Surgical management of giant sphenoid wing meningiomas encasing major cerebral arteries

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Sphenoid wing meningiomas are a heterogeneous group of tumors with variable surgical risks and prognosis. Those that have grown to a very large size, encasing the major cerebral arteries, are associated with a high risk of stroke. In reviewing the authors’ series of giant sphenoid wing meningiomas, the goal was to evaluate how the extent of the tumor’s invasion of surrounding structures affected the ability to safely remove the tumor and restore function.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>The authors conducted a retrospective study of a series of giant sphenoid wing meningiomas operated on between 1996 and 2016. Inclusion criteria were meningiomas with a globoid component ≥ 6 cm, encasing at least 1 major intradural cerebral artery. Extent of resection was measured according to Simpson grade.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>This series included 12 patients, with a mean age of 59 years. Visual symptoms were the most common clinical presentation. There was complete or partial encasement of all 3 major cerebral arteries except for 3 cases in which only the anterior cerebral artery was not involved. The lateral wall of the cavernous sinus was invaded in 8 cases (67%) and the optic canal in 6 (50%). Complete resection was achieved in 2 cases (Simpson grades 2 and 3). In the remaining 10 cases of partial resection (Simpson grade 4), radical removal (&gt; 90%) was achieved in 7 cases (70%). In the immediate postoperative period, there were no deaths. Four of 9 patients with visual deficits improved, while the 5 others remained unchanged. Two patients experienced transient neurological deficits. Other than an asymptomatic lacuna of the internal capsule, there were no ischemic lesions following surgery. Tumor recurrence occurred in 5 patients, between 24 and 168 months (mean 61 months) following surgery.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Although these giant lesions encasing major cerebral arteries are particularly treacherous for surgery, this series demonstrates that it is possible to safely achieve radical removal and at times even gross-total resection. However, the risk of recurrence remains high and larger studies are needed to see if and how improvement can be achieved, whether in surgical technique or technological advances, and by determining the timing and modality of adjuvant radiation therapy.</jats:p></jats:sec>

Surgery on giant meningiomas in very old patients entails frequent postoperative intracranial hemorrhages and atypical histopathology

“…In our series, overall complication rates were high (57%), and slightly higher (64%) in giant meningiomas. Previous studies on giant meningiomas have reported complication rates ranging from 46% to 59% [6,7,14,[17][18][19], which is in line with our results. However, the median age in our study was much higher than in the previous studies (Table 3).…”

Transorbital Endoscopic Surgery for Sphenoid Wing Meningioma: Long-Term Outcomes and Surgical Technique

“…Traditional open neurosurgical approaches have aimed for gross-total resection and is associated with significant morbidity, mostly related to traction of the brain and surgical manipulation, 23 and increases the risk of new-onset cranial nerve palsy, stroke, and mortality. 15 The open approach may inadequately address the primary symptoms of proptosis, decreased visual acuity, and pain. Thus a move to subtotal tumor resection has evolved due to the benign nature of the disease and the risk of damage to underlying vital neurovascular structures.…”

“…The study showed that total resection via an open approach was only achieved in a minority of cases and was associated with a higher recurrence rate. 15 Therefore, the paradigm of menin-gioma surgical resection has evolved with time due to the understanding of the biology of the tumor. Although benign, they are locally invasive into surrounding bone and dura.…”

“…16 Tumors that partly encase or invade multiple cerebral vessels are not resectable and have an increased risk of postoperative cerebrovascular accident. 15 The Simpson grading system is typically used as the standard for grading tumor resection. 17 This grading system is used to predict the recurrence rates as it correlates directly with the extent of the tumor resection.…”

STA-MCA bypass following sphenoid wing meningioma resection: A case report

“…Despite vessel sacrifice and revascularization, gross total resection was only achieved in 63% [5]. In Champagne`s study, complete resection occurred in 2 out of 12 cases (Simpson grades 2 and 3) [7].…”