Extradural Clinoidectomy in Clinoidal Meningiomas: Analysis of the Surgical Technique and Evaluation of the Clinical Outcome

The surgical treatment of clinoidal meningiomas is still discussed in the literature. Different sur-gical approaches have been proposed and evaluated in multiple studies in order to improve the surgical outcomes. The aim of this study is to evaluate advantages of extradural clinoidectomy as tumor removal radicality as the visual function improvement. A retrospective analysis was per-formed on 74 patients. 26 patients with clinoidal meningiomas was group III according to Al Mefty classification who underwent surgery at the Policlinico Umberto I Hospital between 2000 and 2019. Extradural Clinoidectomy was performed to 15 patients (Group A), 11 patients un-derwent only pterional approach (Group B). visual impairment is present in all 26 patients before surgery. Visual function assessment was performed in all patients pre-surgery and post-surgery. Radiological follow up was performed at 3,6 and every 12 months. Gross Total Resection (GTR) was achieved in 13/15 (86.7%) patients who underwent clinoidectomy and in 4/ 11 (36.4%) who did not undergo clinoidectomy. visual function improvement was achieved in 12/15 (80%) pa-tients underwent clinoidectomy and in 4 of 11 (36.4%) not underwent clinoidectomy. In our study, Extradural clinoidectomy is the most suitable method for facilitating the gross total resec-tion of clinoidal meningiomas. Our experience and data suggest higher rate of total resection and the best visual outcomes. Extradural drilling of the Anterior Clinoid Process reveals a wider sur-gical corridor for a meticulous tumor resection