Invading meningiomas of the sphenoid ridge

Abstract

The authors report a series of 34 meningiomas of the sphenoid ridge. Eight tumors were totally removed uneventfully: two from the middle sphenoid ridge and six from the pterion or Sylvian point. Five tumors were not operated on because of their extensions or the patient's age. Twenty-one tumors raised serious surgical problems, resulting in a classification into three groups: deep or clinoidal, invading beyond the sphenoid wings, and a combination of both. Histological study of the hyperostotic bone showed meningiomatous cells in the bone in 12 of 13 cases so examined. Surgical limitations included invasion of the cavernous sinus (15 cases), of the dura mater of the sella turcica (seven cases), of the lateral part of the sphenoid body at the insertion point of the ala magna (seven cases), and of the common tendinous annulus of Zinn in the orbit (five cases), and basilar extracranial extension, particularly in the pterygomaxillary fossa (three cases). Following extensive removal, there were no early recurrences and three late recurrences (9 years and more). In 13 cases with a follow-up period of 1 to 8 years, there were no clinical recurrences. In only two cases was the meningioma totally removed. There were three postoperative deaths, two cases of hemiparesis with aphasia and epilepsy, one case with a frontal lobe syndrome, and nine with slight oculomotor, visual, or esthetic sequelae.

Large medial sphenoid wing meningiomas: long-term outcome and correlation with tumor size after microsurgical treatment in 127 consecutive cases

“…In the majority of cases in our series, the dural and bony attachments were heavily coagulated after tumor removal by unipolar or bipolar coagulation instead of resection. Some authors (7,8) stated that hyperostosis must be considered of bone invasion by tumors and the bony attachment should be removed. In small tumors it was usually accessible, while, in large or giant tumors, the tumor infiltrate wildly and more difficulty may be encountered to remove all of the dural and bony attachments radically which may increase the risk of injury of neural structure and exposure-induced complications.…”

“…They are still reported to have the worst neurological functional outcome hindering postoperative quality of life (next to petroclival meningiomas) with highest recurrence rate (2,8,18), partly because of their intricate and intimate relationship with cavernous sinus (CS), arteries of anterior circulation, and optic pathways. As radiosurgery plays an increasing important role in benign tumors, there is much controversy about the indications for aggressive resection of MSWM 1,5,13,20 .…”

Orbit-associated tumors: navigation and control of resection using intraoperative computed tomography

“…Although 5-to 10-year regrowth rates of 50% and more 1,9,21 seem to be a thing of the past, complete resection is seldom achieved. 6,20,27 However, there is a clear correlation between extent of resection and recurrence rate. [18][19][20] Furthermore, surgical debulking of tumor masses is often necessary to achieve an exact histological diagnosis, and decompression of neurological structures at risk is a prerequisite for subsequent radiation therapy or radiosurgery.…”

Intraoperative Extracorporeal Irradiation for the Treatment of the Meningioma-Infiltrated Calvarium

“…1 Although they arise from arachnoid cap cells, meningiomas often transgress the periosteal layer of the dura and involve local calvaria via infiltration of the Haversian canals. 2,3 To achieve gross total tumor resection in these scenarios, involved bone is resected and often reconstructed with a nonnative implant. An alternative option to bone resection is extracorporeal irradiation and reimplantation, a strategy that has been reported extensively as a successful limb-sparing treatment option for tumors involving bone.…”