Eningiomas of the anterior cranial fossa: Review of 62 cases

The authors report 62 cases of meningiomas of the anterior cranial fossa treated surgically in Rambam Medical Center over the last 10 years. The most frequent origins of tumors were olfactory groove (26) and planum sphenoidale (13). Twelve tumors were from the tuberculum selle or both from tuberculum selle and planum sphenoidale. Other tumors were from anterior clinoid and mixed origins; 81%were over 4 cm in diameter. In 20% the surgeon reported an encasement of main blood vessel. The average pre-operative symptom duration was 22 months. Presenting symptoms were visual disturbances (61%), headache (53%), behavioral problems (42%), and anosmia (29%), as well as convulsion, endocrinological disturbances. Two patients presented with acute brain herniation. Operation was done through bifrontal craniotomy (68%) and subfrontal approach. Complete removal was performed in 70% and in 21% a residual of less then 1 cm2 was left. Partial removal was done in 11% because of vessel encasement. Mortality was 6.5%; 78% of the patients were discharged from hospital to their home in a good functional state; 15.5% needed rehabilitation. Post-operative complications were pneumonia (23%), intracerebral hematomas (6%), deep vein thrombosis (4.8%), CSF leak (1.6%), and meningitis (1.6%). In 2 patients radiosurgery was given for small residual tumor. The management of those difficult tumors and the surgical technique are discussed. Early diagnosis of these tumors and increasing the use of autonomie retractors during the resection are stressed.