anterior clinoid line: a predictor for operative outcome ...€¦ · • meningiomas are benign...
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Anterior Clinoid line: A Predictor for Operative Outcome of Medial Sphenoid
Wing Meningiomas
Arab A. , Hawasai A.1, AlObaid A.2
King Abdulaziz Medical CityKing Fahad Medical City, Riyadh
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Introduction• Meningiomas are benign tumors that are the most frequently diagnosed
primary brain tumors representing about 16-20% of intracranial tumors.
• Sphenoid wing meningioma accounts for approximately 20% of supratentorial lesions.
• Resection of this tumor is challenging and has a high mortality rate up to 32% and morbidity due to its proximity to vital structures including: the optic nerve, internal carotid artery and its branches, and cavernous sinus.
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Objective
The purpose of this study is to establish an association between the
maximum diameter of the medial sphenoid wing meningioma (MSWM)
medial to the anterior cliondal line (AC line) and post-operative
complications.
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Methodology• Study Design:
• A retrospective cohort study
• Sampling Technique:
• Convenience sampling of all surgically resected MSWM cases at the National Neurosciences
Institute at King Fahad medical City, Riyadh, Saudi Arabia over the last 10 years, who had pre-
operative MRI, and were followed up for at least three months.
• Data Collection
• Demographics, pre-operative signs and symptoms, post-operative complications and radiological
measurements were collected for all 35 cases that have fulfilled the inclusion criteria using
available medical records and radiological imaging.
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AC Line MeasurementWe have measured the MSWM maximum medial
margin and maximum lateral margin in relation to a
line crossing the tip of the AC and parallel to a
midline that extends between the most caudal
edge of superior sagittal sinus and the most midline
structure, such as vomer or rostrum of the
sphenoid sinus.
AB
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B
These measurements were then correlated
with patient demographics, preoperative
symptoms and post-operative assessment to
look for any significant correlations.
AC Line Measurement cont’d
A
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Methodology cont’d
• The measurement of the maximum medial diameter of the MSWM ranged from 0 to 35, therefore, the median (13mm) was used to divide the cases into two groups.
• Group A: Medial extension of MSWM is <13mm
• Group B: Medial extension of MSWM is ≥13mm
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Results
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Demographics
Table 1.Clinical Features of Patients with Medial Sphenoid Wing Meningioma
Variable Number %
Number of cases 35 100
GenderFemale, noMale, no
279
75%25%
Median age, years 51 (Q25=40.5-Q75=70.0)
Diabetes, no 8 22%
Hypertension, no 9 25%
Out of 259 cases, 35 fulfilled the inclusion criteria
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Medial Extension of MSWM and Extent of Resection
40%
60%
Group A
25%
75%
Group B
Total Resection
Subtotal Resection
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Group A
0%
10%
20%
30%
40%
50%
60%
Pre-operative
Post-operative Worsening
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Group B
0%
10%
20%
30%
40%
50%
60%
70%
80%
Pre-operative
Post-operative Worsening
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Results cont’d
• In Group A, 10% developed ICH postoperatively, however, none of the
patients developed major complications including, CSF leak,
hydrocephalus, pneumocephalus, meningitis, or death.
• In Group B, meningitis was observed in 13% of the patients and
hydrocephalus in 7%.
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Discussion
• This is the first description of AC line measurement and correlation with post operative complications.
• Goel et. Al. have created a grading system that depends on visual involvement, tumor size, and internal carotid involvement and correlates the total score with the extent of excision.
• Concluding that the extent of invasion has a direct effect on the extent of excision.
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Conclusion• The percentage of gross total resection is higher in cases of MSWM
with medial extension less than 13mm, whereas the percentage of
subtotal resection is higher in cases with medial extension more than
13mm.
• The current study suggests that worsening of preoperative
neurological deficits can be correlated with increase in medial
extension of MSWM.
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References1. Watts J, Box G, Galvin A, Brotchie P, Trost N, Sutherland T. Magnetic resonance imaging
of meningiomas: a pictorial review. Insights Imaging [Internet]. 2014 Feb [cited 2016 Jun 7];5(1):113–22. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24399610
2. Fonkem E, Dandashi JA, Stroberg E, Garrett D, Harris FS, El Nihum IM, et al. A retrospective analysis of meningioma in Central Texas. J Epidemiol Glob Health. 2016;6(2):87–93.
3. Lee JH, Sade B. Anterior Clinoidal Meningiomas. Meningiomas [Internet]. London: Springer London; 2009 [cited 2016 May 22]. p. 347–54. Available from: http://link.springer.com/10.1007/978-1-84628-784-8_36
4. Goel A, Gupta S, Desai K. New Grading System to Predict Resectability of Anterior Clinoid Meningiomas. Neurologia medico-chirurgica [Internet]. 2000;40(12):610–7. Available from: https://www.jstage.jst.go.jp/article/nmc/40/12/40_12_610/_pdf
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Thank you