Modern surgical outcomes following surgery for sphenoid wing meningiomas

Clinical article

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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.

Abbreviations used in this paper:CS = cavernous sinus; ICA = internal carotid artery; MCA = middle cerebral artery; NS = not significant; SRS = stereotactic radiosurgery; UCSF = University of California, San Francisco.

Article Information

Address correspondence to: Michael W. McDermott, M.D., Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, Box 0112, San Francisco, California 94143. email: mcdermottm@neurosurg.ucsf.edu.

Please include this information when citing this paper: published online February 22, 2013; DOI: 10.3171/2012.12.JNS11539.

© AANS, except where prohibited by US copyright law.

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Figures

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    Anatomy of various sphenoid wing meningiomas. Representative axial T1-weighted postcontrast MR images depicting medial-third (A), middle-third (B), and lateral-third (C) sphenoid wing meningiomas. The red arrow in panel B depicts the point of origin for this meningioma, which invades the orbit. Artist's rendition of a small medial sphenoid wing meningioma (D) and a depiction of a larger medial sphenoid wing tumor with canal invasion and involvement of the ICA and MCA (E). Depiction of a large lateral-third sphenoid wing meningioma in axial view (F)—the sylvian fissure is pushed medially and a cleft of brain typically separates the tumor from the vessels—and depiction of the same tumor in coronal view (G).

References

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