Surgery for clinoidal meningiomas with cavernous sinus extension: Near-total excision and chiasmopexy.

Abstract

The main factors limiting the extent of resection for clinoidal meningiomas are cavernous sinus extension and vessel adventitia involvement. The proximity to the optic apparatus and the risk of radiation-induced optic neuropathy often prevents many surgeons from proposing adjuvant radiosurgery. We describe a simple technical solution that is to place a fat graft between the optic apparatus and the residual tumor to maintain the distance gained at surgery and facilitates the identification of anatomic structures. This technique allows to deliver optimal therapeutic doses to the residue reduces the dose received by the optic nerve below 8 Gy.