title: Comparison of the Surgical Outcome of Pterional and Frontotemporal-Orbitozygomatic Approaches and Determination of Predictors of Recurrence for Sphenoid Wing Meningiomas.
abstract: OBJECTIVE
  The pterional/frontotemporal orbitozygomatic (FTOZ) approaches are the 2 most widely used procedures for resection of sphenoid wing meningiomas; however, a comparison of outcomes and complications of these 2 approaches has not been well described yet. Here, we investigated the outcomes, complications, and predictors of favorable outcomes of these 2 approaches.
  
  
  METHODS
  Data of 90 consecutive cases with sphenoid wing meningiomas between 1995 and 2015 was reviewed retrospectively. A Kaplan-Meier survival analysis and Cox proportional hazards regression model was used to determine the recurrence-free (RFS) survival and independent predictor of RFS.
  
  
  RESULTS
  In this study, the overall recurrence rate after tumor excision with pterional and FTOZ approaches was 36.5% and 12.2% respectively (P = 0.001). Based on surgical approach, the median RFS of the patients with sphenoid wing meningiomas also varied significantly (pterional, 114 months vs. FTOZ, 145 months, P = 0.03). The median RFS for patients with sphenoid wing meningiomas also varied according to the extent of resection (gross total resection [GTR], 146 months vs. subtotal resection, 52 months, P = 0.009). In Cox regression analysis, the FTOZ approach (P = 0.041), GTR (P = 0.047), and Karnofsky performance score >70 (P = 0.04) were revealed as significant predictors of favorable outcome after resection of sphenoid wing meningiomas.
  
  
  CONCLUSIONS
  In summary, sphenoid wing meningiomas undergoing extensive skull base approach (FTOZ) and GTR had a low recurrence rate and greater RFS. Even though FTOZ with GTR is preferable to resect the sphenoid wing meningiomas, the procedure should be tailored to each patient depending on the risks and surgical morbidity.
authors: Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, USA.
authors: Shyamal C
authors: SC
authors: Bir
authors: Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, USA.
authors: Tanmoy
authors: T
authors: Maiti
authors: Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, USA.
authors: Subhas
authors: S
authors: Konar
authors: Department of Neurosurgery, LSU Health-Shreveport, Shreveport, Louisiana, USA. Electronic address: ananda@lsuhsc.edu.
authors: Anil
authors: A
authors: Nanda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008579:Meningioma / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D019635:Neurosurgical Procedures / Q000379:methods*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013100:Sphenoid Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Craniotomy; Frontotemporal orbitozygomatic; Meningiomas; Pterional