Anterior clinoidal meningiomas: report of a series of 33 patients operated on through the pterional approach.

Between 1985 and 1995, 33 cases of clinoidal meningioma were surgically treated by pterional approach. In 6 cases, according to the grading scale of Al-Mefty, the lesions were group I, having originated from the lower part of the clinoid; in 22 cases, the lesions were group II, having originated from the upper or lateral part of the clinoid process; and in 5 cases, the lesions were group III since they arose from the optic foramen. Postoperatively, 17 patients showed an improvement, 4 were unchanged, and 6 presented further deficits. Five patients died after surgery: two from pulmonary thromboembolism, one from myocardial infarction, one from hematoma of the operative field, and one from cerebral ischemia after severe vasospasm of the internal carotid artery (unresponsive to treatment). The mean follow-up was 53.7 months (range 12-108 months) and included 19 patients. During this period, there were five recurrences, and three patients underwent resection again and showed no signs of tumor regrowth 1 year later; one patient who did not undergo resection again due to his age and poor general conditions died 3 years after onset of the recurrence; the last patient has so far refused a second operation. The clinical, diagnostic, and therapeutic aspects of this not infrequent pathology are discussed in the light of our experience and the pertinent literature.