Article
Interdisciplinary treatment of large medial sphenoid wing meningiomas
Interdisziplinäre Behandlung von großen medialen Keilbeinflügel-Meningeomen
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Published: | April 11, 2007 |
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Objective: Medial sphenoid wing meningiomas still present a particular surgical challenge especially when they are large and involve the cavernous sinus.
Methods: We reviewed the charts of 27 consecutive patients with sphenocavernous, clinoidocavernous and sphenoclinoidocavernous meningiomas treated by surgery in the period between January 1999 and July 2005. We assessed early and late post-operative morbidity, extent of resection and long-term outcome. The mean follow-up period was 41 months.
Results: Most patients in this series harbored large tumors (mean tumor diameter was 4.3cm). Total resection was achieved in 16 patients (59.3%), while only subtotal resection was possible in the remaining 11 cases followed by fractionated stereotactic radiotherapy. However, two patients refused post-operative radiotherapy. Using modified Hirsch grading, we found complete encasement of the cavernous carotid artery in 16 cases, 7 of these patients underwent total resection. In 9 of 11 cases with tumors touching or partially encasing the cavernous carotid artery (modified Hirsch Grades 0 and 1) total resection was achieved. The Dolenc approach was the most commonly used approach (20 cases). There was no mortality in this series. The most common postoperative morbidity was cranial nerves dysfunction (7 cases). However, these palsies were only temporary in all but one case. Repeated clinical and radiological examinations revealed successful tumor control in all cases.
Conclusions: This study with several other similar studies show that total excision of medial sphenoid ridge meningioma is possible even in the presence of large tumor size and cavernous sinus involvement with no mortality and minor morbidity rates. The primary goal of management is the improvement of the functional outcome. The Dolenc approach is ideal in dealing with these tumors as it minimizes the intra-operative blood loss and brain retraction and decompresses the optic nerve.