A Month in Cross Section: A Case Series of Eleven Sphenoid Wing Meningioma’s: A Single Center Experience

Abstract

Introduction:  Sphenoid wing meningiomas represent 20% of supratentorial meningiomas. The tumor usually involves the visual pathway, the anterior vasculature, and cavernous sinus invasion. A higher morbidity, mortality, and recurrence are documented in comparison to meningiomas in other locations.

Materials & Methods:  11 cases of joint global sphenoid wing meningiomas were operated in September 2022. Patient demographic, clinical, radiology, and per-operative salient features were noted. Post-operative clinical outcomes included improvement in visual acuity, neural deficit, and headache. The extent of resection on radiology plus survival was noted as an outcome measure.

Results:  Patients aged 28 to 65 years, with 9 females and 2 males had giant sphenoid wing meningioma. Complete medial sphenoid wing involvement along with neurovascular structures, post-operatively they had visual deterioration, hence, the extent of resection was limited to prevent greater post-operative morbidity. 3/7 undergoing GTR had complete carotid artery encasement, in which full thickness MCA infarct was noted in 6 hours’ post-operative scan, they were later converted to a full 16 cm decompressive craniotomy. One survived with hemiparesis and aphasia while two died – a male (49y) and, a female (65), both left craniectomies. STR was done in four patients, with cavernous sinus invasion and internal carotid encasement.

Conclusion:  Giant sphenoid meningioma involving the medial sphenoid wing and associated neurovascular structures is surgically challenging and must be treated with STR. If GTR is to be attempted, early CT Brain postoperatively to prevent mortality.