachnoid kefty of the carotid cistern separates the tumor from the adventitia, rendering dissection possible. When this membrane was absent Group I in our classificationdissection was impossible; none of the tumors was removed totally and the outcome was a disappointment.


Hence, our classification has a deep impact on surgical decision-making and outcome. Lateral carotid arteriogram demonstrating narrowing of the carotid and middle cerebral arteries by the encasing tumor. Recurrence with eventual death occurred in five patients. Olivecrona 41 reported no recurrences in 26 surviving patients after complete removal of their medial ridge meningiomas, with a postoperative follow-up period of up to 25 years.

Clinoidal meningiomas

Preoperative computerized tomography appearance. The third patient showed some recovery of extraocular movement and received radiation therapy, showing no changes on an MR image 24 months later.

Although meningiomas of the anterior clinoid invade the cavernous sinus, there exist meningiomas that are strictly intracavernous, originating from within the cavernous sinus.

The second patient had postoperative hemiplegia and was treated for pulmonary embolism.

Clinoidal meningiomas.

Artist’s drawing of a Group Menimgiomas meningioma. Optic Nerve Dissection The optic nerves in these tumors are displaced in several different ways.

Elevation of the frontal lobe should be minimal — a distance of 1.

The scalp incision is begun 1 cm anterior to the tragus, proceeding in a curvilinear fashion behind the hairline to the level of the superior temporal line on the opposite side. The expert authors then provide detailed descriptions of state-of-the-art surgical approaches listed by anatomical site and special operative considerations for intracranial meningiomas.

A Group I meningioma. More recently, this was accomplished by exposing the intrapetrous segment of the carotid artery. There was only one asymptomatic recurrence which was observed to be without change on a CT scan 3 years later in the one Group II patient with subtotal removal. Particular attention is paid to preserve the inferior group of arteries, which are the sole blood supply to the decussating fibers in the central chiasm.


This book is organized into 11 sections with forty-four chapters. It also assures removal of the involved bone at the insertion and prepares for exposure of the internal carotid upon entry to the cavernous sinus. Artist’s drawing showing the tumor originating in the optic foramen. Despite total encasement of these vessels, a thickened arachnoid membrane separated the tumor from the adventitia in Group II tumors. The arachnoid membrane is present between the vessels and tumor but may be absent between the optic nerve and the tumor Figs.

Our experience with intraoperative anatomical observation led us to distinguish three categories of this tumor Groups I, II, and IIIeach with a marked influence on the surgical difficulties, ability to achieve total removal, and outcome.

Prior to high-resolution CT and MR imaging, radiological studies were frequently normal and the tumor was usually found upon exploration for unexplained visual loss. Overall, the references for every chapter are up-to-date and include recent articles from the modern imaging era, up to Discussion Distinguishing Clinoidal Meningiomas To subclassify anterior clinoidal meningiomas into three groups may be surprising since many authors find it difficult to distinguish clinoidal meningiomas from those with more lateral attachment on the sphenoid ridge, and prefer the notion of wide or small attachment.