Tag: sphenoid wing meningioma

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Degree of Vascular Encasement in Sphenoid Wing Meningiomas Predicts Postoperative Ischemic Complications

Neurosurgery 80:957–966, 2017

Sphenoid wing meningiomas (SWMs) can encase arteries of the circle of Willis, increasing their susceptibility to intraoperative vascular injury and severe ischemic complications.

OBJECTIVE: To demonstrate the effect of circumferential vascular encasement in SWM on postoperative ischemia.

METHODS: A retrospective review of 75 patients surgically treated for SWM from 2009 to 2015 was undertaken to determine the degree of circumferential vascular encasement (0◦-360◦) as assessed by preoperativemagnetic resonance imaging (MRI). A novel grading system describing “maximum”and “total” arterial encasement scores was created. Postoperative MRIs were reviewed for total ischemia volume measured on sequential diffusionweighted images.

RESULTS: Of the 75 patients, 89.3% had some degree of vascular involvement with a median maximum encasement score of 3.0 (2.0-3.0) in the internal carotid artery (ICA), M1, M2, and A1 segments; 76% of patients had some degree of ischemia with median infarct volume of 3.75 cm3 (0.81-9.3 cm3). Univariate analysis determined risk factors associated with larger infarction volume, which were encasement of the supraclinoid ICA (P < .001), M1 segment (P < .001), A1 segment (P = .015), and diabetes (P = .019). As the maximum encasement score increased from 1 to 5 in each of the significant arterial segments, so did mean and median infarction volume (P < .001). Risk for devastating ischemic injury >62 cm3 was found when the ICA, M1, and A1 vessels all had ≥360◦ involvement (P = .001). Residual tumorwas associated with smaller infarct volumes (P=.022). As infarction volume increased, so did modified Rankin Score at discharge (P = .025).

CONCLUSION: Subtotal resection should be considered in SWM with significant vascular encasement of proximal arteries to limit postoperative ischemic complications.

 

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Internal and external spheno-orbital meningioma varieties: different outcomes and prognoses

SO Meningiomas

Acta Neurochir (2016) 158:1587–1596

Internal variation among spheno-orbital meningiomas  (SOM) is surgically challenging. Optic canal invasion  management is discussed.

Method This retrospective study includes 70 patients with  SOM who underwent surgery between 1995 and 2012.  Preoperative ophthalmological, neurological and aesthetic  clinical signs were collected. All patients benefitted from repeated  tomography and magnetic resonance imaging (MRI).  The surgical team consisted of a neurosurgeon and a plastic  surgeon. In the majority of cases, resection was followed by  bone reconstruction using an autologous iliac crest graft. The  extent of resection was evaluated on the dural and osseous  sides. Early clinical outcomes, long-term follow-up, recurrence  and adjuvant therapies were reported.

Results The mean age was 52 years old, and 91 % of the  patients were women. Initial symptoms primarily included  proptosis (65 %), decreased visual acuity (39 %) and soft  tissue tumefaction (16 %).We classified 40 cases as the internal  variety when considering the inner third of the greater  wing of the sphenoid, optic canal, anterior clinoid process or  cavernous sinus. The remaining cases were described as the  external variety. The complete resection rates for the internal  and external varieties were 12 % and 61 %, respectively  (P< 0.001). In total, 90% of cases were grade I meningiomas.  For grade I, we reported 30 % recurrence, and 50 % of these  cases recurred in the first 2 years. Grade II cases without early  adjuvant radiotherapy increased at 2 years.We did not observe  any difference in recurrence rate among grade I tumours with  or without tumour remnants. At the end of follow-up, visual  acuity was stabilised or increased in 88 % of patients. In addition,  14 % of patients experienced persistent pain at the  location of the iliac harvesting site.

Conclusions The internal SOM variety exhibited a reduced  total resection rate and a shorter progression-free survival  (PFS). Unroofing of the optic canal extended PFS. Among  grade I cases, the persistence of a negligible tumour remnant  did not alter the probability of recurrence. For superior grades,  radiotherapy must be administered in addition to surgery as  soon as possible. SOMs require prolonged follow-up.  Autologous iliac reconstruction is related to substantial morbidity  and could be replaced by prosthetic bone threedimensional  reconstruction.

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Sphenoorbital meningioma: surgical technique and outcome

J Neurosurg 114:1241–1249, 2011.DOI: 10.3171/2010.10.JNS101128

The aim of this study was to describe the surgical technique used for removal of sphenoorbital meningiomas in the authors’ practice and to review the operative outcome.

Methods. Review of the senior author’s practice between 1994 and 2009 revealed 39 patients (mean age 48 years) eligible for this study. Clinical presentation, surgical technique, postoperative outcome, and follow-up data are presented. Surgical technique is detailed, with an emphasis on aggressive removal consisting of drilling of the hypertrophied sphenoid bone, orbital wall, and anterior clinoid process, followed by tumor removal and a wide resection of the involved dura. A simple dural closure without reconstruction of the orbital roof or the lateral wall of the orbit is also described.

Results. Gross-total resection was achieved in 15 cases (38.5%), near-total resection with small residual in the cavernous sinus or periorbita in 20 cases (51.3%), and subtotal resection in 4 cases (10.3%). Postoperative complications included trigeminal hypesthesia in 9 patients, oculomotor palsy in 3 patients, and seizure in 2 patients. Seven patients had recurrence within the mean follow-up period of 40.7 months. Preoperative visual deficits were present in 21 patients (53.8%). Of these, 14 (66.7%) experienced visual recovery to normal levels postoperatively. Statistical analyses revealed preoperative severe visual deficit and sphenoid bone hypertrophy as an independent risk factor and an independent favorable factor, respectively, for a favorable visual outcome. Proptosis was resolved (≤ 2 mm) in 73.5% of the authors’ patients. No patient had postoperative enophthalmos.

Conclusions. In the authors’ practice, surgery for sphenoorbital meningiomas consists of resection of the orbital/ sphenoid intraosseous, intraorbital, and intradural tumor components. The authors believe that aggressive removal of the orbital/sphenoid intraosseous tumor is critical for a favorable visual outcome and tumor control. Furthermore, satisfactory cosmetic results can be achieved with simple reconstruction techniques as described.

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