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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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Al-Mefty’s Meningiomas – AJNR Blog

Ultrasonic aspiration is used to debulk large tumors. Anatomical Considerations and Meningkomas As the carotid artery emerges from the cavernous sinus inferomedial to the anterior clinoid, it enters the subdural space to be vested in the carotid cistern.

When the tumor extends into the cavernous sinus, as it did in nine of our cases, proximal and distal control of the carotid artery is necessary. Cushing’s series is a typical example: Preservation of the olfactory nerve deters excessive frontal lobe retraction, otherwise resulting in avulsion of the olfactory nerve. Foremost authorities present the milestone text on meningioma management, now in a fully updated Second Edition This is an excellent book and a needed update.

Since the tumor may be supplied by arterial twigs from the cerebral artery, the surgeon first confirms that they are tumor feeders and not hypothalamic perforators or the optic nerve blood supply.

Clinoidal meningiomas.

Caution is used not to carry debulking close to the carotid artery or the middle cerebral artery branches. Acknowledging that the best chance for cure comes through radical total removal, most authors, both pioneer and modern, have been content with subtotal removal to avoid the devastating sequelae of injury to the encased cerebral vessels; 6, 9, 17, 22, 31, 43, 51, 56 hence, repeated surgery and radiation therapy are frequently required.

Section IV of the book covers Diagnostic Radiology with one chapter on cross-sectional imaging and one on angiography: There is a comprehensive review of meningiomas by location, with a focus on anatomy and surgical approach, which includes important information on recurrence and survival.


This observation correlates with reports in menintiomas literature concerning the feasibility of tumor dissection despite total vascular encasement. Notice the resection of the anterior clinoid.

However, this is also a great reference book for any Neuroradiology section—both academic and private practice. The presence or absence of arachnoid membranes depends on the origin of the ap and its relation to the naked segment of la artery lying outside the carotid cistern. Operative Technique Early in this series, the pterional approach was used in seven patients and subfrontal approach in three.

Summary of Cases Case Material Twenty-four cases qualifying as clinoidal meningiomas were operated on over a 7-year period, from November,through October, 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. Elliott and John G.

Careful dissection under high magnification is continued to free the ventriculostriate arteries, the perforator of the anterior cerebral artery, and the internal carotid artery branches to the optic apparatus.

Clinoidal meningiomas

The temporal muscle is retracted posteriorly and inferiorly, exposing the junction of the zygomatic, sphenoidal, and frontal bones. Any further bone hyperostosis is drilled with the diamond bit of a high-speed drill.

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. McDermott No preview available – Several cases of these small meningiomas at the anterior clinoid Group III in our classification can be found. These groups relate to the presence of interfacing arachnoid membranes between the tumor and the cerebral vessels. The carotid, middle cerebral, and anterior cerebral arteries, as well as the menngiomas apparatus, were all mdningiomas involved with the tumor, meningiojas displaced, adherent, or totally engulfed.

Preoperative visual impairment improved in only two patients. Only a thorough review of the literature can extract cases of anterior clinoidal meningiomas Table 1. This maneuver intercepts the arterial feeders coming from branches of the middle meningeal artery. Two patients had transient diabetes insipidus, and one patient had permanent diabetes insipidus. Four patients had impairment of the oculomotor or trigeminal nerve, while seizure was present in three patients. The arachnoid over sl sylvian fissure is opened, allowing separation of the temporal and frontal lobes.


These subgroups relate to the presence of interfacing arachnoid membranes between the tumor and cerebral vessels. Repeatedly, the operative cause is injury to the major cerebral vessels, 9, 17, 23, 41, 43, 53 a risk that has forced an overwhelming number of surgeons to accept and recommend subtotal meningomas. Although meningiomas of the anterior clinoid invade the cavernous sinus, there exist meningiomas that are strictly menintiomas, originating from within the cavernous sinus. The Role of Radiation Therapy The role of radiation therapy cannot be left unaddressed in a discussion of clinoidal meningiomas in mefth subtotal removal or recurrence are prominent features.

The symptoms of two women presented during pregnancy. This landmark reference will enhance the precision and surgical skills of every clinician or resident in neurosurgery or neurology. This is an excellent book and a needed update.

Dissection becomes easier along the posterior communicating artery and the anterior choroidal artery, since these two arteries have their own vesting arachnoid membranes.

Recent advances in cranial-base and cavernous sinus surgery have facilitated total removal, allowing respectable mortality and morbidity rates for these tumors. Both are well written and up to date, although there is little discussion of MRS or diffusion imaging in diagnosis and grading of meningioma. 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.

The optic nerves in these tumors are displaced in several different ways.