Surgical strategies for giant medial sphenoid wing meningiomas: a new scoring system for predicting extent of resection

Behari, Sanjay; Giri, Pramod Janardan; Shukla, D. K.; Jain, Vibha; Banerji, Deepu

doi:10.1007/s00701-008-0006-6

Cited by 51 publications

(57 citation statements)

References 43 publications

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“…Although the visual outcome had seen some progress in recent years, the overall outcomes remains unsatisfactory (5,6,11,19 (29). In our series, the tumor extending into optic nerve canal was encountered in 10 cases, and the tumor can be pulled out in 9 and only in 1 case the tumor infiltrated the optic canal or optic nerve and needed optic canal opening.…”

Section: Visual Outcomementioning

confidence: 67%

“…It was reported that difficulty of surgery, extent of tumor removal, associated surgical risks, and patients outcomes are related to the tumor size in meningiomas of suprasellar and parasellar region (6,11,14,17,22,36). Goel et al (11) proposed a different system for grading ACP meningiomas, in which tumor size was included as an impact factors.…”

Section: Tumor Sizementioning

confidence: 99%

“…Many neurosurgeons have observed that the clinical outcomes are even worse in larger tumors than that in smaller ones due to higher incidence of involving neural and vascular structures (6,11,14,17,22,36). While, systemic studies about the correlation of tumor size with clinical characteristics and outcomes especially with long-term outcomes have not been reported in a series of large tumors.…”

Section: Introductionmentioning

confidence: 99%

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

Liu

Yuan²,

Liu³

et al. 2012

Turkish Neurosurgery

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AIm:We present the long-term outcomes as well as their correlation with tumor size in 127 consecutive patients harboring large MSWM after microsurgical treatment. mATeRIAL and meTHods:The retrospective analysis of clinical data and follow-up data of 127 microsurgical treated patients with MSWM was performed. The mean maximum diameter of tumors was 5.2cm (ranged 1.5-10.0cm).ResuLTs: 104 cases (81.9%) achieved gross total resection. There was no operative mortality. Detailed follow-up data was available in 120 cases for a mean duration of 81.6 months (12-216 months). The permanent morbidity was 14.2%. The mean KPS score 1 year after surgery was 90.6 (ranged 60-100). Among 74 patients of preoperative visual acuity (VA) impairment, postoperative VA improved in 42 cases (56.8%), unchanged in 30 (40.5%), and deteriorated in 2 (2.7%). MR images revealed tumor recurrence after total resection in 10 cases (10.2%) and tumor progression after subtotal resection in 10 cases (45.5%).CoNCLusIoN: Tumor recurrence was the major risk in the long run, thus the initial surgery was extremely important and hence should be aggressive. The size of tumor affected the extent of tumor removal determining clinical outcomes including VA improvement and KPS score immediately after surgery; however, it was not correlated with long-term overall outcomes. BuLGuLAR: 104 olguda (%81,9) gros total rezeksiyon yapıldı. Operatif mortalite yoktu. Ayrıntılı takip verileri 120 olguda ortalama 81,6 ay (12-216 ay) için mevcuttu. Kalıcı morbidite %14,2 oranında görüldü. Cerrahiden 1 yıl sonra ortalama KPS skoru 90,6 (aralık 60-100) bulundu. Preoperatif görme keskinliği bozukluğu olan 74 hasta içinde postoperatif dönemde görme keskinliği 42 hastada (%56,8) arttı, 30'unda (%40,5) değişmedi ve 2'sinde (%2,7) kötüye gitti. MR görüntüleri total rezeksiyon sonrasında 10 olguda (%10,2) tümör reküransı ve subtotal rezeksiyon sonrasında 10 olguda (%45,5) tümör ilerlemesi gösterdi. soNuÇ: Uzun dönemde temel risk tümör reküransıydı ve bu nedenle ilk cerrahi çok önemlidir ve agresif olmalıdır. Tümör büyüklüğü, tümör çıkarma kapsamını etkileyerek ameliyattan hemen sonra görme keskinliği düzelmesi ve KPS skoru dahil klinik sonuçları etkiledi ancak uzun dönemli genel sonuçlarla korelasyon göstermedi.ANAHTAR sÖZCÜKLeR: Medial sfenoid kanat menenjiyomları, Tümör büyüklüğü, Tümör reküransı, İşlevsel sonuç

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Section: Visual Outcomementioning

confidence: 67%

Section: Tumor Sizementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Liu

Yuan²,

Liu³

et al. 2012

Turkish Neurosurgery

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“…18 The rates of successful tumor control with this approach have generally been good, with control rates ap proaching 80% over 7-8 years postsurgery without any additional treatment. 1,3,14 Presently the major remaining morbidity in modern management of these tumors is cranial neuropathy, typi cally of the third cranial nerve, and typically with medi althird tumors. We try to minimize the use of cautery near the tentorial junction, near where the third cranial nerve would be expected to enter the oculomotor trian gle.…”

Section: Discussionmentioning

confidence: 99%

Modern surgical outcomes following surgery for sphenoid wing meningiomas

Sughrue¹,

Rutkowski²,

Chen³

et al. 2013

JNS

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Object Cushing and Eisenhardt were the first to describe sphenoid wing meningiomas in detail, categorizing globoid tumors into 3 groups: 1) medial; 2) middle; and 3) lateral. The authors review their experience with resection of sphenoid wing meningiomas at a single center, to examine whether this classification predicts clinical presentation and postsurgical outcome. Methods All patients undergoing resection of sphenoid wing meningioma at the authors' institution over a 9-year period were identified. Clinical data were compared from patients with tumors arising at different points along the sphenoid wing to determine if these tumors behaved differently in terms of symptoms, radiographic characteristics, and postsurgical outcome. Results A total of 56 patients underwent microsurgical resection for sphenoid wing meningioma during this period. The rates of optic canal invasion (medial 50% vs middle 5% vs lateral 0%; p < 0.0001, chi-square test), supraclinoid internal carotid artery encasement (medial 32% vs middle 5% vs lateral 0%; p < 0.01, chi-square test), and middle cerebral artery encasement (medial 45% vs middle 24% vs lateral 0%; p < 0.01, chi-square test) were all highest with medial-third tumors. New or worsened neurological deficits occurred in 10 (19%) of 56 patients. Of all the imaging characteristics studied, only location of the tumor along the medial third of the sphenoid wing significantly predicted an increased rate of new or worsened neurological deficit (OR 2.7, p < 0.05). Conclusions The authors report outcomes in a large series of sphenoid wing meningiomas that were treated using modern surgical techniques.

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“…Because skull base tumors often have extended osseous components that grossly distort normal anatomy, intraoperative orientation might be further compromised. 2,16,25 Therefore, aggressive resection can be associated with significant morbidity, and previously many of these lesions were considered unresectable. The development of complex neurosurgical approaches to the skull base and orbit as well as interdisciplinary operation teams including ophthalmic, otorhinolaryngological, and craniomaxillofacial surgeons led to a drop in morbidity rates while extent of resection increased.…”

Section: Discussionmentioning

confidence: 99%

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

Terpolilli¹,

Rachinger²,

Kunz³

et al. 2016

JNS

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S kull base tumors with close anatomical association to orbit, optic nerve, and the cavernous sinus often cause neurological symptoms like loss of visual function and exophthalmus. In most cases resection (complete or partial removal) is the most promising and most effective therapeutic approach with regard to preservation or restoration of visual function. Furthermore, operative tumor removal or reduction is a crucial step in multidisciplinary operative as well as medical or radiotherapeutic treatment concepts, because it allows exact histological diagnosis and safe decompression of anatomical structures at risk. However, resection of these tumors is associated with increased perioperative morbidity due to the proximity of highly sensitive structures-e.g., cranial nerves abbreviatioNs CN = cranial nerve; iCT = intraoperative CT; iMRI = intraoperative MRI; NNS = neuronavigational system. obJective Treatment of skull base lesions is complex and usually requires a multidisciplinary approach. In meningioma, which is the most common tumor entity in this region, resection is considered to be the most important therapeutic step to avoid tumor recurrence. However, resection of skull base lesions with orbital or optic nerve involvement poses a challenge due to their anatomical structure and their proximity to eloquent areas. Therefore the main goal of surgery should be to achieve the maximum extent of resection while preserving neurological function. In the postoperative course, medical and radiotherapeutic strategies may then be successfully used to treat possible tumor residues. Methods to safely improve the extent of resection in skull base lesions therefore are desirable. The current study reports the authors' experience with the use of intraoperative CT (iCT) combined with neuronavigation with regard to feasibility and possible benefits of the method. methods Those patients with tumorous lesions in relationship to the orbit, sphenoid wing, or cavernous sinus who were surgically treated between October 2008 and December 2013 using iCT-based neuronavigation and in whom an intraoperative scan was obtained for control of resection were included. In all cases a second iCT scan was performed under sterile conditions after completion of navigation-guided microsurgical tumor resection. The surgical strategy was adapted accordingly; if necessary, resection was continued. results Twenty-three patients (19 with WHO Grade I meningioma and 4 with other lesions) were included. The most common clinical symptoms were loss of visual acuity and exophthalmus. Intraoperative control of resection by iCT was successfully obtained in all cases. Intraoperative imaging changed the surgical approach in more than half (52.2%) of these patients, either because iCT demonstrated unexpected residual tumor masses or because the second scan revealed additional tumor tissue that was not detected in the first scan due to overlay by osseous tumor parts; in these cases resection was continued. In the remaining cases resection was concluded as planned ...

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Surgical strategies for giant medial sphenoid wing meningiomas: a new scoring system for predicting extent of resection

Cited by 51 publications

References 43 publications

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

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

Modern surgical outcomes following surgery for sphenoid wing meningiomas

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

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