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Large and Giant Sphenoid Wing Meningiomas: Management Intricacies
1108 14:30-14:40
Skull Base/304A
Introduction: Sphenoid wing meningiomas are challenging tumours due to their location in relation to vital neurovascular structures. Treatment goal remains aggressive tumour removal, avoidance of intraoperative morbidities, and improvement in visual function. Author presents his personal experience of treating these patients and their surgical results. Material & methods: We have consecutively operated 83 cases of sphenoid wing meningiomas and 13 cases of spheno-orbital meningiomas. There were 64 cases involving medial sphenoid ridge with some of the tumours having extensive sphenoid ridge involvement. Thirty five (35) patients had discrete clinoidal attachment. Nineteen patients had visual involvement. Treatment intricacies of these tumours are obvious due to the location, giant size, vascularity and consistency, vascular encasement, invasion into optic canal, involvement of cavernous sinus, rarely, ICA aneurysm in relation to the tumour, intraorbital extension and consideration of staged operation for giant tumours. Results: All the tumours were completely excised via frontotemporal craniotomy and in a few early cases, addition of orbitozygomatic (4), zygomatic (5), or supraorbital (2) osteotomies. While 4 patients were electively ventilated postoperatively for brain swelling, six had oculomotor nerve paresis, mild speech difficulty and hemeparesis in 3 and one had meningitis. All patients recovered without any significant disability. Twelve patients (63%) had visual improvement after surgery. There was no mortality. Conclusions: Proper preoperative planning and meticulous dissection makes safe resection of these tumours with excellent out come. Vital neurovascular structures particularly optic nerve, ICA and its branches, oculomotor nerve needs painstaking careful dissection under high magnification. Visual improvement is expected if vision loss is not complete.

Microsurgical Clipping Techniques for Ophthalmic Segment Aneurysms (OSA)
1108 09:00-09:10
Cerebrovascular/304B
Introduction: Aneurysms originating from ICA - ophthalmic segment are complex, technically demanding and carries high risk for safe clipping. Microsurgical clipping techniques depend on many factors apart from location and projection of aneurysms. Material and Methods: Author presents his experience of operating 45 ophthalmic segment aneurysms in 43 patients, out of 460 cases of total aneurysms, of these last 35 cases were done at a peripheral hospital in India. Female outnumbered male and mean age was 45 years. Thirty five patients presented with subarachnoid haemorrhage, one with visual deficits and 9 aneurysms were incidentally detected or part of multiple aneurysms. Thirty seven patients were in WFNS grade 1-2, 3 were in grade 3 and another 3 patients were in grade 5. While twenty three aneurysms were originating from dorsal wall, 22 aneurysms originated from ventral wall of ophthalmic segment. Aneurysms were classified as small (26), large (17), and giant (2). Thirty seven patients underwent microsurgical clipping where as 7 aneurysms were wrapped and one was trapped. Carotid exposure in the neck for proximal control and optimal drilling of clinoid process for delineation of proximal neck of aneurysm were essential steps. Results: Thirty four patients resumed normal life following treatment and 4 patients were moderately disabled but independent for daily life activities. There were three mortalities. Two patients were in preoperative grade 2-3 and one was in grade 5. Follow up ranging from 6 months to 13 years with excellent neurological status. Conclusions: Microsurgical clipping for ophthalmic segment aneurysm is safe and provide more durable long term outcome.