File 9: MIDDLE FOSSA MENINGIOMA
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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.
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
| 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)
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
|TABLE 17.7 Middle
aT, total removal
RST, radical subtotal removal
ST, subtotal removal
bGood, free of major
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
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.
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