En plaque sphenoid wing meningiomas: recurrence factors and surgical strategy in a series of 71 patients.
OBJECTIVE
En plaque sphenoid wing meningiomas are complex tumors involving the sphenoid wing, the orbit, and sometimes the cavernous sinus. Complete removal is difficult, so these tumors have high rates of recurrence and postoperative morbidity. The authors report a series of 71 patients with sphenoid wing meningiomas that were managed surgically.


METHODS
The clinical records of 71 consecutive patients undergoing surgery for sphenoid wing meningiomas at Lariboisière Hospital, Paris, were prospectively collected in a database during a 20-year period and analyzed for presenting symptoms, surgical technique, clinical outcome, and follow-up.


RESULTS
Among the 71 patients (mean age, 52. 7 years; range, 12-79 years), 62 were females and 9 were males. The most typical symptoms recorded were proptosis in 61 patients (85.9%), visual impairment in 41 patients (57.7%), and oculomotor paresis in 9 patients (12.7%). Complete removal was achieved in 59 patients (83%). At 6 months of follow-up, magnetic resonance imaging scans revealed residual tumor in 12 patients (9 in the cavernous sinus and 3 around the superior orbital fissure). Mean follow-up was 76.8 months (range, 12-168 months). Tumor recurrence was recorded in 3 of 59 patients (5%) with total macroscopic removal. Among the patients with subtotal resection, tumor progression was observed in 3 of 12 patients (25%; 2 patients with grade III and 1 patient with grade IV resection). Mean time to recurrence was 43.3 months (range, 32-53 months).


CONCLUSIONS
Surgical management of patients with sphenoid wing meningiomas cannot be uniform; it must be tailored on a case-by-case basis. Successful resection requires extensive intra- and extradural surgery. We recommend optic canal decompression in all patients to ameliorate and/or preserve visual function.
Mirone
Giuseppe
G
Department of Neurosurgery, Hôpital Lariboisière, Paris, France. peppemirone@fastwebnet.it
Chibbaro
Salvatore
S
Schiabello
Luigi
L
Tola
Serena
S
George
Bernard
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D035262:Cranial Fossa, Anterior / Q000473:pathology / Q000601:surgery; D035301:Cranial Fossa, Middle / Q000473:pathology / Q000601:surgery; D004388:Dura Mater / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology / Q000503:physiopathology; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D009886:Ophthalmoplegia / Q000209:etiology; D009918:Orbital Neoplasms / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D019292:Skull Base Neoplasms / Q000473:pathology / Q000601:surgery; D013100:Sphenoid Bone / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D015354:Vision, Low / Q000209:etiology; D055815:Young Adult