Selection of Surgical Approach for Trigonal Meningiomas in Consideration of Visual Outcome

• Published in: World neurosurgery Vol. 118; pp. e436 - e442
• Main Authors: Kim, Ju-Hwi, Jang, Woo-Youl, Duy Khuong, Le Nguyen, Jung, Tae-Young, Moon, Kyung-Sub, Kim, In-Young, Park, Won-Ju, Jung, Shin
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2018
• Subjects: Meningioma; Superior parietal lobule; Surgical approach; Trigonal; Visual field; MTG; Trigonal; Visual field; Surgical approach; TM; Superior parietal lobule; Meningioma; SPL
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.06.211

We report the surgical outcome of trigonal meningiomas through 3 different approaches with attention to visual outcomes.
Between 1994 and 2017, 23 patients underwent resection of trigonal meningiomas. We performed tumor removal using 3 different surgical approaches through the superior parietal lobule, middle temporal gyrus (MTG), and modified MTG. The patients were retrospectively identified, and surgical results including visual outcome were analyzed.
Twenty-three patients with a mean age of 45 years formed the study group. The most common symptom and sign were headache (N = 14, 60.9%) and visual disturbance (N = 6, 26.1%). All patients underwent surgical resection, 6 via a translateral approach through MTG, 8 via a translateral approach through modified MTG, and 9 via a transparietal approach through the superior parietal lobule (SPL). Gross total resection was achieved in all patients. We found that visual preservation rate was 25% (1/4) in the MTG group, 62.5% (5/8) in the modified MTG group, and 100% (7/7) in the SPL group, respectively (P = 0.044). Permanent complication rate was 50% (3/6) in the MTG group, 50% (n = 4/8) in the modified MTG group, and 11.1% (n = 1/9) in the SPL group.
The superior parietal lobule approach is a safe and applicable procedure with a great visual preservation and an acceptable risk of morbidity for trigonal meningiomas when there is a chance of visual recovery or preservation.
•The superior parietal lobule approach for trigonal meningioma was much better than other 2 approaches in visual outcomes.•If there is a chance to improve or preserve postoperative visual outcome, the SPL approach should be considered first.•This study provides guidance for the selection of a surgical approach in consideration of visual outcome.