Abstract
The functional prognosis for deep-seated meningiomas is mostly dictated by the approach chosen and the dissection technique employed to remove tumor tissue from deep veins, cranial nerves and the brainstem. Accordingly, in this study among a consecutive 293 meningioma operations, the incidence, location, preservation rate of cranial nerve function, and the most appropriate approach selection for deep-seated meningiomas were retrospectively analyzed. The rate of vision improvement was 89% in 36 cases with visual dysfunction, the olfaction preservation was 93% in 30 cases operated via a basal interhemispheric approach, and hearing rate improvement was 44% in 9 cases with hearing disturbances. In order to determine the most appropriate approach to gain direct observation and secure dissection, detailed neuro-imagings including 320-row area detector CT, preoperative embolization of feeders from the internal carotid artery, and a thorough understandings of the biological behavior and pathology of the tumor-brain interface are important. Finally, after due delligence, it may become apparent that a multi-staged operation and/or Simpson Grade IV surgery might be a good alternative choice.
