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Medial sphenoid wing meningiomas: clinical outcome and recurrence rate
Makoto Nakamura1, Florian Roser, Cornelius Jacobs
1Department of Neurosurgery, Nordstadt Hospital, Klinikum Hannover, Hannover, Germany. mnakamura@web.de
Objective:
To provide clinical data concerning the visual outcome and recurrence rate of medial sphenoid wing meningiomas in consideration of two different subgroups of this tumor entity.
Methods:
Among 256 sphenoid wing meningiomas, there were 108 medial sphenoid wing meningiomas of globoid shape. They were classified into Group 1 (without cavernous sinus involvement) and Group 2 (with cavernous sinus involvement). En plaque meningiomas were excluded from the analysis. The charts of the patients including surgical records, discharge letters, follow-up records, and imaging studies were analyzed retrospectively.
Results:
There were 39 Group 1 tumors and 69 Group 2 tumors. For microsurgical tumor removal, the frontolateral (15.7%) or the pterional approach (84.3%) was performed. Total resection was achieved in 92.3% of patients with Group 1 tumors and 14.5% of those with Group 2 tumors. Radiological recurrence was observed in 7.7% (Group 1 tumors) and 27.5% (Group 2 tumors). The mean follow-up time was 79.04 months (6.59 yr). Improvement of visual function (or stable visual function) was observed in 56% (44%) of patients with Group 1 tumors, in 30% (60%) with newly diagnosed Group 2 tumors, and 10% (70%) undergoing recurrent surgery for Group 2 tumors.
Conclusion:
Group 1 meningiomas present a more favorable subgroup with fortunate visual outcome. In Group 2 tumors, visual improvement was less favorable and radical removal is limited because of cavernous sinus infiltration, with consequential higher recurrence rates. Patients harboring recurrent Group 2 tumors with deteriorating visual function profit from microsurgery because vision can be preserved on the same preoperative level in the majority.
Insights
Medial sphenoid wing meningiomas without cavernous sinus involvement (Group 1) show better visual outcomes and lower recurrence rates than those with involvement (Group 2). Surgery for recurrent Group 2 tumors can preserve vision.
Area of Science:
- Neurosurgery
- Oncology
- Ophthalmology
Background:
- Sphenoid wing meningiomas are tumors affecting the skull base.
- Medial sphenoid wing meningiomas are classified based on cavernous sinus involvement.
- Understanding visual outcomes and recurrence is crucial for patient management.
Purpose of the Study:
- To compare visual outcomes and recurrence rates of medial sphenoid wing meningiomas.
- To analyze data for two distinct subgroups: Group 1 (no cavernous sinus involvement) and Group 2 (cavernous sinus involvement).
Main Methods:
- Retrospective analysis of 108 medial sphenoid wing meningiomas (globoid shape).
- Tumors classified into Group 1 (39 cases) and Group 2 (69 cases).
- Surgical approaches included frontolateral and pterional; data analyzed from patient charts and imaging.
Main Results:
- Total resection rates were 92.3% for Group 1 and 14.5% for Group 2.
- Radiological recurrence was 7.7% in Group 1 and 27.5% in Group 2.
- Visual function improved or remained stable in 56% (Group 1), 30% (new Group 2), and 10% (recurrent Group 2).
Conclusions:
- Group 1 meningiomas have a favorable prognosis with better visual outcomes.
- Group 2 meningiomas present challenges for radical resection and have higher recurrence rates.
- Microsurgery for recurrent Group 2 tumors can stabilize visual function.