Reconstruction After Resection of Sphenoid Wing Meningiomas

Abstract

To review our experience of reconstructing the lateral and superior orbital walls after resection of sphenoid wing meningiomas. We will review the presentation and complications, examine the aesthetic results postoperatively, and compare preoperative and postoperative computed tomographic scans. To our knowledge, a comparative analysis of preoperative defect and postoperative reconstruction has not been performed. Methods:We conducted a retrospective analysis, with a minimum of 5 months and a maximum of 9 years of follow-up in an academic multidisciplinary skull base center. Twenty-two patients were treated for sphenoid wing meningiomas by resection and reconstruction with split calvarial bone graft and, for more than half of the patients, also with free abdominal fat graft. The main outcome measures were aesthetic evaluation of patients and analysis of tumor control using computed tomographic scans, survival, and complications.Results: A total of 24 resections were performed on 22 patients. The average follow-up was 14.6 months. All patients had meningiomas with similar preoperative presentations, and for 21 of the 22 patients aesthetic reconstruction resulted in the near symmetry of the 2 sides. All patients are currently alive, those who underwent complete resection are without recurrence, and 15 (68.2%) did not incur complications. One patient experienced a worsening of temporal wasting following radiation therapy. Conclusion:Reconstruction of the defect with split calvarial bone and free abdominal fat grafts affords the patient excellent aesthetic results as well as good symmetry, as demonstrated by a postoperative computed tomographic scan.

Modern surgical outcomes following surgery for sphenoid wing meningiomas

“…Additionally, when there is hyperostosis of the greater sphenoid wing with involvement of the posterolateral orbit and floor of the middle fossa, an orbitozygomatic approach drops the temporalis muscle bulk away from the line of sight for the surgical approach and facilitates removal of involved bone in the posterolateral orbit above and below the su perior orbital fissure and medially to the foramen rotun dum and foramen ovale. 4,12,13 Thus, approach selection for lateral sphenoid wing meningiomas should be performed on a casebycase basis, with a bias toward avoiding the use of orbital osteotomy in these cases unless necessary.…”

Microsurgical Technique and Results of a Series of 63 Spheno-Orbital Meningiomas

“…Depending on the extent of orbital wall and roof resection, most authors propagate a firm reconstruction of the orbital walls to avoid an enophthalmus, a pulsating eye bulb, or oculomotor muscle fibrosis, which may result in ophthalmoplegia (5,6,14,22,23). Although the resection of one orbital wall is reported to be of little importance, making reconstruction unnecessary, according to general consensus, further bony resection demands a firm reconstruction using autograft in form of iliac crest bone, calvarial split bone, rib bone, or allograft.…”

Porous polyethylene implant reconstruction of the orbit after resection of spheno-orbital meningiomas: A novel technique

“…First, many surgeons advocate use of bone autograft (Columella et al, 1974;Evans et al, 1994;Carrizo and Basso, 1998;Brusati et al, 2005;Leake et al, 2005;Shrivastava et al, 2005). Some authors have described good cosmetic outcomes with the use of iliac crest autograft (Gaillard et al, 1997) but high rates of donor site morbidity have led this method to fall out of favor in most centers.…”

“…Traditionally, reconstruction has been performed using a bone graft from the iliac crest (Columella et al, 1974) or split-thickness calvarium (Brusati et al, 2005;Leake et al, 2005;Shrivastava et al, 2005). Autologous bone graft is the standard technique for craniofacial reconstruction in many settings, and has the advantage of using primarily native material which is biologically inert.…”