To investigate the strategy of surgical treatment for anterior clinoid meningiomas and to analyze the influencing factors of efficacy.

A retrospective review was performed on 51 patients with anterior clinoid meningioma who were consecutively admitted to Department of Neurosurgery, the Xiangya Hospital of Central South University from January 2012 to April 2018. All patients underwent tumor resection via the pterional approach or extended pterional approach. The extent of tumor resection was assessed using the Simpson classification. Karnofsky performance status (KPS) scale was used to evaluate the patents′ outcomes.

Among all 51 patients, Simpson Ⅰ-Ⅱ resection was achieved in 41 (80.4%) cases, Ⅲ in 7 (13.7%) and Ⅳ in 3 (5.9%). All 51 patients were followed up. The postoperative follow-up duration was 48.6±28.4 months. Tumor recurrence and progression were identified in 1 case and 4 cases respectively. The KPS at the last visit was 90.3±9.6 and higher than that at discharge (87.0±7.8) and prior to operation (74.3±10.5) (both P<0.01). Univariate analysis indicated that the relationship between tumor and cavernous sinus (P<0.001), the tumor types (P<0.001) and the maximum diameter of tumor (P=0.004) are the risk factors influencing total resection of tumor.

Total resection seems to be easier to be achieved when the tumor has not invaded the cavernous sinus, the maximum diameter of the tumor is less than 2 cm and the Al-Mefty type is Ⅱ or Ⅲ. According to the radiological features of the tumor before surgery, surgical strategies for each patient could be customized, which contribute to maximal tumor resection and preservation of neurological function, thus improving the prognosis of patients.

Meningioma; Anterior clinoid; Microsurgery; Risk factors