Modern surgical outcomes following surgery for sphenoid wing meningiomas

Abstract

Object Cushing and Eisenhardt were the first to describe sphenoid wing meningiomas in detail, categorizing globoid tumors into 3 groups: 1) medial; 2) middle; and 3) lateral. The authors review their experience with resection of sphenoid wing meningiomas at a single center, to examine whether this classification predicts clinical presentation and postsurgical outcome. Methods All patients undergoing resection of sphenoid wing meningioma at the authors' institution over a 9-year period were identified. Clinical data were compared from patients with tumors arising at different points along the sphenoid wing to determine if these tumors behaved differently in terms of symptoms, radiographic characteristics, and postsurgical outcome. Results A total of 56 patients underwent microsurgical resection for sphenoid wing meningioma during this period. The rates of optic canal invasion (medial 50% vs middle 5% vs lateral 0%; p < 0.0001, chi-square test), supraclinoid internal carotid artery encasement (medial 32% vs middle 5% vs lateral 0%; p < 0.01, chi-square test), and middle cerebral artery encasement (medial 45% vs middle 24% vs lateral 0%; p < 0.01, chi-square test) were all highest with medial-third tumors. New or worsened neurological deficits occurred in 10 (19%) of 56 patients. Of all the imaging characteristics studied, only location of the tumor along the medial third of the sphenoid wing significantly predicted an increased rate of new or worsened neurological deficit (OR 2.7, p < 0.05). Conclusions The authors report outcomes in a large series of sphenoid wing meningiomas that were treated using modern surgical techniques.

Surgical management of giant sphenoid wing meningiomas encasing major cerebral arteries

“…4,6,18 However, with a prudent approach using modern surgical techniques, the risk of arterial injuries is reported to be low. 5,10,15,30 In our series, the second main anatomical characteristic preventing gross-total removal is CS invasion. Our tumoral resection was limited to outer-layer dura propria of the external wall of the lateral CS.…”

“…These results do not support the hypothesis that leaving small amounts of tumor has little impact, or that many of the tumor remnants undergo growth arrest and remain dormant. 29,30 Follow-up data of at least 2 years are available in only 9 of our 12 cases and revealed tumor recurrence in 5 of these 9 patients; in 4 of them, recurrence was at the site of the tumor remnant, and in 1 in whom gross-total removal had been achieved, recurrence was on the MCA. Because the degree of resection in most of our cases was Simpson grade 4, one would expect the rate of recurrence to be high, emphasizing the need for long follow-up durations.…”

“…Consequently, the clinical presentation, risk of surgery, and prognosis can vary from case to case. 30 Those that have grown to a very large size, encasing the major cerebral arteries, are particularly treacherous, and their surgical management is highly challenging with a high risk of stroke. …”

“…They account for approximately 20% of supratentorial meningiomas. 23,30 Cushing and Eisenhardt classified these lesions into middle, medial, and lateral according to the location of their origin along the wing. Consequently, the clinical presentation, risk of surgery, and prognosis can vary from case to case.…”

Outcome of medial sphenoidal wing meningioma surgery

“…On the light of this concepts, many neurosurgery preferred to remove these tumours partially or grossly subtotally then refer the patients to radiosurgery. [13,17] The decision making became more difficult to get balance between surgical morbidity & mortality and recurrent rate by adopting a good microsurgical technique maintaining cranial nerves & skull base vessels integrity.…”