New grading system to predict resectability of anterior clinoid meningiomas.

Sixty patients with anterior clinoid meningiomas (mean age 48 years) were surgically treated. There was a slight female predominance. Headache and visual impairment were the commonest clinical symptoms at presentation. The patients were classified on the basis of extent of the visual impairment, size of the tumor, and the tumor relationship with the internal carotid artery. A grading system was designed using the total scores in these classifications on the scale of 2-10. The classifications and the grading system were assessed for planning of the operative strategy, anticipating the extent of resectability, possible difficulties in dissecting the carotid artery and optic nerve during the operation, and prognosis. Total resection was achieved in 42 cases (scores 4-8), subtotal resection in 17 cases (scores 7-10), and only partial resection in one case (score 10). Vision improved in 14 cases. Three patients died following surgery. Mean follow up was 26 months. There was one recurrence. Fifty-four patients are leading independent and active lives.