MGHbanner BulfinchBldg
Cranial Base Ceneter at MGH
Cranial Base Center at MGH
Otolaryngology at MEEINeurosurgery at MGHRadiation Oncology at MGH
MEEI

Massachusetts General HospitalHarvard Medical School

MGH  Neurosurgical Service HomeMGH ShieldHvd Med Sch ShieldPartners Logo
A joint program of the Departments of Otolaryngology, Neurosurgery, and Radiation Oncology dedicated to the evaluation and treatment of patients with cranial base lesions. Including the Cranial Base Center News - A newsletter with information regarding lesions affecting the base of the skull including acoustic neuromas (vestibular schwannoma) and other tumors of the cranial nerves).
Neurosurgery @ MGHPeople @ MGH NeurosurgeryClinical Centers @ MGH NeurosurgeryResearch @ MGH NSEducation @ MGH NeurosurgerySupport Groups @ MGH NeurosurgeryNews @ MGH NeurosurgeryReferrals @ MGH Neurosurgery
Management of Meningiomas
File 9: MIDDLE FOSSA MENINGIOMA

To the MGH/Harvard Meningioma Treatment Homepage
To the Introduction and Contents of Management of Cranial and Spinal Meningiomas

CBC Members | Referrals | Newsletter | Guestbook | Links | Selected Publications | CBC HomePage


by ROBERT G. OJEMANN, M.D.
Congress of Neurological Surgeons Honored Guest Presentation
Originally Published Clinical Neurosurgery, Volume 40, Chapter 17, Pages 321-383, 1992
Used with permission of the Congress of Neurological Surgeons.
HTML Editor: Stephen B. Tatter, M.D., Ph.D.
Disclaimer: The information and reference materials contained herein are intended solely to provide background information. They were written for an audience of physicians. They are in no way intended to constitute medical advise. For medical advise a physician must, of course, be consulted.

Contents


CT Scan of Meningioma
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.
Ceanial Base Center at MGH Members | Referrals | Newsletter | Guestbook
Links | Selected Publications | CBC HomePage
[Divider]

Disclaimer About Medical Information: The information and reference materials contained herein is intended solely for the information of the reader. It should not be used for treatment purposes, but rather for discussion with the patient's own physician. All visitors to this and associated sites from the Neurosurgical Service at MGH agree to read and abide by the the complete terms of legal agreement found at the Neurosurgery "disclaimer & legal agreement." See also: the MGH Disclaimer, the MGH Privacy Policy, and the MGH Interactive Program Disclaimer - Copyright 2005.
[Divider]
electronswebs
MGH  Neurosurgical Service Home
Research@NeurosurgeryVisitors must read the disclaimer - legal agreement.
All Rights Reserved. Copyright 20005 MGH Neurosurgical Service
Neurosurgery@MGH
IntraNet

(internal access only)
System Info Contact: WebServant or the PageServant or e-mail C.Owen
Last modified: May 11, 2005
Referral@Neurosurgery.MassGeneral.org