Most intracranial meningiomas are not cleavable tumors: anatomic-surgical evidence and angiographic predictibility

Neurosurgery
M P Sindou, M Alaywan

Abstract

The statement that intracranial meningiomas are cleavable tumors has to be seriously questioned from a surgical standpoint. The purpose of this study was 1) to analyze the operative reports of a personal series of meningiomas to evaluate the percentages of the tumors that could be dissected by passing in the extrapial plane (i.e., "cleavable") and of those in which the dissection had to be subpial (i.e., "noncleavable") and 2) to see whether preoperative angiography could help in predicting cleavability. The series includes 150 consecutive patients with intracranial meningiomas diagnosed with computed tomographic scans and explored preoperatively by selective external/internal carotid angiography, operated on using microsurgical techniques, and followed for more than 4 years. Dissection between tumor and underlying cortex could be achieved in the extrapial plane predominantly (i.e., on more than two-thirds of the interface) in only 54.6% of patients. On angiography, the pial-cortical arterial supply participated in at least equal part with the meningeal-dural arterial supply in vascularization of the tumor in 59.4% of patients. In this group, dissection could pass through the extrapial plane in only 34.8% of patients. Conversel...Continue Reading

Citations

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