Parasellar meningiomas (m.) may be subdivided in three groups on the basis of their anatomical location and radical removal possibility. The 'true' spheno-cavernous m. are those that grow primarily in the cavernous sinus (c.s.), generally starting from the gasserian region. They are mostly extradural and, if the patient has no neurological deficits, these m. should be considered as unresectable without an unacceptable morbility. In recent years, many operations on the c.s. have been done on vascular and neoplastic lesions. But, if the c.s. is infiltrated from inside, as it happens in true spheno-cavernous m., the oncological radicality could be obtained only with an 'en bloc' resection of the sinus along with its contents. This option is obviously unacceptable in neurologically intact patients. A second group comprises the 'en plaque' m. of the sphenoid ridge and those 'en masse' tumors that invade the bone of the base of the skull. These tumors recur frequently and need important operations. However the resection is rather safe with good longterm results. These m. occur typically in middle-aged females. They do invade bone through the haversian canals and the bone typically thickens, becoming the predominant clinical feature of these patients. The surgeon should remove all the pathological bone, open the optic canal, the superior sphenoidal fissure, the foramina rotundum and ovalis, and, if necessary, the walls of the orbit and the floor of the middle cranial fossa. The infiltration of the periorbita and of the anulus is a limit to radical resection. The third group comprises all the globous m. of the sphenoid ridge. These tumors are generally non-infiltrating. Their removal should be possible with low morbidity and mortality. This is true also in those cases where the carotid artery and its branches appear encased by the tumor. The dissection is generally feasible, unless the arterial adventitia is infiltrated; and this is a rare event. The walls of the c.s. are generally tumor-free and the m. may be dissected. Thus the radical removal of the m. of this group should be programmed and pursued tenaciously.
|Translated title of the contribution||'Parasellar meningiomas'. Examples for a simplified surgical classification|
|Number of pages||11|
|Journal||Rivista di Neurobiologia|
|Publication status||Published - 1995|
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