Clinoidal Meningiomas

Anterior clinoidal meningiomas (ACMs), also commonly referred to as medial sphenoidal wing meningiomas, arise from the meninges covering of the anterior clinoid process. The most common symptoms are visual loss and headache; other symptoms depend on tumor size and/or cavernous sinus extension. ACMs frequently encase the carotid artery and its branches, involve the optic nerve and cavernous sinus, thus constituting a surgical challenge and resulting in high surgical morbidity and recurrence rate. Microsurgery is the first-line treatment. We recommend the fronto-orbito-zygomatic approach with tailored clinoidectomy and unroofing of the optic canal: gross-total resection, defined as Simpson 1–3, was achieved in 72.5% of cases. However, arterial encasement or cavernous sinus invasion can be treated with excellent results by Gamma Knife Stereotactic Radiosurgery (GKSRS), so in these cases subtotal resection combined with radiosurgery could be proposed. Five- and 10-year cumulative progression-free survival after surgery w/wo adjuvant GKSRS was 91.4% and 83.8%, respectively. GKSRS can be a primary treatment in small asymptomatic patients; in our experience, the cumulative tumor control was 93.3% at 10 years.