Related Experiment Video
Updated: Mar 5, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Degree of Vascular Encasement in Sphenoid Wing Meningiomas Predicts Postoperative Ischemic Complications
D Jay McCracken1, Raymond A Higginbotham2, Jason H Boulter3
1Department of Neurosurgery, Emory University, Atlanta, Georgia.
Background:
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 preoperative magnetic 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 diffusion-weighted 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 cm 3 (0.81-9.3 cm 3 ). 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 cm 3 was found when the ICA, M1, and A1 vessels all had ≥360° involvement ( P = .001). Residual tumor was 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.
Insights
Sphenoid wing meningiomas encasing arteries increase stroke risk. Significant arterial encasement, particularly of the internal carotid artery, M1, and A1 segments, correlates with larger postoperative ischemic volumes and worse outcomes.
Area of Science:
- Neurosurgery
- Neuroradiology
- Vascular Neurology
Background:
- Sphenoid wing meningiomas (SWMs) pose a risk of intraoperative vascular injury due to their proximity to the circle of Willis.
- Encasement of arteries by SWMs can lead to severe postoperative ischemic complications.
Purpose of the Study:
- To evaluate the relationship between the degree of arterial encasement by SWMs and the extent of postoperative ischemia.
- To identify specific arterial segments whose encasement is associated with increased ischemic complications.
Main Methods:
- Retrospective review of 75 patients surgically treated for SWM between 2009 and 2015.
- Preoperative MRI was used to assess the degree of circumferential vascular encasement (0°-360°) using a novel grading system.
- Postoperative MRIs were analyzed to quantify total ischemia volume using diffusion-weighted images.
Main Results:
- 89.3% of patients exhibited some degree of vascular involvement, with high median encasement scores for the internal carotid artery (ICA), M1, and A1 segments.
- 76% of patients experienced postoperative ischemia, with a median infarct volume of 3.75 cm³.
- Encasement of the supraclinoid ICA, M1, and A1 segments, along with diabetes, were significant risk factors for larger infarct volumes. Complete (≥360°) encasement of ICA, M1, and A1 significantly increased the risk of devastating ischemic injury (>62 cm³).
Conclusions:
- Significant vascular encasement of proximal arteries by SWMs is strongly associated with postoperative ischemic complications.
- Subtotal tumor resection should be considered for SWMs with extensive vascular encasement to mitigate the risk of stroke.
- The degree of arterial encasement is a critical factor in predicting ischemic outcomes after SWM surgery.
