Surgical Management of Middle Cranial Fossa Meningiomas: Experience of 35 Cases

Abstract Background: Meningiomas are the most common tumors of the middle cranial fossa. Different surgical approaches have been described for excision of these tumors. Common approaches are the pterional, subtemporal, and the subfrontal approaches. These tumors are challenging in their management due to the variability of their surgical routes, and due to their close proximity to the cavernous sinus, carotids, optics, and other cranial nerves. Aim of Study: Discussing our experience in surgical excision of middle cranial fossa meningiomas, discussing different surgical routes and incidence of morbidities and mortalities. Patients and Methods: This is a retrospective observational study conducted on the data of 35 cases with middle cranial fossa meningiomas between January 2016 and July 2017. We included data of cases with outer (Pterional), middle and inner sphenoid wing (clinoidal), suprasellar, and cavernous sinus meningiomas. The Simpson grading system was utilized for assessment of the extent of tumor excisions; while the Karnof-sky performance scale as well as the comparison between the pre and the postoperative clinical examination was utilized for assessment of the functional outcomes. Results: 6 convexity meningiomas, 12 suprasellar menin-giomas, and 17 middle and inner sphenoid wing meningiomas (clinoidal) including cavernous sinus extension were included in the study. Simpson grade 1 excision was achieved in 34%, grade 2 in 46%, grade 3 and 4 in 20%. Visual functions improved in 57% of cases. The most common complication was cranial nerve affection. We didn't detect any cases with tumor recurrences. Conclusion: Middle cranial fossa meningiomas are chal-lenging cases that are becoming possible for gross total surgical excision with minimal complications. Cranial nerves palsies are the most common morbidities specially the optic nerve and the cranial nerves in the region of the cavernous sinus. The pterional approach is considered to be the key approach for most types.