Medial clinoidal meningiomas are among the most challenging skull base tumors, historically linked with high morbidity. Modern cranial base techniques have significantly improved outcomes. Al-Mefty Classification:
▪️ Type I – Origin below the carotid cistern → no arachnoid plane → tumor tightly adherent to the ICA & MCA → high surgical risk
▪️ Type II – Origin above/lateral to clinoid → preserved arachnoid plane → safer dissection despite vessel encasement
▪️ Type III – Origin at optic foramen → early visual symptoms → possible lack of arachnoid plane with optic nerve
Following removal of a Type I lesion - where no arachnoid plane exists between the tumor and vessels - meticulous microsurgical technique is critical.
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