Contents

• Introduction to the therapy of Meningiomas (File 1)
• General Considerations in Management of Meningiomas (File 1)
  • Surgery of Meningiomas (File 1)
  • Radiation Therapy of Meningiomas (File 1)
  • Observation of Meningiomas (File 1)
• Summary of Dr. Ojemann's Meningioma Series (File 1)
  • MIDDLE FOSSA MENINGIOMAS (This File)
    • Management (This File)
    • Results (This File)
• References (File 22)

FIG. 17.9. Middle fossa meningioma. This 47-year-old woman presented with a seizure. Removal was followed by total recovery. (A and B) CT axial images (A and B) after contrast show the tumor projecting into the left temporal lobe from the floor and lateral wall of the middle fossa, with associated hyperostosis.

MIDDLE FOSSA MENINGIOMAS

(Meningioma Management, File 9)

Management

Meningiomas in the middle fossa may arise from the region of the cavernous sinus, from the posterior aspect of the sphenoid wing or the floor of the middle fossa, or from growth which extends into the area from the clivus, petrous bone, or sphenoid wing. The cavernous sinus meningiomas will be considered in the next section.

MRI or CT usually provides all the information the surgeon needs (FIG. 17.9). Angiography is not needed in smaller tumors but may be necessary in larger tumors to define the relationship to the internal carotid artery and to evaluate the blood supply. Embolization has not been needed. The indications for surgery are neurological symptoms in younger patients with any size tumor and in older patients with large tumors. Radiation therapy is used when there is regrowth following radical subtotal removal. Observation is recommended in older patients when the tumor is small.

The key considerations of the operation are the same as outlined under "General Considerations in Management" (see above). For anteriorly placed lesions a question mark incision is made. For more posterior tumors a horseshoe-shaped incision is made.

TABLE 17.7 Middle Fossa Meningiomas
aRemoval		bOutcome		Complications	Recurrence
T	7	Good	10	None	None
RST	3	Fair	1 (1)
ST	2	Poor	1 (1)
aT, total removal RST, radical subtotal removal ST, subtotal removal bGood, free of major neurological deficit and able to return to previous activity level Fair, independent but not able to return to full activity because of new neurological deficit or significant preoperative deficit that did not fully recover Poor, dependent.

Results

There were 12 patients, eight women and four men, ranging in age from 43 to 78 years, with four over 70 years of age (Table 17.7). In all patients the tumor compressed the temporal lobe. Seven had a total removal, three a radical subtotal removal, and two a subtotal removal because of age and/or growth into the cavernous sinus. There were no major complications and all were helped by the operation. Ten had a good result. One was judged to be in the fair category and one in the poor category because serious preoperative disabilities did not recover.

To the MGH/MEEI/Harvard Cranial Base Center or the MGH Proton Beam Radiosurgery Homepage.

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