Sphenoid wing meningiomas: Neurosurgical recommendations

Abstract

Introduction: Evolution of modern neuro-imaging and innovative surgical techniques, coupled with promotion of modified surgical avenues enhances safe resection and improves outcome in most brain and base of skull tumors. Cushing and Eisenhard anatomical classification of spenoid wing (SW) carcinomas anatomical classification of sphenoid wing (SW) meningiomas remains the most valuable taxonomy for neurosurgeons in helping them to: (a) tailor surgical approach, (b) anticipate risks and surgical difficulties, and (c) predict outcome. Materials and methods: Since 1986, more than 600 patients with intracranial meningioma have been admitted to King Faisal Specialist Hospital and Research Center (KFSH and RC). A retrospective study was performed and revealed that two-thirds of these tumors were at the base of skull; half of them were located fronto-basally. The number of patients diagnosed to have SW meningioma was 96. Visual impairment was the leading cause for referral. Magnetic resonance imaging (MRI) was the study of choice for the last 15 years, complemented with MRA or earlier with CT and angiography. Eighty-nine patients underwent surgery; the degree of surgical exposure was dictated by the size, location and extension of the tumor. Pterional approach with extensive drilling of the SW or modified fronto-orbito-zygomatic approach was selected. Results: Gross resection was achieved in 92%. The mortality rate of 5.6% was precipitated by vascular injury or vasospasm as a result of surgical manipulation or thromboembolic events associated with complex clinoidal meningioma surgery. Medial SW meningiomas with extensive invasion into the cavernous sinus or infiltration into adventitia that defied complete resection were considered for close follow-up or stereotactic radiotherapy. Conclusion: Radical microsurgical resection of meningiomas remains the best treatment option. Most lateral and middle SW meningiomas are removed without major incident. However, medial SW meningiomas, in contrast, are a surgical challenge with potential morbidity and deserve special consideration.