Degree of Vascular Encasement in Sphenoid Wing Meningiomas Predicts Postoperative Ischemic Complications.
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).


CONCLUSIONS
Subtotal resection should be considered in SWM with significant vascular encasement of proximal arteries to limit postoperative ischemic complications.
Department of Neurosurgery, Emory University, Atlanta, Georgia.
D Jay
DJ
McCracken
Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia.
Raymond A
RA
Higginbotham
Emory University School of Medicine, Atlanta, Georgia.
Jason H
JH
Boulter
Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia.
Yuan
Y
Liu
Emory University School of Medicine, Atlanta, Georgia.
John A
JA
Wells
Emory University School of Medicine, Atlanta, Georgia.
Sameer H
SH
Halani
Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia.
Amit M
AM
Saindane
Department of Neurosurgery, Emory University, Atlanta, Georgia.
Nelson M
NM
Oyesiku
Department of Neurosurgery, Emory University, Atlanta, Georgia.
Daniel L
DL
Barrow
Department of Neurosurgery, Emory University, Atlanta, Georgia.
Jeffrey J
JJ
Olson
D000328:Adult; D000368:Aged; D002343:Carotid Artery, Internal / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008579:Meningioma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies
Ischemia; Sphenoid wing meningioma; Tumor; Vascular encasement