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Simplifying the Surgical Strategy for Excising Medial Sphenoid Wing Meningiomas: A Stepwise Approach
V R Roopesh Kumar1, Venkatesh S Madhugiri2, Arunkumar Karthikayan1
1Department of Neurosurgery, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India.
Background:
Medial sphenoid wing meningiomas constitute 15%-20% of all intracranial meningiomas. These lesions have a propensity to encase the vessels of the circle of Willis and the surrounding cranial nerves. Thus, radical excision is a difficult proposition.
Objectives:
In this paper, we analyzed our series of sphenoid wing meningiomas. We describe our surgical strategy, which was based on zone-wise dissection of the tumor. We describe the complications and outcomes of surgery.
Materials And Methods:
This case series is a retrospective analysis of a single surgeon series of medial sphenoid wing meningiomas operated over a 13-year period. Clinical, radiographic, and outcome variables were studied. The surgical videos were analyzed in detail. The meningioma and its extensions were divided into several zones and a zone-wise strategy for tumor excision was evolved.
Results:
Twenty-four patients with medial sphenoid wing meningiomas were operated. In 14 patients, Simpson grade 3 excision could be achieved; 5 patients had Simpson grade 4 and 1 patient, grade 5 excision. Four (of 24 patients, 16.7%) had vessel injuries.
Conclusions:
Medial sphenoid wing meningiomas are difficult lesions to excise radically. Close follow-up of residual lesions (especially if attached to the basal dura) is warranted. Additional modalities of treatment like radiosurgery may be required in case of any progression and for higher-grade lesions.
Insights
Medial sphenoid wing meningiomas are challenging tumors to remove completely due to their location. A zone-wise surgical strategy can help manage these complex intracranial meningiomas.
Area of Science:
- Neurosurgery
- Oncology
- Neurology
Background:
- Medial sphenoid wing meningiomas represent 15-20% of intracranial meningiomas.
- These tumors frequently encase critical neurovascular structures, complicating radical excision.
Purpose of the Study:
- To analyze a series of medial sphenoid wing meningiomas.
- To describe a zone-wise surgical strategy for tumor dissection.
- To report complications and outcomes of surgical management.
Main Methods:
- Retrospective analysis of a single-surgeon series over 13 years.
- Detailed review of clinical, radiographic, and outcome data.
- Surgical videos analyzed to develop a zone-wise excision strategy.
Main Results:
- Twenty-four patients with medial sphenoid wing meningiomas underwent surgery.
- Simpson grade 3 excision achieved in 14 patients; grades 4 and 5 in 6 patients.
- Vessel injury occurred in 16.7% of patients.
Conclusions:
- Radical excision of medial sphenoid wing meningiomas is challenging.
- Close follow-up of residual tumors is essential.
- Radiosurgery may be considered for residual or higher-grade lesions.
