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Published on: January 17, 2018
Sphenoid wing meningiomas with osseous involvement
Florian Roser1, Makoto Nakamura, Cornelius Jacobs
1Department of Neurosurgery, Klinikum Hannover Nordstadt, 30167 Hannover, Germany. f.roser@gmx.de
Background:
Sphenoid wing meningiomas (SWMs) with osseous involvement are neurosurgically challenging because of their position within the skull base and their high rates of recurrence. Sufficient resection of these meningiomas requires extensive surgical exposure. We report on 82 patients with meningiomas infiltrating the sphenoid wing, analyzing radiological appearance and its influence on surgical management.
Methods:
Charts of the patients including surgical records, clinical reports, histological examinations, imaging studies, and meticulously focusing questionnaires were reviewed.
Results:
Among the 82 patients with osseous-involved SWMs, the mean age was 52.2 years in the female group and 54.7 years in the male group with a mean follow-up of 66.23 months (24-206). Histological evaluation revealed World Health Organization grade I meningiomas in 94% of case patients, tumor infiltration of examined bone in all case patients, and proliferation rates of 2.2% Ki-67. Magnetic resonance imaging appearance of the SWMs demonstrated various densities as well as Gd enhancement within the affected bone. Recurrence rates in this subgroup of SWMs are higher (>30%) compared with meningiomas without osseous involvement (11.6%).
Conclusion:
Osseous involvement in SWMs accounts for lower resection and higher recurrence rates than meningiomas in other locations. In those cases with involvement of the cavernous sinus, a subtotal but extensive removal combined with bony decompression of the cranial nerves at the superior orbital fissure and optic canal frequently produces good functional and cosmetic results.
Insights
Sphenoid wing meningiomas (SWMs) with bone invasion have higher recurrence rates. Extensive surgical removal and bony decompression are crucial for good outcomes, especially with cavernous sinus involvement.
Area of Science:
- Neurosurgery
- Oncology
- Radiology
Background:
- Sphenoid wing meningiomas (SWMs) with osseous involvement present significant neurosurgical challenges due to skull base location and high recurrence rates.
- Extensive surgical exposure is necessary for adequate resection of these tumors.
Purpose of the Study:
- To analyze the radiological appearance of SWMs with osseous involvement and its impact on surgical management.
- To evaluate recurrence rates and outcomes in patients with osseous-involved SWMs.
Main Methods:
- Retrospective review of 82 patients with osseous-involved SWMs.
- Analysis of surgical records, clinical reports, histological examinations, imaging studies, and questionnaires.
Main Results:
- 94% of tumors were World Health Organization grade I, with 100% bone infiltration and a 2.2% Ki-67 proliferation rate.
- Magnetic resonance imaging showed varied densities and Gd enhancement within the affected bone.
- Recurrence rates were over 30% for osseous-involved SWMs, compared to 11.6% for those without bone involvement.
Conclusions:
- Osseous involvement in SWMs is associated with lower resection rates and higher recurrence compared to meningiomas in other locations.
- Subtotal removal with bony decompression of cranial nerves offers good functional and cosmetic results in cases involving the cavernous sinus.
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