Meningiomas in the middle fossa may arise from the region of the cavernous sinus, from the posterior aspect of the sphenoid wing, or from the floor of the middle fossa; or from growth that extends into the area from the clivus. petrous bone, or sphenoid wing and cavernous sinus. MRI or CT usually provides all the information the surgeon needs. MRA is necessary in larger tumors to define the relationship of the tumor to the internal carotid artery and to evaluate the tumor's blood supply. Embolization rarely 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.
For anterior-placed lesions a frontotemporal exposure is made using a question-mark incision to increase the temporal exposure. For more posterior tumors a U-shaped incision is made to expose the middle and posterior temporal region.
In all patients the tumor compressed the temporal lobe. In 50% of patients a total removal can be achieved. 30% a radical subtotal removal, and 20% a subtotal removal because of age and/or tumor growth into the cavernous sinus. No major complications and all patients are helped by the operation. 80% has a good result. 5% fall to fair category and 5% in the poor category because serious preoperative disabilities did not recover.