내측 접형능선수막종의 수술적 치료

Surgical management of medial sphenoid ridge meningiomas: preoperative evaluation of patency of superficial middle cerebral vein and surgical outcomes

Objectives Surgical management of medial sphenoid ridge meningioma is challenging due to their intimate relationship with anterior visual pathway, cavernous sinus, and arteries of anterior circulation. We analyzed extent of resection and recurrence rate of medial sphenoid ridge meningiomas and discuss the usefulness of preoperative cerebral angiogram in determining preservation of large drainage vein. Methods Between 1995 and 2010, 38 cases of medial sphenoid ridge meningioma underwent surgical resection. Preoperative cerebral angiogram was performed in 29 patients (76.3%) and evaluated the patency of superficial middle cerebral vein and collateral circulation. Results Total resection was achieved in 27 patients (71.1%). Recurrence was observed in 3 patients (11.1%). Regrowth was observed in 4 (36.4%) of the 11 patients with subtotal resection. Two patients of sphenoid ridge meningioma with interdural cavernous sinus extension were successfully removed. Superficial middle cerebral vein was sacrificed in 1 patient. There was no surgical mortality and symptomatic cerebral infarction. Conclusions Sphenoid ridge meningioma with interdural cavernous sinus extension can be removed safely without cranial nerve deficit compared to the meningioma with intracavernous sinus extension. The patency of superficial middle cerebral vein and development of collateral vessel were helpful to determine intraoperative preservation of large drainage vein.