Large medial sphenoid wing meningiomas: long-term outcome and correlation with tumor size after microsurgical treatment in 127 consecutive cases

Abstract

AIm:We present the long-term outcomes as well as their correlation with tumor size in 127 consecutive patients harboring large MSWM after microsurgical treatment. mATeRIAL and meTHods:The retrospective analysis of clinical data and follow-up data of 127 microsurgical treated patients with MSWM was performed. The mean maximum diameter of tumors was 5.2cm (ranged 1.5-10.0cm).ResuLTs: 104 cases (81.9%) achieved gross total resection. There was no operative mortality. Detailed follow-up data was available in 120 cases for a mean duration of 81.6 months (12-216 months). The permanent morbidity was 14.2%. The mean KPS score 1 year after surgery was 90.6 (ranged 60-100). Among 74 patients of preoperative visual acuity (VA) impairment, postoperative VA improved in 42 cases (56.8%), unchanged in 30 (40.5%), and deteriorated in 2 (2.7%). MR images revealed tumor recurrence after total resection in 10 cases (10.2%) and tumor progression after subtotal resection in 10 cases (45.5%).CoNCLusIoN: Tumor recurrence was the major risk in the long run, thus the initial surgery was extremely important and hence should be aggressive. The size of tumor affected the extent of tumor removal determining clinical outcomes including VA improvement and KPS score immediately after surgery; however, it was not correlated with long-term overall outcomes. BuLGuLAR: 104 olguda (%81,9) gros total rezeksiyon yapıldı. Operatif mortalite yoktu. Ayrıntılı takip verileri 120 olguda ortalama 81,6 ay (12-216 ay) için mevcuttu. Kalıcı morbidite %14,2 oranında görüldü. Cerrahiden 1 yıl sonra ortalama KPS skoru 90,6 (aralık 60-100) bulundu. Preoperatif görme keskinliği bozukluğu olan 74 hasta içinde postoperatif dönemde görme keskinliği 42 hastada (%56,8) arttı, 30'unda (%40,5) değişmedi ve 2'sinde (%2,7) kötüye gitti. MR görüntüleri total rezeksiyon sonrasında 10 olguda (%10,2) tümör reküransı ve subtotal rezeksiyon sonrasında 10 olguda (%45,5) tümör ilerlemesi gösterdi. soNuÇ: Uzun dönemde temel risk tümör reküransıydı ve bu nedenle ilk cerrahi çok önemlidir ve agresif olmalıdır. Tümör büyüklüğü, tümör çıkarma kapsamını etkileyerek ameliyattan hemen sonra görme keskinliği düzelmesi ve KPS skoru dahil klinik sonuçları etkiledi ancak uzun dönemli genel sonuçlarla korelasyon göstermedi.ANAHTAR sÖZCÜKLeR: Medial sfenoid kanat menenjiyomları, Tümör büyüklüğü, Tümör reküransı, İşlevsel sonuç

Outcome of medial sphenoidal wing meningioma surgery

“…[7] Histopathological examination showed the most common type was WHO Grade I Mesothelial meningioma in 23 cases (48.9%) as reported by many authorities. [11,14,17] but we had three cases of atypical meningioma which different from Nakamura et al who did not report any cases of atypical meningioma [14] In patients long-term prognosis regarding the quality of life: Over all the mean KPS score for the patients in the study was 86.2 (ranged from 60 to 100) at 1 year after surgery, which was 74.5 at 10 days after surgery. While AbdelAziz et al stated excellent outcomes 38 patients, with a KPS score > 90 in 89% of their cases 1 year after surgery [1]and Liu et al showed In 120 MSWMS cases mean KPS was 83.5 at 10 days after surgery then improved to be 90.6 as mean KPS (ranged from 60 to 100) 12 months after [11].so our results may goes with international data because of advanced microsurgical techniques, learning curve with preservation of perforators whenever possible and appropriate decision making according to patient condition.…”

“…during the series upgrade we adopt more skull base bone removal to minimize brain retraction, minimize coagulation to reduce the incidence of new neurological deficit. Many paper mentioned these complications in similar surgeries for MSWM as Nakamura et al, Czernicki et al, Bassiouni et al, Hao, Liu et al [3,7,8,11,14] may be it appeared in ours and in Nakamura et al study due to presence of larger tumours that extend posteriorly and superiorly wit adherence to MCA or ACA perforators or to the MCA or ACA adventitia [2]. Thus also explain the presence of two cases of cerebral infarction which was evident clinically & radiologically.…”

“…In the case of complete removal who showed recurrence the tumorous hyperostotic bone & dura may be the nidus for regrowth. Nakamura et al reported the high rate of recurrence (27.5%) of clinoidal meningioma related to involvement of cavernous sinus as only cause in comparison to low rate of tumor recurrent in case showed no cavernous sinus involvement (7.7%) [2] While Liu et al mentioned the close relation between recurrence in his series and tumor Atypia [11] By analyzing the data statistically ,we found the influence of several factors on postoperative patient's prognosis: Extent of tumor excision (P=0.026) and we can explained that by the major effect of residual volume to promote the chance of recurrence as mentioned earlier, Peritumoral edema (P=0.038) due to Lower blood flow to the brain, Limited space for retraction & Higher incidence of brain contusion during surgery (we can overcome this by more removing skull base bone as total drilling of sphenoid wing, clinoidectomy). The Vascularity of the tumours represent one of the main factors affecting our patients prognosis (P=0.005) especially internal carotid parasitic blood supply that may be difficult to identify & control intraoperative beside its sometimes related to perforators.…”

“…They died few weeks after the surgery and the case of death in patient was massive cerebral edema with massive infarction & the other case was sever chest infection in 67 years old male with history of heavy smokers and Bronchial Asthma. Liu et al conducted 6 patient died due to recurrence or progression of the tumours and 2 died of unrelated diseases [11] There was 3 case of acute epidural haematoma: two case treated surgically and a case managed conservatively. The bleeder was the stem of Middle meningeal in two cases due to retraction in foramen spinosum.…”

“…The factors that did not affect the patient postoperative status include: patients age, sex, duration of symptoms, surgical approach. Many researchers conducted the importance of some of these factor on patient survival and quality of life like Sughrue et al Nakamura et al, Zhang etal, Liu D et al [9,13,11,17,19] but our result disagree with Kim et al about age as influencing factor [9] Conclusion: There are many factors influence the prognosis of inner sphenoid wing meningioma including the extent of surgical resection, cavernous sinus invasion, present or absent of peritumoral edema, vascularity of the tumor, size of the tumor, presence or absence of arachnoid plane between the tumor and surrounding neurovascular structures and preoperative neurological condition.…”