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Sphenoid Wing en plaque meningiomas: Surgical results and recurrence rates
Nuno M Simas1, João Paulo Farias
1Department of Neurosurgery, Santa Maria Hospital, Lisboa, Portugal.
Background:
Sphenoid wing en plaque meningiomas are a subgroup of meningiomas defined by its particular sheet-like dural involvement and its disproportionately large bone hyperostosis. En plaque meningiomas represent 2-9% of all meningiomas and they are mainly located in the sphenoid wing. Total surgical resection is difficult and therefore these tumors have high recurrence rates.
Methods:
Eighteen patients with sphenoid wing en plaque meningiomas surgically treated between January 1998 and December 2008 were included. Clinical, surgical, and follow-up data were retrospectively analyzed.
Results:
Mean age was 52.2 years and 83% were female. Five patients presented extension of dural component into the orbit and six patients presented cavernous sinus infiltration. Adjuvant radiation therapy was performed in three patients. After a mean follow-up of 4.6 years, five patients developed tumor recurrence - two patients were submitted to surgical treatment and the other three were submitted to radiation therapy. No patient presented recurrence after radiation therapy, whether performed immediately in the postoperative period or performed after recurrence. Patients without tumor extension to cavernous sinus or orbital cavity have the best prognosis treated with surgery alone. When tumor extension involves these locations the recurrence rate is high, especially in cases not submitted to adjuvant radiation therapy.
Conclusion:
Cavernous sinus and superior orbital fissure involvement are frequent and should be considered surgical limits. Postoperative radiation therapy is indicated in cases with residual tumor in these locations.
Insights
Sphenoid wing en plaque meningiomas often recur after surgery, particularly when involving the orbit or cavernous sinus. Postoperative radiation therapy can prevent recurrence in these challenging cases.
Area of Science:
- Neurosurgery
- Oncology
- Radiology
Background:
- Sphenoid wing en plaque meningiomas are rare, characterized by dural involvement and bone hyperostosis.
- These tumors, representing 2-9% of meningiomas, primarily affect the sphenoid wing and are difficult to resect completely, leading to high recurrence rates.
Purpose of the Study:
- To evaluate the outcomes of surgical treatment for sphenoid wing en plaque meningiomas.
- To identify factors influencing tumor recurrence and the role of adjuvant radiation therapy.
Main Methods:
- Retrospective analysis of 18 patients with sphenoid wing en plaque meningiomas treated surgically between 1998 and 2008.
- Evaluation of clinical data, surgical procedures, and follow-up information.
Main Results:
- The study included 18 patients (83% female, mean age 52.2 years).
- Tumor extension into the orbit (5 patients) and cavernous sinus (6 patients) was observed. Five patients experienced recurrence after a mean follow-up of 4.6 years.
- Radiation therapy, whether immediate or delayed, prevented recurrence. Patients without orbital or cavernous sinus involvement had better surgical outcomes.
Conclusions:
- Cavernous sinus and superior orbital fissure involvement are significant surgical challenges.
- Postoperative radiation therapy is recommended for residual tumors in these critical locations to improve outcomes.
