Romanian Neurosurgery (Mar 2018)
Anterior skull base meningiomas: surgery related hypothalamic sequalae. How to avoid?
Abstract
Introduction: Surgical: morbidities related to anterior skull base meningiomas are widely addressed in the literature and mostly related to tumor relations to cranial nerves and vascular structures in this challenging area. However; there is infrequent complications related to hypothalamic insult either from direct affection or via manipulation of vascular supply of this area. The aim of this study: is to address hypothalamic complications occurred after surgery for anterior skull base meningiomas, pitfalls in our surgical technique and the way to minimize such morbidities. Patients and methods: Retrospective study was conducted on all patients who did surgery for anterior skull base meningiomas in the neurosurgery department, Mansoura University during the period from 2011 to 2016. All the patients clinical and radiological data before and after surgery were analyzed. All patients who developed transient or permeant hypothalamic manifestation were included in this study and data regarding their tumor morphology, surgical technique and post-operative early and late imaging were assessed. Results: Among 93 patients who did surgery for anterior skull base meningiomas; 12 patients developed post-operative sequalae related to hypothalamic function. In 7 patients; tumor was recurrent and in 4 patients; conformal radiotherapy was given after the initial surgery. Complication was transient in 3 patients and permeant in 9 patients. 8 patients died from their hypothalamic sequalae. Early post-operative imaging showed hypothalamic infarction in 8 patients. Conclusion: Through reviewing these cases we can address the importance of many factors in the tumours especially size, morphology, recurrence who increase hypothalamic insults. Factors in surgery include preservation of arachnoid plain, perforators, meticulous dissection for minimize this complication.
